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SPECIAL PATHOLOGY 



DIAGNOSTICS 



THERAPEUTIC HINTS 



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C. G.'RAUE, M.D. 



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THIRD EDITION 

REVISED AND AUGMENTED. 





PHILADELPHIA : 

F. E. BOERICKE, 

HAHNEMANN PUBLISHING HOUSE. 

1885. 




Copyright, C. G. Raue, 1885. 




TO 

MY STUDENTS, 

NEAR AND FAR, 
IN WHOSE BEHALF THE FIRST EDITION WAS ELABORATED, 

AND 
TO THE MEMORY OF OUR MUTUAL FRLEND AND TEACHER, 

CONSTANTINE HERING, 

THIS THIRD EDITION IS DEDICATED. 



PREFACE TO THIRD EDITION. 



"M" OW that I have finished this revision and can look over the 
task performed — I at last begin to realize a sense of satisfaction and 
comfort. 

Not that I have made great changes in the text of the second edi- 
tion — the pathology of to-day remains nearly the same as it was a 
few years ago, with the exception of increased efforts bestowed upon 
the cultivation of disease-germs, things already alluded to in many 
places of the second edition, but of little use as to curing disease — 
neither have I changed the therapeutic hints, although new expe- 
riences have been added: the main work done in this revision is the 
addition of a digest to all such chapters which present a list of thera- 
peutic hints of three pages and over. These formidable lists ap- 
peared to me always as pretty hard lumps, that needed some aid 
for digestion, indeed required means which would make it easier 
for the practitioner to find out of the many the one remedy for a 
given case. 

A similar plan had been conceived and executed by Hering in 
his "Analytical Therapeutics of Typhoid Fevers," and in his first 
volume of "Analytical Therapeutics." Bell has given us a reper- 
tory on diarrhoea and dysentery, Gushing on leucorrhcea, Eggert on 
uterine and vaginal discharges, King on headaches, Wm. A. Allen 
on intermittent fevers, Minton on uterine therapeutics, Lee on 
cough and expectoration, H. C. Allen on intermittent fevers and 
P. P. Wells on cholera — all very valuable contributions to our 
therapeutics. 

(xi) 



Xll PREFACE. 

My "digests," however, are not alphabetical repertories; each sin- 
gle one has been arranged according to the requirements of each 
single chapter. What belongs naturally together, or what is nearly 
related to each other, has been put together in order to facilitate 
comparison and choice between the different remedies. These di- 
gests further contain only what the preceding therapeutic hints 
contain, and are not made up artificially from the Materia Medica 
or existing repertories; they are not meant to present anything 
more or less than the preceding hints worked over and arranged me- 
thodically for ready use. 

This laborious task I have undertaken because I wished to accom- 
plish two very important objects. First, to assist the accurate pre- 
scriber, as far as it lies in the scope of this work, in his arduous 
task of finding the required remedy quickly and safely ; and, sec- 
ondly, to induce my young friends to study closely their cases, in 
order to keep out of the ruts, so easily trodden, of prescribing for a 
name. For in these digests they surely will find inducements for 
individualizing their cases, and although I do not promise that 
they will find in every instance what they are hunting for, I am 
sure they will be greatly aided in many cases. 

C. G. Eaue. 

Philadelphia, 121 North 10th St., 
August 3d, 1885. 



PREFACE TO SECOND EDITION, 



PHE first edition had become old; it needed renovation. The 
pathological views had changed so grievously since its appearance, 
that a re-statement of the same throughout the work became a 
necessity. 

Not so, however, the therapeutic hints. They are as true to-day 
as they were when written years ago, and, I am happy to say, have 
been reliable guides at the bedside to many physicians, and also a 
fruitful source, acknowledged or not, to many writers in journals 
and of books. What I had to do with these hints was this : to ex- 
press their meaning still more accurately, to enlarge their spheres, 
and to add such new facts as the experience of others and my own 
would admit. This has augmented to a considerable extent even 
the therapeutic part of the work, and thus I may state in truth, that 
this second edition is re-written for the most part, that it is greatly 
enlarged and, I hope, also greatly improved. 

Although I have given credit in the text to the several authors 
from whom I have drawn, it may be well to mention the principal 
sources for the pathological part : von Ziemssen's Cyclopaedia, Fre- 
nch's Diseases of the Liver, Walton's work on the Eye and von 
Trcelsch's work on the Ear. Compare also the introductory remarks 
to the first edition. The therapeutic hints I have selected from the 
entire homoeopathic literature, using all such indications as I deemed 
reliable and characteristic. 

The chapter on the eye has been kindly and carefully over- 
hauled in the manuscript by Dr. G. S. Norton and that on the ear 

(xiii) 



XIV PREFACE. 

by Drs. G. S. Norton and Henry C. Houghton ; their valuable notes 
will be found credited to them in the text. 

The arrangement is the same as that of the first edition. 

Although great pains have been taken to avoid clerical errors, 
nevertheless some have crept in, for instance, salycilic for salicylic 
and others. Wherever you find them, please correct them. 

C. G. Kaue. 

Philadelphia, 121 North Tenth St., 
in the month of , 
1881. 



INTRODUCTORY REMARKS TO FIRST EDITION 



AACHEN I was called upon to lecture on Special Pathology and 
Diagnostics, about four years ago, I looked around for a work which 
would furnish the essential points of these branches of medical edu- 
cation, together with Homoeopathic Therapeutics, in a concise man- 
ner and up to the latest researches ; but I looked in vain. I was 
obliged to prepare my own materials. The result of these labors 
seemed, in the estimation of my pupils and indulgent friends, worthy 
of a more permanent form and a wider diffusion than oral teaching 
affords. 

In its preparation I have consulted the best recent as well as 
older works on the different subjects contained herein: Virchow, 
Rokitansky, Vogel, Griesinger, Hasse, Wintrich, Bamberger, Simon, 
Niemeyer, Bock, Bednar, Hiibner, Kiittner, Wagner, Skoda, Hebra, 
Wilson, Da Costa, Hughes, Barclay, Bryan, Hammond ; Hahnemann, 
Hering, v. Boenninghausen, Riickert, Oehme, Hartmann, Jahr, v. 
Grauvogl, Mtiller, Meyer, Baehr, Kafka, Ludlam, Hale, Wells, Dun- 
ham, and others; New York Homoeopathic Transactions and various 
journals. I have made free use of all of them as far as they suited 
my purpose, but have not followed any one exclusively. The ar- 
rangement, selection and elaboration of the whole are my own. The 
composition, however, would have unavoidably contained many 
Germanisms had they not been expurgated. I am indebted to Dr. 
G. R. Starkey, formerly Professor of Surgery in the Homoeopathic 
College of Pennsylvania, for his kind offices in correcting the manu- 
script so as to render it more agreeable to the English ear. 

(XV) 



XVI INTRODUCTORY REMARKS. 

This book does not pretend to be a special Therapia, because as v. 
Grauvogl already remarks: "It is impossible to prepare a complete, 
special Therapia for any so-called disease; just as impossible as to de- 
scribe all human beings of all times, because the conditions of getting sick 
change constantly in the course of timer What the genius epidemicus 
requires, for example, in an epidemic of whooping-cough at this 
season may not answer at all for a like epidemic of next year. 
Hence, my intention has been to give only therapeutic hints. These 
hints I have carefully selected out of the rich treasury of our 
Homoeopathic literature, and I have added the results of my own 
experience. But all this does not make it perfect. Many a col- 
league, on opening the book and glancing over this or that chapter, 
will miss one or another remedy which he has been applying suc- 
cessfully in a certain form of disease. It lies in the nature of such 
a work that this must be so. On being informed, however, of such 
remedies and their characteristic indications, the author would be 
happy to receive and apply them. 

This book does not give any prescriptions in regard to the dose, 
because that is still an open question, and must be left entirely to 
the free judgment of the practitioner. My hints are collected from 
all sorts of observations, with low, middle, high and highest potencies. 
I, myself, prefer the higher potencies; and it is possible that the 
more accurately we individualize the more we may become inclined 
to choose the highest. Others may think differently. So much is 
certain, that there are undoubted facts which seem to favor both 
sides of the question. Cases are recorded in which low potencies 
were given in vain, and a higher one of the same remedy at once 
effected a cure, and vice versa. Judge then for thyself. 

THE AUTHOR. 



CONTENTS. 



HEAD. 

Diseases of the Brain asd its Membranes. 

Ansemia, 33 

Hyperemia, 36 

Vertigo, 40 

Digest to vertigo, 4S 

Sleep, stupor, insomnia, 54 

Meningitis tuberculosa, hydrocephalus acutus, 59 

Leptomeningitis infantum, hydrocephalus acutus sine tuberculosis; simple 

meningitis, 61 

Simple meningitis of the base, . . • 62 

Meningitis of the convexity, 62 

Metastatic meningitis, 63 

Traumatic meningitis, 63 

Digest to meningeal inflammations, 67 

Hydrocephalus chronicus, • 72 

Hydrocephalus congenitus, 72 

Hydrocephalus senilis, 73 

Meningitis cerebro-spinalis epidemica, spotted fever, 74 

Digest to spotted fever, 78 

Pachymeningitis, inflammation of the dura mater, 80 

Encephalitis, abscess of the brain, red and yellow softening of the brain, . 81 

Insulatio, sunstroke, thermic fever, 82 

Apoplexia sanguinea, 85 

Occlusion of the cerebral arteries, embolism and thrombosis, softening of 

the brain, « . . . . 90 

Aphasia, 92 

Thrombosis of the cerebral sinuses, 95 

Hypertrophy of the brain 96 

Atrophy of the brain, 97 

Dementia paralytica, 98 

Senile dementia 100 

Digest to dementia paralytica, 103 

Delirium tremens, ]07 

Chronic alcoholism, dipsomania, 110 

Opium and morphine poisoning, 113 

Tumors of the brain and its membranes, 114 

(xvii) 



XV111 CONTENTS. 

Diseases of the Cranium and its Integuments. 

a. Abnormal largeness of the head. 

Dropsy of the scalp, 117 

Hypertrophy of the skull, 117 

The bruised head of a child after birth, «... 117 

6. Abnormal smallness. 

c. Affections of the skuU without enlargement. 

Atrophy of the skull, 119 

d. Diseases of the integuments. 

Erysipelas of the scalp and face, 119 

Eczema capitis, humid tetter or scald, 123 

Impetigo, 124 

Dandruff, 126 

Seborrhcea capillittii, 126 

Favus, honey-comb ringworm, tinea favosa or maligna, porrigo favosa or 

lupinosa, 127 

Tinea, herpes tonsurans, or ringworm of the scalp, 128 

The wen, 128 

Teleangiectasia, or vascular nsevus, mother's mark, . . . 129 

The Hair. 

Alopecia, 129 

Baldness, 129 

Change in color, 130 

Plica polonica, matted hair, 130 

EYES. 

General observations, 131 

IAds and Lachrymal Apparatus. 

Inflammation of the eyelids, 131 

Hordeolum, stye, , 136 

Tumors of the lid, 136 

Dacryocystitis, 137 

Blennorrhea of lachrymal sac, 138 

Conjunctiva. 

Catarrhal ophthalmia, 139 

Purulent ophthalmia, 141 

Gonorrheal ophthalmia, 141 

Ophthalmia neonatorum, 141 

Granular ophthalmia, 143 

Phlyctenular ophthalmia, 145 



CONTENTS. XIX 

Digest to the different forms of ophthalmia, 147 

Diphtheritic conjunctivitis, 150 

Croupous conjunctivitis, 151 

Pterygium, 151 

Cornea. 

Corneitis, keratitis, 152 

Abscess of cornea, 153 

Onyx, 153 

Hypopion, 153 

Staphyloma, 154 

Sclerotica. 

Scleritis, sclerotitis, 157 

Iris. 

Iritis, 158 

Choroidea. 

Choroiditis 160 

Glaucoma, 162 

Optic Nerve and Retina. 

Neuro-retinitis, 164 

Hemiopia, 166 

Hemeralopia, night-blindness, 167 

Hyperesthesia retinae, 167 

Lens. 

Cataract, 168 

Sight. 

Eefraction and accommodation, 170 

Presbyopia or old sight, 171 

Hypermetropia, .... • 172 

Myopia or shortsightedness, 172 

Astigmatism, . . 173 

Asthenopia, , 174 

Muscles and Nerves. 

Mydriasis, 176 

Myosis, 176 

Ptosis, falling of upper lid, 176 

Strabismus, squint, 177 

Nystagmus, trembling of eyeballs, 178 

Luscitas, or fixed state of eyeball, 178 

Morbid winking, 178 



XX CONTEXTS. 



Twitching of lids or quivering, 179 

Blepharospasm, 179 

Neuralgia of eye, 179 

Orbit. 

Orbital cellulitis, 180 

Basedow's or Graves' disease; exophthalmic goitre, 180 

EAES. 

Analogy between ear and eye, 183 

General observations on ear, 184 

Auricle. 

Eczema, 185 

Auditory Canal and Drumhead or membrana tympani. 

Examination of these parts, 186 

Earwax diminished or increased, 187 

Furuncles of external canal, 189 

Otitis externa, or diffuse inflammation of the auditory canal, 190 

The Middle Ear. 

Examination of the middle ear, 191 

Otitis media, 195 

Chronic forms of otitis media, 199 

Digest to acute and chronic otitis media, 204 

Polypi, . . . 209 

Nervous deafness, 209 

Meniere's disease, 210 

Tinnitus aurium, 211 

Otalgia nervosa, 212 

NOSE. 

General observations, 213 

Examination of the cavity of the nose, 214 

Catarrh, coryza, cold in head, 216 

Chronic catarrh, ozsena, 220 

Digest to acute and chronic catarrh in head, 224 

Influenza, grippe, , 228 

Yearly cold, rose cold, hay fever, hay asthma, 230 

Epistaxis, nosebleed, 231 

Polypi in nose, 233 

Inflammation of the nose, 233 

FACE. 

General observations, 234 



CONTEXTS. XXI 

Erysipelas of face, 238 

Crusta lactea, milk crust, 238 

Comedo, acne punctata et rosacea, 239 

Lupus, 240 

Ulcus rodens and epithelioma, 241 

MOUTH. 

Its external parts, 242 



TheGi 



Parnlis, gumboil, inflammatory swelling of the gums, 243 

Epulis, a kind of fungoid growth on the gums, - 243 

Fistula of the teeth, 244 

The Teeth. 

Odontalgia, toothache, 245 

Swelled face from toothache, « 261 

The Tongue. 

Its color, . . . . 261 

Its humectation, 262 

Its temperature, 262 

Its covering or coating, 262 

Its form and size, 263 

Its consistency, 264 

Cracks and fissures, 264 

Paralysis, 264 

Glossitis, inflammation of tongue, 266 

Cancer of tongue, 267 

The Salivary Glands and their Duets. 

Saliva, 268 

Parotitis, 269 

Eanula, frog 271 

The Tonsils. 

Inflammation of tonsils, amygdalitis, tonsillitis, angina tonsillaris, .... 272 

The Uvula and Soft Palate. 

Angina faucium, angina catarrhalis, sore throat, 275 

Chronic sore throat, angina granulosa or follicularis, 277 

Digest to acute and chronic inflammation of throat, 280 

Ulcers in the fauces, ulcerated sore throat, 282 

Ketro-pharyngeal abscess, . . . ; 283 

Deep inflammation of the connective tissue of the throat ; angina Ludovici, 284 



XX11 CONTENTS. 

The Mucous Membrane of the Mouth in General. 

Parasitic sore month of infants, thrush, 285 

Stomatitis ulcerosa, ulcers in the mouth, 287 

Diphtheria, diphtheritis, • 289 

Digest to diphtheria, 300 

Noma, gangrene of the cheeks, ..... • 303 

NECK. 

General observations, 305 

Bronchocele, struma or goitre, . 306 

(Esophagus. 

Oesophagitis, dysphagia inflammatoria, 307 

Stenosis oesophagi, narrowing of the oesophagus, . . . . 309 

Dilatation of the oesophagus, , 310 

Larynx and Trachea. 

Auscultation, . • 312 

Laryngoscopy, 312 

Acute catarrhal laryngitis, catarrh of larynx, 314 

Laryngitis catarrhalis chronica, 316 

Digest to acute and chronic laryngitis, 318 

Croup, 320 

(Edema glottidis, oedema laryngis, 325 

Perichondritis laryngea, ..... 326 

Pthisis laryngis, tubercular ulceration, 327 

Syphilis laryngis, 329 

Neoplasms of the larynx, 329 

Neuroses of the larynx, 330 

Hypersesthesia and neuralgia, 330 

Paralysis, 331 

Spasm of the glottis, 332 

THOEAX. 

Inspection, 335 

Palpation, 337 

Percussion, . 340 

Auscultation, 345 

Affections of the Bronchial Tubes. 

Bronchitis, bronchial catarrh, 357 

Digest to bronchitis, 367 

Tussis convulsiva, pertussis, whooping-cough, 371 

Bronchial asthma, asthma bronchiale nervosum seu convulsivum, .... 375 

Affections of the Pulmonary Parenchyma. 

Pneumonia 379 



CONTENTS. XX111 

Digest to pneumonia, 387 

Pulmonary consumption, phthisis, 389 

Digest to phthisis, 399 

Acute miliary tuberculosis, 402 

Emphysema pulmonum, 403 

Hyperemia and oedema of the lungs, 407 

Gangraena pulmonum, 409 

Haemorrhage of lungs, haemoptoe, haemoptysis, 410 

Affections of the Pleura. 

Pleuritis, pleurisy, inflammation of the pleura, 413 

Pneumothorax, < . . . . 420 

Hydrothorax, dropsy of the chest, 422 

Haematothorax, < 424 



THE HEAKT. 

Auscultation, 426 

Diseases of the Pericardium. 

Pericarditis, inflammation of the pericardium, 433 

Hydropericardium, dropsy of the pericardium, 437 

Diseases of the Endocardium. 

Endocarditis, 438 

Insufficiency of the mitral or bicuspid valve, 441 

Constriction or stenosis of left auriculo-ventricular opening, 442 

Insufficiency of the aortic valves, 443 

Constriction or stenosis of the aortic opening, 443 

Insufficiency of the tricuspid valves, 444 

Stenosis of the right auriculo-ventricular opening, 444 

Insufficiency of the pulmonary valves, 444 

Stenosis of the pulmonary opening, 444 

Heart-elots, 446 

Diseases of the Heart- Muscle. 

Myocarditis, carditis, inflammation of the heart-muscle, 447 

Hypertrophy and dilatation of the heart, 448 

Fatty heart and fatty degeneration of the heart, 449 

Nervous Affections of the Heart. 

Nervous palpitation of the heart, ^ 451 

Angina pectoris, stenocardia, , 453 

Diseases of the Aorta. 

Aneurism of the thoracic aorta, 457 



XXIV 



CONTENTS. 



Diaphragm. 

Diaphragmitis or inflammation of the diaphragm, 458 

Singultus, hiccough, 459 

Neuralgia, 460 

Rupture and perforation, , 460 

ABDOMEN. 

General observations, 461 

Stomach. 

Dyspepsia, indigestion, 464 

Vomiting, 465 

Acute catarrh, gastritis, 466 

Chronic catarrh, 470 

Gastritis toxica seu caustica, 47 1 

Gastralgia, cardialgia nervosa, cramp of stomach, 472 

Digest to gastralgia, 476 

Ulcus ventriculi perforans (rotundum, chronicum), the round perforating 

ulcer of the stomach, 478 

Carcinoma or scirrhus ventriculi, cancer of stomach, 481 

Haemorrhage from the stomach, haematemesis, 485 

Gastromalacia, softening of the stomach, 488 

Intestinal Canal. 

Catarrhus intestinalis, enteritis catarrhalis, intestinal catarrh, 489 

Chronic intestinal catarrh, 493 

Digest to acute and chronic intestinal catarrh, 496 

Typhlitis, perityphlitis and inflammation of the vermiform process, . . . 499 

Proctitis, catarrhal inflammation of the rectum, 502 

Periproctitis, 503 

Dysentery, 504 

Digest to dysentery, 510 

Cholera, 512 

Cholera morbus or nostras or Europaea, 523 

Cholera infantum, 524 

Summer-complaint, 524 

Digest to summer-complaint, . . 530 

Constipation, 533 

Digest to constipation, 538 

Hernia, internal and external strangulation, 540 

Torsion or twisting of the bowels, 543 

Intussusception, invagination, 544 

Ileus, miserere, - 545 

Haemorrhagia intestinalis, intestinal haemorrhages, malaena, 546 

Haemorrhoids, piles, 547 

Digest to haemorrhoids, piles, 552 

Flatulency, bloatedness, meteorism of the abdomen, 555 






CONTENTS. XXV 

Colica, enteralgia, 557 

Digest to colica, enteralgia, 564 

Tuberculosis intestinalis, consumption of bowels, 566 

Cancer of the intestines, 567 

Polypus of rectum, 568 

Fissura ani, 569 

Fistula recti, 570 

Prolapsus recti, 571 

Proctalgia, 572 

Intestinal worms, entozoes, helminthes, 572 

Oxyuris vermicularis, thread, seat or pin-worm, 572 

Ascaris lumbricoides, round worm, 573 

Tape-worms, ' 574 

Tricocephalus dispar, 578 

Anchylostomum duodenale, dochmius s. strongylus duodenalis, 578 

Trichina spiralis, 579 

Trichinosis, 581 

Peritoneum, 585 

Peritonitis, 585 

Ascites, dropsy of the peritoneum, 588 

Tympanites abdominalis, 592 

Diseases of the Liver. 

Physical examination, 592 

Pigment liver, melansemic liver resulting from malarial fever, 593 

Hyperemia, congestion of the liver, 593 

Peri-hepatitis, inflammation of the capsule of the liver and of Glisson's cap- 
sule, 596 

Hepatitis vera circumscripta seu suppurativa, 596 

Cirrhosis, hob-nail liver, interstitial inflammation, gin-drinkers' liver, . . . 599 

Syphilitic inflammation of the liver, 601 

Acute yellow atrophy, 602 

Hepar adiposum, fatty liver, 603 

Colloid, lardaceous, waxy liver, amyloid degeneration, 604 

Carcinoma hepatis, cancer of the liver, 605 

Hydatids of the liver, echinococcus cysts, 608 

Catarrhal inflammation of the biliary passages, 609 

Cholelithiasis, gall-stones, 610 

Thrombosis and occlusion of the portal vein; pvlethrombosis; pylephlebitis 

adhsesiva chronica, 613 

Phlebitis suppurativa, purulent inflammation of the portal vein, 614 

Icterus, cholsemia, jaundice, 615 

Digest to jaundice, 623 

Diseases of the Spleen. 

Physical examination, 625 

Anatomical peculiarities of the spleen, 626 

Hemorrhagic infarction, splenitis, lienitis or inflammation of the spleen, . 627 



XXVI CONTENTS. 

Acute tumor, or hyperemia of the spleen, 628 

Chronic tumor, or hypertrophy of the spleen, 629 

Cancer of the spleen, 630 

Echinococcus cysts, 630 

Rupture of the spleen, 630 

Diseases of the Pancreas. 

Pancreatitis, inflammation of the pancreas, 631 

Fatty disease of the pancreas, 632 

Cancer of the pancreas, 632 

Diseases of the Kidneys. 

Examination of urine, 632 

Diabetes, mellituria, glycosuria, 639 

Diabetes insipidus, 647 

Hematuria, passing blood with the urine, 648 

Albuminuria, 651 

Uraemia, 652 

Acute parenchymatous nephritis, 653 

Chronic parenchymatous nephritis, 658 

Interstitial inflammation or induration of the connective tissue of the kidneys, 661 

Amyloid degeneration of the kidneys, lardaceous or waxy kidneys, .... 665 

Suppurative nephritis, renal abscess, 666 

Nephrolithiasis, renal gravel or calculi, nephralgia, colica renalis, .... 666 

Pyelitis,- inflammation of the renal pelvis, 669 

Perinephritis, paranephritis, inflammation of the renal capsule, 670 

Morbus Addisonii, 670 

Diseases of the Bladder. 

Cystitis, inflammation of the bladder, 672 

Calculi vesicae, stones in the bladder, 677 

Hypersesthesia or irritability of the bladder; spasm of the bladder, .... 679 

Atony, paresis, paralysis of the bladder, 680 

Enuresis nocturna, 682 

Eetention of urine, ischuria vesicalis, 683 

ORGANS OF GENERATION. 

Male Genitals. 

Veneral Diseases. 

Gonorrhoea, 685 

Complications and sequelae, 690 

Epididymitis; orchitis, 690 

Prostatis gonorrhoica, inflammation of the prostata, . . . 691 

Gonorrhoea vesicae, 691 

Buboes, 691 

Ophthalmia gonorrhoica, 691 



CONTENTS. XXV11 

Gonorrhoea of the rectum, . . . 691 

Strictures of the urethra, , 692 

Gonorrheal rheumatism, 692 

General contamination of the system, 692 

Balanitis, gonorrhoea spuria or prseputialis, 693 

Chancre, 693 

Constitutional syphilis, 696 

Digest to chancre and constitutional syphilis, 701 

Condylomata, sycosis, fig-warts, 705 

Inguinal bubo, 706 

Syphilitic skin diseases or syphilides, 707 

Macular syphilide, 708 

Papular syphilide, 708 

Squamous syphilide, 709 

Lichen syphiliticus, 709 

Pustular syphilide, 709 

Tubercular syphilide, 710 

Alopecia, 710 

Alterations of nails, 710 

Syphilitic affections of the mucous membranes, 711 

.Syphilitic affections of the periosteum, of the bones and cartilages, .... 711 

Syphilitic contractions of muscles and tendons, 712 

Gummata in the subcutaneous and submucous cellular tissue, 712 

Syphilitic affections of inner organs, 712 

Syphilis congenita sive hereditaria, 713 

Diseases of the Testes. 

Hydrocele, , 714 

Orchitis, inflammation of the testicles, 715 

Sarcocele, hydrosarcocele, 716 

Carcinoma testes, 716 

Varicocele, ....••• 717 

Spermatocele, • • • 717 

Diseases of the Prostata. 

Prostatitis, inflammation of the prostate gland, 717 

Enlargement and tumors of the prostata, 718 

Diseases of the Vesievloz Seminales. 

Pollutiones nocturnae et diurnae ; spermatorrhoea, 721 

Impotence ; sterility in the male, 724 

Aspermatism, 725 

Azoospermatism, 725 



Female Genital Organs. 
Examination of the parts, 726 



XXV111 CONTENTS. 



Ovaries. 



Oophoritis, ovaritis, 727 

Hydrops ovarii, ovarian dropsy ; formation of cysts in the ovaries, . . . ." 730 

Uterus. 

Endometritis; catarrh of the uterus ; leucorrhoea, 733 

Digest to leucorrhoea, ■ • * . . 739 

Parenchymatous metritis, 742 

Hydrometra, haemometra, partial or total closure of the womb, 746 

Displacements of the womb, 746 

Anteversion and anteflexion, 747 

Retroversion and retroflexion, 747 

Prolapsus and procidentia, 748 

Inversion, 749 

Digest to displacements of the womb, 754 

Morbid growths within the womb, 757 

Cancer of the womb, 759 

Hysteralgia, 762 

Metrorrhagia, haemorrhage from the womb, 762 

Menstrual Anomalies. 

1. Menorrhagia, 766 

Digest to metrorrhagia and menorrhagia, 769 

2. Amenorrhoea, 772 

3. Dysmenorrhoea, mentruatio difficilis, 775 

Digest to amenorrhoea, dysmenorrhea, 779 

Vagina. 

Catarrh of the vagina, vaginitis, 784 

Vaginismus • 784 

Pruritus vulvae, 785 

Mammoz. 

Mastitis, inflammation of the breast, 786 

Scirrhus seu carcinoma mammae, scirrhus or cancer of the breast, 788 



SPINE. 

Anaemia, 791 

Hyperemia, 791 

Apoplexy, or extravasation of blood, 792 

Spinal irritation, 794 

Neurasthenia spinalis, spinal nervous weakness, 796 

Hydrorrhachis congenita, spina bifida, 797 

Leptomeningitis spinalis, 798 

Myelitis, inflammation of the spinal marrow, 800 

Myelomalacia, non-inflammatory softening of the spinal marrow, 803 



CONTENTS. XXIX 

Multiple sclerosis, 803 

Tabes dorsalis, sclerosis of the posterior columns, gray degeneration of the 
posterior columns, progressive locomotor ataxy, leukomyelitis posterior 

chronica, 805 

Spasmodic spinal paralysis, 809 

Polyomyelitis anterior acuta, acute inflammtion of the gray anterior columns 

(anterior horns), 810 

Polyomyelitis anterior subacnta et chronica, subacute and chronic inflamma- 
tion of the gray anterior horns, chronic atrophic spinal paralysis, ... 811 

Paralysis ascendens acuta, acute ascending paralysis, 811 

Coccyodynia, 812 

MOTOKY APPAKATUS. 

Eheumatismus, 815 

1. Eheumatismus articulorum acutus, acute rheumatism of the joints; polyar- 

thritis rheumatica acuta, 815 

2. Eheumatismus articulorum chronicus, chronic rheumatism of the joints, . 817 

3. Eheumatismus muscularis, muscular rheumatism; myopathia, myalgia 

rheumatica, 817 

Digest to rheumatism, 825 

4. Gout, podagra, arthritis, 830 

5. Arthritis deformans, 832 

Eachitis, rickets, 833 

Malacosteon; mollities ossiuni; osteomalacia, softening of the bones, . . . 835 

Progressive muscular atrophy, 836 

Osteitis, caries, necrosis, exostosis, 837 

Tuberculosis of the joints, white swelling, 839 

Coxarthrocace, coxalgia, hip-disease, 840 

Gonarthrocace, tumor albus genu, white swelling of the knee, 843 

Bursitis, 845 

Podarthrocace, abscess of the ankle-joint, 845 

Malum Pottii, kyphosis, angular curvature of spine, spondylarthrocace, . . 846 

Bunion, 847 

Ingrowing toe-nails, 847 

XEEVES. 
Anatomical Diseases of the Nerves. 

1. Neuritis, inflammation of the nerves, 848 

2. Atrophy of the nerves, 848 

3. Hypertrophy and neoplastic formations in the nerves, 848 

Functional Diseases of the Nerves. 

1. Hyperesthesia, anesthesia, 849 

2. Neuralgia, 850 

Cephalalgia, hemicrania or migrama, nervous sick-headache, 851 

Digest to cephalalgia, 857 



XXX CONTENTS. 

Neuralgia of the trigeminus or fifth nerve, prosopalgia, neuralgia facialis, 

dolor faciei Fothergillii, tic douleureux, 861 

Digest to neuralgia of face, 865 

Cervico-occipital neuralgia, 868 

Cervico-brachial neuralgia, 868 

Intercostal neuralgia, 869 

Lumbo-abdominal neuralgia, 869 

Mastodynia, neuralgia of the mammae, 870 

Neuralgia ischiadica, sciatica, ischias postica, malum cotunnii, ...... 870 

Digest to sciatica, 875 

Crural neuralgia, ischias antica, 877 

Anaesthesia, 877 

Anaesthesia of the trigeminus, 877 

Spasm, convulsion, cramp, hyperkinesis, 878 

Spasmus facialis, mimic spasm of the face, , 880 

Mogographia, graphospasms, writer's cramp, pianist's cramp, etc., .... 881 

Chorea, St. Vitus' dance, 881 

Hysteria, 885 

Trismus and tetanus, 889 

Catalepsy, 893 

Epilepsy, ■ 893 

Digest to epilepsy, 901 

Eclampsia acuta, 904 

Eclampsia gravidarum et parturientium, puerperal convulsions, 905 

Eclampsia infantum, convulsions of children, . . 906 

Tremor, trembling, 909 

Paralysis agitans, shaking palsy, 910 

Paralysis, akinesis, 911 

Peripheral paralyses, 912 

Spinal paralyses, 912 

Cerebral paralyses, 913 

Myopathic paralyses, 913 

Infantile wasting palsy, essential infautile palsy, 918 

Hydrophobia, lyssa, rabies, 918 



THE BLOOD. 

Cyanosis, 924 

Dissolution of the red blood-corpuscles, 925 

Leukaemia, 926 

Hydraemia, 927 

Plethora, 927 

Anaemia, oligaemia, 928 

Progressive pernicious aneemia, 929 

Chlorosis, 930 

Digest to chlorosis, 934 

Scurvy, scorbutus, 937 

Purpura haemorrhagica, morbus maculosus Werlhofii, 940 



CONTENTS. XXXI 

Haemophilia, hsemorrhophilia, 941 

Scrofulosis, 942 



FEVER. 

Clinical thermometry, 945 

Crisis and critical days, 947 

Intermittent fever, fever and ague, 949 

Digest to intermittent fever, 959 

Pernicious intermittent ; remittent and continuous malarial fevers ; conges- 
tive fevers, 967 

Yellow fever, 968 

Digest to yellow fever, 976 

Dengue or break-bone fever, 981 

Typhus, 982 

Typhus exanthematicus, petechial typhus, 982 

Typhoid fever, typhus abdominalis, ileo-typhus, 985 

Abortive typhoid fever, 990 

Typhus ambulatorius, 990 

Typhus tumultuarius, 990 

Pneumo-typhus, broncho-typhus, 990 

Digest to typhoid fever, 1002 

Relapsing fever, typhus recurrens, 1013 

The plague, 1016 

Exanthemata. 

Measles, morbilli, 1018 

Scarlatina, - . 1023 

Scarlatina maligna, typhosa, 1026 

Angina maligna, 1026 

Digest to scarlatina, 1034 

Rubeola, rcetheln, 1040 

Variola, small-pox, variolois, varioloid, 1040 

Varioloid, 1043 

Purpura variolosa, 1044 

Varicella, chicken-pox, 1047 



SKIN. 
I Hypertrophy of shin. 

Ichthyosis or fish-skin, 1049 

II. Atrophy of the skin. 

III. Hypercemia and anaemia of the skin. 

IV. Dermatitis, inflammation of the skin. 

1. Erythema, 1050 



XXX11 CONTENTS. 

2. Herpes, 1052 

facialis, ... 1052 

prseputialis, 1052 

Zoster, or Zona, shingles, 1052 

3. Urticaria, nettle-rash, 1054 

4. Eczema, vesicular eruption, -' .■ 1055 

5. Impetigo, pustular eruption, 1058 

contagiosa, 1058 

6. Ecthyma, isolated, large pustules, 1059 

7. Pemphigus, pompholyx, isolated large bullae, 1059 

8. Rupia or rhypia, isolated blisters which form crusts, . 1060 

9. Furunculus, boils, 1061 

10. Carbunculus, 1061 

11. Pustula maligna, malignant pustule, 1063 

12. Epithelioma, epithelial cancer, 1064 

13. Panaritium, paronychia, whitlow, run-around, felon, ......... 1064 

14. Psoriasis, 1067 

15. Lichen, . . . 1068 

1 6. Prurigo, pruritus, 1 068 

17. Scabies, itch, 1069 

18. Prairie itch, prurigo contagiosa, 1072 

19. Burns and scalds, 1072 

20. Chilblains frostlites, etc.,. - 1074 

V. Anomalies in the seeretions of the skin, 

Sudamina, miliary rash, 1076 

Prickly heat, 1076 

Foot-sweats, 1076 

Partial hyperidrosis, 1078 

Comedones, 1078 

Milium, 1079 

Atheromata, 1079 

Molluscum, • 1079 



HEAD. 

DISEASES OF THE BRAIN AND ITS MEMBRANES. 



Anaemia. 

A deficiency in the proper quantity of blood in the brain in general, 
or of arterial blood in particular. Inspection shows the grayish substance to 
be paler, or nearly white ; and the white substance still whiter than normal 
on account of the absence of the usual blood-points. The blood-vessels are 
not entirely empty, though they contain comparatively less blood than usual, 
while in most cases an increased quantity of serum has been found between 
the subarachnoid spaces. 

As Causes, may be mentioned : 

1. All influences ivhich biding on general ancemia: blood-letting, haemor- 
rhages, loss of vital fluids by too long-continued lactation or exhausting 
diarrhoeas, especially summer-complaint; long-continued fevers, hepatization 
of the lungs in weakly persons from the constant wasting away of blood and 
muscles; and starvation, which cuts off all recuperation of the lost vital 
fluid. 

2. Congestion or fluxion of blood to other organs. So may Junod's cup- 
ping-boot, an instrument which has been invented in imitation of the cup- 
ping-glass, to be applied to a whole limb, in order to cause an artificial afflux 
of blood into it, when used incautiously, produce anaemia in the brain, and 
for the same reason do we find persons of weakened activity of the heart 
faint more easily in a standing than in a lying position, because then the 
propelling force is not sufficient to overcome the natural gravity of the blood. 
We may add the effects of "shock," where, according to H. Fischer's theory, 
a reflex paralysis of the vasomotor nerves, especially the splanchnic, causes a 
collection of blood in large quantity in the distended vessels of the abdomi- 
nal cavity ; the fainting away sometimes after the sudden expulsion of the 
foetus, where the hitherto compressed abdominal vessels fill quickly after the 

3 



34 BRAIN. 

compressing cause is removed; the fainting in consequence of too rapid with- 
drawal of ascitic fluid for the same reason. 

3. Compression or obstruction of the carotid or vertebral arteries — by arti- 
ficial ligation, tumors or emboli, which prevent the normal afflux of blood to 
the brain. 

4. Spasmodic contractions of these vessels, as is evident in emotions of the 
mind, from which not only paleness of the face, but also swooning and un- 
consciousness may result ; nervous apoplexy of some writers? 

5. Exudations, extravasations, tumors, depressions of the skull, whereby 
the internal capacity of the skull becoming diminished, the necessary supply 
of blood to the brain is impossible. 

Anaemia, when it consists in a deficiency of arterial blcod in the brain, 
is caused by 

6. All those states of the system which prevent the normal oxygenization of 
the blood, such as different heart and lung diseases. It has been shown by 
Kussmaul and Tenner that by sudden suppression of respiration, whereby 
the blood ceases to receive oxygen, the same symptoms are produced which 
a depletion will bring on. 

In accordance with these causes the Symptoms vary. In case of sudden 
depletion we ' have : sudden paleness of face with cold perspiration on fore- 
head; gaping; slow breathing; ringing in the ears; dimness and flickering 
before the eyes; nausea, even vomiting; fainting away, which maybe at- 
tended or followed by epileptiform convulsions. 

In the gradual development of ansemia the symptoms differ in individ- 
ual cases more widely ; all, however, are characterized by a great paleness of 
the face. The cerebral disturbances take either the form of depression 
(mental torpor, drowsiness, somnolence, coma), or excitation (restlessness, 
sleeplessness, delirium, a condition mostly observed in cases caused by star- 
vation, and in persons whose general state of anaemia is excessively aggravated 
by exhausting diseases or lo&s of blood). Vertigo is frequently present and 
headache occasionally. Specks and dimness before the eyes is common, and 
commoner still the ringing and buzzing in the ears; total amaurosis is rare. 
As regards the motor apparatus, we have either great weakness of all the 
muscles amounting to temporary paralysis, or epileptiform convulsions. The 
latter rarely happen in the gradual form, w T hile the first, at least as general 
weakness, is present in almost all cases. 

The anaemia consequent upon summer-complaint was first and well 
described by Marshall Hall, who appropriately named it hydrocephaloid, 
on account of the great similarity of its symptoms to those of hydrocephalus 
acutus, and by him was divided into two stages — the irritable and torpid. 

In the first the children are restless; throwing themselves about in bed; 
starting frequently in sleep, and giving piercing shrieks ; they grate their 



ANEMIA. ' 35 

teeth; their face looks red; the pulse is frequent, and the skin hot; and 
spasms even may occur; thus making the whole resemble very much an 
acute attack of hydrocephalus. 

In the second stage, however, the children collapse, become apathetic ; 
do not look at objects held before their eyes; their eyelids are half closed; 
pupils do not react against the light ; their respiration becomes irregular ; 
pulse very frequent and small ; they gradually grow cold all over, first in 
the face ; and, in fatal cases, they die with symptoms of coma. 

THERAPEUTIC HINTS.— In the first place, where the patient suf- 
fers with general anaemia, we ought to provide for him a diet which will best 
supply the lost vital fluids. Especially in summer-complaint, wine and 
mutton-chops often do more good than medicine. Beef-tea, which princi- 
pally consists of Potassa combinations, produces, according to Pfliiger's ex- 
periments in small doses, an increase in the frequency and force of cardiac 
contractions; in large doses it acts as a poison, causing death by apparent 
paralysis of the heart. "Mr. G. F. Masterman, in the London Lancet, 
called attention to the chemical analysis of beef-tea, which shows that it is 
analogous to urine, except that it contains less urea and uric acid. The 
analysis also proves that the tea even when most carefully prepared, does 
not contain, including alkaline salts, more than from 1.50 to 2.25 per cent, 
of solid matter, and that such matter is composed mainly of urea, kreatine, 
kreatinine, isoline, and decomposed haematine, exactly the animal constitu- 
ents of the urine, except that there is but a trace of urea." — Boston Journal 
of Chemistry. It ought to be used, therefore, with great caution. 

In the second place, where the heart's impulse has become weakened, 
we ought to take care that the patient should lie quiet in a horizontal posi- 
tion, not to allow him to leave the bed too soon, or even to rise for the pur- 
pose of using the chamber. 

The special treatment must be dictated by the conditions of each case ; 
success is possible only when we take each case as a "unicum," and search 
for its corresponding remedy in the Materia Medica. The symptoms indi- 
cating the remedy may lie entirely outside of the group of those symptoms 
which constitute the diagnosis. 

In general, however, the following remedies may be mentioned as the 
most important in anaemic states after loss of vital fluids: Calc. carb., Garb, 
veg., China, Ferrum, Kali carb., Mercur., Nux vom., Phosphor., Phosph. ac, 
Pulsat., Sepia, Silic, Staphis., Sulphur. 

Dizziness, vertigo, better in a horizontal position, after eating; worse in 
the morning, and in the open air; complaint of old people: Ambra, Bar. 
carb., Graphit., Lycop., Phosphor., Silic. 

Delirium in consequence of great loss of blood : Arnica, Arsen., Ignat., 
Laches., Lycop., Phosphor., Phosph. ac, Scilla, Sepia, Sulphur, Veratr. 



36 BRAIN. 

Convulsions in consequence of loss of blood : Arsen., Bellad., Calc. carb., 
Cina, Conium, Ignat., Lycop., Nux vom., Pulsat., Sulphur, Veratr. 

Summer-complaint will find particular mentioning under the head of 
abdominal disorders. 

Hyperemia 

Of the brain is that state in which it is overcharged with blood, either by 
active congestion, rush of blood, or fluxion to the brain, or by stagnation of 
blood in the hv^iw, passive hyperemia, or hypercemia by stasis. 

Post-mortem examination frequently reveals a large quantity of blood 
in the vessels and sinuses, especially of the dependent parts of the cranial 
cavity. This may be a mere post-mortem result, since in other cases nothing 
of the kind is to be seen. The gray substance appears swollen and darker 
than usual; the white substance presents, in exceptional cases only, a reddish 
hue. The subarachnoidal meshes contain no fluid. 

In chronic cases the blood-vessels are almost always dilated; the sub- 
stance of the brain is atrophied, and the subarachnoid spaces are filled with 
a large quantity of fluid, especially in the bodies of drunkards. 

In some cases, however, post-mortem examination does not reveal any 
such objective signs. On the contrary, the brain appears entirely empty of 
blood, although during life every symptom pointed to hypersemia. This 
fact has not yet been fully explained, and shows that appearances in the 
dead body do not always clearly reveal what has been going on in the living. 

Here the question maybe asked: Is hypersemia possible at all? As the 
brain is encased in an unyielding capsule, how can more blood enter than 
there is flowing off? To answer this question we have to point to the cerebro- 
spinal fluid as a means of regulating the intracranial circulation. This fluid 
easily recedes when the cerebral vessels become distended and enters again 
whenever the pressure subsides, and thus we find it always absent when there 
is a greater afflux of blood, and present in considerable quantity within the 
meshes of the textus cellulosus subarachnoidealis, where there is an anaemic 
state of the brain. Only when the brain is atrophied, there is also an in- 
crease of this fluid besides hypersemia ; and it is wanting again even if there 
be anaemia present, when the room of the skull is filled by tumors or effusion 
in the ventricles. As still other means for the regulation of the intracranial 
circulation recent researches consider: the perivascular lymph-spaces, the 
thyroid gland, the peculiar arrangement of the cerebral sinuses and the 
mechanism of the circle of Willis. 

Congestion takes place — 

1. In consequence of an undue activity of the serous membranes which, en- 
veloping the brain, act like a suction-pump within the skull. This seems to 



HYPEREMIA. 37 

be the condition of those persons who are subject to "rush of blood to the 
head." 

2. In consequence of obstructions to the flow of blood to other and different 
portions of the body, whereby it is diverted with increased force towards the 
brain. We see examples of this condition in compression of the aorta ab- 
dominalis by tumors, effusions, or enlarged abdominal viscera ; in the con- 
traction of the capillaries of the skin during the chilly stage of intermittent 
fever; and in the suppression of menstrual and hemorrhoidal discharges. 

3. In consequence of dilatation of the capillaries within the brain; gener- 
ally the result of the abuse of opium and alcoholic drinks and other narcotic 
substances ; of the exposure to the rays of the sun ; of long-continued irrita- 
tion of the brain by mental overexertion. 

4. In consequence of paralysis of vasomotoric nerves. For example: after 
cutting through the cervical portion of the sympatheticus we find that the 
blood-vessels of the corresponding side dilate. So have also certain emotions 
similar effects; by them the normal innervation of the walls of the vessels is 
altered, they dilate and thus convey a larger mass of blood. This may be 
the key for the explanation of some sudden deaths which ensue in conse- 
quence of violent mental emotions, fright or joy. 

Stagnation or hyperemia by stasis may be caused — 

1. By compression of the jugular veins from strangulation ; by goitre, 
glandular tumors in the neck, or by aneurism of the aorta pressing upon the 
vena cava descendens. 

2. By violent expiratory movements, as take place during violent fits of 
coughing, straining, and the blowing of instruments; to which also belongs 
Dr. Bonwill's method of producing a transient state of anesthesia for the 
purpose of drawing teeth and performing minor surgical operations, by caus- 
ing the patient to make rapid and deep inspirations. 

3. By diseases of the heart; such as tricuspid insufficiency, stenosis of the 
venous orifice, and insufficiency of its valves. 

4. By some lung diseases, as emphysema, extensive pneumonia, cirrhosis, 
and large pleuritic exudations ; also diseases of the larynx, such as croup, 
cedema of the glottis and presence of foreign bodies. 

The Symptoms of hyperemia are best arranged under two heads, in 
accordance with its two stages: that of excitability and depression. 

To the first belong headache, sensitiveness to light, noise and touch ; 
flickering before the eyes ; singing and ringing in the ears ; pain and formi- 
cation in the flesh; restlessness; jerking and automatic motions of the 
limbs; grating of the teeth ; convulsions ; dizziness ; hallucination; sleepless- 
ness and vivid dreams. 

To the second, the stage of depression, belong insensibility to light, 
noise or pressure. In this stage also the limbs go to sleep, lose their mobility, 



38 BRAIN. 

and feel heavy as lead ; the pupils become dilated ; the pulse frequent, and 
the respiration quite slow, irregular or snoring; and there is frequent 
vomiting. 

These are the general symptoms which vary, however, greatly in indi- 
vidual cases. In some, signs of irritation predominate, such as headache, 
great sensitiveness of the senses, flickering before the eyes and ringing in the 
ears; restless, dreamful sleep; redness of face, injected conjunctiva, quick 
and full pulse. In some persons a cup of coffee or glass of wine brings on 
such a condition. In place of these external signs of hyperemia there may 
be paleness of the face. In other cases, especially those of children during 
dentition, convulsive motions predominate, from the mere jerking, twitching 
of single muscles to general convulsions with loss of consciousness, vomiting, 
constipation, contraction of pupils, etc. Other cases are characterized by 
headache, sleeplessness, restlessness, a feeling as if they should go crazy, 
delirium, symptoms, mostly brought on by overexertion of the brain. In 
still other cases we find this mental irritation increased to mania and rage 
after exposure of the head to the rays of the sun and the abuse of alcoholic 
drinks, especially in such individuals as use them periodically and then to 
excess. Still other cases are characterized by depression and paralytic symp- 
toms, which it is often difficult and sometimes impossible to distinguish from 
apoplectic fits. 

THERAPEUTIC HINTS.— Rush of blood to the head indicates: 

Aeon., dry and hot skin; the patient is very restless and beside him- 
self; cries and complains much ; is impatient and full of anxiety. 

Amyl. nitr., heat, throbbing and feeling of intense fulness in the head; 
protruding, staring eyes, throbbing in the ears; flushing of the face, choking 
feeling in throat, along the carotids; tumultuous action of the heart. 

Apis, jerking, crying out in sleep; frightful visions with fear and 
trembling; drowsiness; apathy; if Bellad. did not help. 

Arnica, head hot, remaining body cool; after a blow or fall. 

Aurum, heat and roaring noise in the head, fiery sparks before the 
eyes, worse after mental exertion ; fearful and longing for death. 

Bellad., hot and red face, sparkling eyes, and dilated pupils; throb- 
bing of the carotids; drowsiness with inability to sleep, or drowsy sleep with 
starting; fearful mood; symptoms are aggravated by motion, leaning the 
head forward, or lying down; by light or sounds. 

Bryon., the patient feels as though his brain would burst through 
the forehead; nosebleed; puffed, red face; great irritability and fits of anger. 

Calc. carb., the patient is worse in the morning, with puffiness of the 
face ; palpitation of the heart after eating ; swelling of the pit of the stomach ; 
after mental overexertion. 



HYPEREMIA. 39 

Chamom., flickering before the eyes, often followed by headache; 
stopped-up feeling in the ears with humming noise, often when awaking in 
the morning; exceedingly irritable, fits of anger; dizziness. Stagnation in 
the portal system with disposition to piles; disagreeable feeling in the small 
of the back. 

China, the slightest touch of the scalp is unbearable; earthy color of 
the face. Headache worse from moving the eyes or shutting them; better 
when sitting still in an upright position. 

Ferrum, the face is hot and red, with swollen blood-vessels, accompa- 
nied by beating and humming in the head, and great sensitiveness of the 
scalp to touch. 

Gelsem., when, during dentition, children become drowsy, comatose 
and convulsive ; or when from the effects of heat there is dizziness, enlarged 
pupils, dimness of sight and a dull, confused headache, spreading from the 
occiput over the whole head. Sleeplessness in delirium tremens. 

Glonoin., throbbing headache, great restlessness; inclination to run 
away; violent pulsations of the carotids; after exposure to excessive heat or 
cold. 

Hyosc, the patient is unconscious and delirious, with red, sparkling 
eyes, and bluish -red face; or drowsy, jerks in sleep, cries out in sleep, grates 
his teeth; subsultus tendinum. After Bellad. 

Kali hydr. , weakly constitution ; disposition to tuberculosis ; hammer- 
ing pain in forehead; anxiety, restlessness, sleeplessness; sensation as though 
the head were larger; even if there is delirium and high fever. 

Nux vom., the patient is worse in the morning, in the open air, after 
the use of coffee, liquors, or opium; with constipated bowels and suppression 
of hemorrhoidal discharges. 

Opium, stupefaction; snoring and rattling; slow breathing; slow 
pulse; sighing and moaning; bluish-red and bloated face; throbbing of tem- 
poral arteries; cold perspiration in face; falling of lower jaw. 

Phosphor., heat on the top of the head, dizziness, buzzing and throb- 
bing in the head ; swelling under the eyes ; and palpitation of the heart from 
mental emotions; emphysema. 

Pulsat., the face looks yellowish, and yet feels hot, with constant chil- 
liness ; worse in a warm room ; better in the open air ; no thirst ; scanty or 
suppressed menses. 

Rhus tox., humming, formication and throbbing in the head; glisten- 
ing redness of the face, and restlessness, which keeps the patient moving 
about. 

Spigel., palpitation of the heart; violent headache; dizziness and stu- 
pefaction; frightfulness ; oppression of the chest. 

Spongia, pressing, beating in the forehead; redness of face with anx- 
ious features; better in a horizontal position; goitre; heart disease. 



40 BRAIN. 

Stramon., unconscious and senseless; loss of sight and hearing; face 
turgescent; convulsive motions of the head; wild or stupid expression; great 
thirst with hydrophobia; or furibund delirium; greatest restlessness, wants 
to run away ; sleeplessness. 

Sulphur, flying heat in the face ; diminished hearing ; burning, throb- 
bing and buzzing in the head ; better in the room, worse in the open air ; in 
hemorrhoidal complaints; and after the suppression of cutaneous eruptions. 

Ver. vir., sense of fulness, weight, distention in the head; giddiness, 
intense headache, throbbing arteries, stupefaction; double, partial, luminous 
visions; nausea; vomiting; tingling, numbness in limbs; mental confusion, 
loss of memory, convulsions or paralysis ; during dentition ; congestion from 
alcoholic stimulants. 

In summing up as to the various causes, the following scheme may be 
of some use, although it must not be considered as exhausting the subject. 

From mental emotions: Aeon., Amyl. nitr., Coffea, Iguat., Opium, Ver. 
vir. 

From mental overexertions: Aurum, Calc. carb., Nux vom., Phosphor., 
Sulphur. 

From teething: Aeon., Bellad., Calc. carb., Gelsem., Ver. vir. 

From suppression of hcemorrhoidal discharges: Aeon., Chamom., Calc. 
carb., Carb. veg., Nux vom., Pulsat., Sulphur. 

From suppressed or scanty menses: Aeon., Apis, Bellad., Bryon., Calc. 
carb., Carb. an., Chamom., Conium, Dulcam., Ferrum, Graphit., Laches., 
Lycop., Merc, sol., Phosphor., Pulsat., Sepia, Silic, Sulphur, Veratr. 

From hypertrophy of the left heart: Aeon., Aurum, Cact. grand., Glonoin., 
Jodium, Kalmia, Spigel., Spongia. 

From insufficiency of the iricuspidalis: Bellad., Hyosc, Kali carb., Pulsat. 

During a chill: Aeon., Arnica, Arsen., Bellad., Bryon., Calc. carb., 
Chamom., Digit., Ferrum, Hyosc, Ipec, Lycop., Mercur., Nitrum, Rhus 
tox., Sabad., Stramon., Sulphur, Veratr. 

From alcoholic drinks: Aeon., Arsen., Calc. carb., Gelsem., Laches., Nux 
vom., Pulsat., Opium, Ver. vir. 

From straining: Aeon., Arnica, Bryon., Bhus tox. 

. In chronic cases : Aurum, Calc. carb., Ferrum, Phosphor., Spongia, 
Sulphur. 

Vertigo. 

This symptom, so conspicuous in anaemia as well as in hyperemia of the 
brain, and in many other quite different affections of the body, has been de- 
fined by F. Niemeyer as "a hallucination, consisting of the vivid conception 
of a motion of the body or of the surrounding objects, which the patient 
imagines to see and to feel, although he himself and his surroundings are in 



VERTIGO. 41 

perfect rest." This definition is undoubtedly defective. For if vertigo is a 
hallucination, colic and all other subjective symptoms would be. Kafka 
calls it " a sensation of seeming motion which, by full consciousness, is per- 
ceived to take place in oneself or in the surrounding objects, with a feeling of 
loss of balance of the body and an uncertainty in standing, walking, sitting 
or lying." He considers it as a peculiar affection of motor-nerves, caused 
either by the brain itself, or the cranial nerves or by some more remote gan- 
glia or organs. This definition, too, wants correction. Let us consider a 
simple instance in which vertigo is produced in even quite healthy persons — 
the swift swinging around of the entire body in a circle. If we observe 
closely, we find that vertigo in such a case is experienced not exactly during 
bat at the sudden cessation of this motion. Why? Because so long as the 
whole body moves in a certain direction, all its parts move with it, fluids and 
solids, just as you may, by means of a sling, swing water in an open vessel in 
a circle without losing a single drop ; but stop its motion suddenly and ves- 
sel and water will fly to the ground. So when the rotatory motion of the 
body is suddenly stopped, the fluid parts of the body and especially the large 
collection of blood in the cranial sinuses must necessarily recoil and assume a 
motion in disharmony with the whole body. It is this commotion of the 
blood in the brain which is immediately felt and designated by the name of 
vertigo. Vertigo, then, we should say, is the sensation of an actual commo- 
tion of the blood within the cranial cavity. This separate, disharmonial mo- 
tion affects the sensient nerves and is perceived by the sensorium, from which 
again, by reflex action, motor nerves are excited, hence the tottering, reeling 
or grasping for something, or the falling down, when the undue excitement 
should bring on momentary unconsciousness, or the seeming motion of the 
surrounding objects, etc. Thus we experience vertigo by all such motions of 
the body which are capable of producing a disharmonial motion of the blood 
within the cranial cavity, for instance, concussions of the body, dancing, bend- 
ing forward or backward and rising, looking up or turning around quickly, 
swinging, sailing in vessels, etc. In regard to this latter it is a known fact, 
that one gets seasick more readily on the lakes than on the ocean, because 
here the waves are shorter and more irregular than there, causing a much 
more abrupt shaking of the passenger. When the body of a passenger is 
thus suddenly concussed, the blood in the sinuses cannot follow the sudden 
motions of the solid parts of the body in equal tempo; it is caused to vibrate 
a tempo of its owu, and this perturbation or commotion of the blood within 
the sinuses we feel as vertigo, or seasickness. Seasickness, therefore, does 
not abate until a person exposed to being constantly tossed about, becomes 
so thoroughly accustomed to the motions of the ship, that he unconsciously 
anticipates all the pranks which the unruly waves may play, and harmonizes 
his motions with those of the vessel, preventing in this way any further per- 
turbation of the blood within the cerebral sinuses. 



42 BRAIN. 

We have still to consider, however, other cases in which the unwonted 
motion of the blood within the cranial cavity is not so apparent a cause of 
vertigo as in the above mentioned instances. We also see vertigo produced 
under circumstances where such external concussions do not exist, as for in- 
stance by exudations within the brain, by tumors, tubercles, cancer or ather- 
omatous degeneration of the cerebral blood-vessels, by great heat, mephitic 
exhalations, aromatic odors and above all by almost every one of the drugs 
proved, with but few exceptions, for instance, Fluor, ac. Does our view 
hold good even in these cases ? 

In the first place we should say that concussions of the body, swinging, 
sailing, etc., do not produce vertigo in all persons. There must, then, some- 
thing still deeper be considered before we shall be able to fully understand 
the phenomenon of vertigo. And here I must draw attention to the arach- 
noid membrane which envelopes the brain and, like other serous membranes, 
is a shut sac. The functional action of this and all other like membranes 
may, according to C. Hering, be likened to that of a suction-pump. When 
excited it draws a greater amount of blood into the cranial cavity than when 
in a state of relaxation. It is thus one of the principal means by which the 
circulation within the brain is regulated. But its influence extends not 
only over the amount of blood in the brain, it at the same time controls more 
or less also the movement of the blood within the sinuses. The more health- 
ful its action, the more readily it will regulate this flow and check any undue 
commotion, while during a relaxed state the slightest functional or mechanical 
cause may bring on perturbation, and this explains why some persons do not 
feel dizzy from turning, dancing, sailing, etc., when others do. And if we 
farther take into consideration that exudation, tumors, tubercles, etc., in short 
various kinds of morbid processes within the brain, and also numerous drugs 
when taken during a state of health, must necessarily affect the arachnoid, 
either excite or relax its action, we have sufficient reason to assume that in 
either case the regular flow and circulation of the blood through the sinuses 
must also be more or less disturbed, which would account for the feeling of 
vertigo in all such cases. We come thus to the conclusion that vertigo, even 
in those instances where its cause is not so apparent as in cases of external 
concussion, etc., is nevertheless the feeling of an undue commotion of the 
blood within the sinuses, which is produced, or which, at least, is not checked 
by the arachnoid in consequence of its own excitation or relaxation. 

Authors have spoken of hypersemic or congestive, of anaemic, nervous, 
toxic, epileptic, stomachic and psychic vertigo. All these different designa- 
tions have reference to morbid affections with which vertigo is frequently 
associated, or which are the cause of disturbance in the circulation of the 
blood within the brain. 

Vertigo may appear under the most varied conditions : in rest or motion ; 



VERTIGO. 43 

on stooping or rising, or turning the head ; during lying, even in sleep ; from 
dazzling or streaked light; from the quick motion of objects before the eyes, 
in passing a railing or riding in the cars ; by the sight of an unpleasant ob- 
ject — bleeding wound, a surgical operation, etc.; by looking down from a 
height or looking up to a height, and in many more other ways. It is rarely 
observed in children, more frequently in adults and oftenest in old age. 

Its Prognosis depends entirely on the nature of those morbid processes 
with which it is connected. 

THERAPEUTIC HINTS— Aeon., congestive; heat and pain in 
head red face ; nosebleed ; pulsation of carotids. When trying to sit up 
in bed, the patient tumbles over ; he is afraid to rise lest he might fall again ; 
must take hold of something. Stoppage of menstrual flow from cold, fright, 
fear or vexation ; after habitual blood-letting. 

Agar., heaving and whirling of objects around; tendency to fall for- 
ward ; partial amaurotic blindness, with floating muscle and vibrating spectra; 
partial numbness of left side of tongue. Hyperesthesia of smell; unusual 
sensitiveness to cold air ; hysteria and nervousness brought on by exciting 
debate or by protracted mental application; by overexertion of the eyes; by 
strong light of the sun. 

Anac, great forgetfulness ; dim sight; on stooping and rising from 
stooping, he feels as if he were turning to the left. 

Apis, headache; heat in head; red face; nosebleed; pulsation of ca- 
rotids. Worse when sitting than when walking ; extreme when lying down 
and closing the eyes. 

Arg. nitr., chronic, as if everything were turning around; dyspnoea; 
palpitation of the heart; paraiysis of diaphragm; left half of body very 
weak ; left arm or hand heavy and numb ; trembling weakness brought on 
by walking with shut eyes; by walking in streets with high houses, which 
seem to fall upon him: 

Arnica, as if everything were turning around or falling upon him; 
ears feel stopped up when speaking, swallowing or blowing the nose ; better 
in lying, disappearing on stooping; after bodily overexertions or injuries. 
"Vertigo on entering an open place, which makes his motions uncertain." — 
Jousset. 

Ast. rub., single case by Petroz. Man has fits of vertigo, as if the 
head were suddenly concussed; head always hot, face red, pulse hard, con- 
tracted and frequent; obstinate constipation by good appetite; constant con- 
tractions of the muscles of the lower limbs ; gait uncertain, because the 
muscles do not obey the will ; restless and sleepless. 

Arsen., hyperesthesia of hearing; burning in stomach and vomiting; 
malarial with loss of appetite, vomiting and headache; dilatation of right 



44 BRAIN. 

ventricle, emphysema, bronchial catarrh; sleeplessness. During pregnancy, 
with pale, bluish, puffed face, blue lips and nails and undulation of jugular 
veins. 

Aur. mur., hypertrophy of left ventricle, with great congestion towards 
head and face. 

Bellad., acute and chronic; revolving; staggering, reeling, must take 
hold of something; transient unconsciousness; anxiety; shuns people, is 
bashful; head appears double; sees frightful things on shutting the eyes. 
Headache pressing, throbbing; gnawing pain in the bones of the skull, face 
and teeth ; rush of blood to head and face ; sometimes sensation as of icy-cold 
water streaming down from head to face ; flickering and dimness before eyes ; 
hyperesthesia of eyes; enlarged pupils; buzzing in ears, with dulness of 
hearing; nosebleed; pulsation of carotids ; loss of appetite and vomiting; 
stitching pain in chest; slow pulse, weakness and trembling of limbs when 
walking; drowsy in daytime, sleepless at night; hysteria and general nerv- 
ousness ; epileptic vertigo. Worse on rising from lying, sitting or stooping ; 
in standing; after eating. After typhoid fever; taking cold; violent fright ; 
overexertion of the eyes, with muscse volantes; from the smell of flowers, 
gas, etheric oils, turpentine, etc., with stupefaction. Some prefer Atrop. in 
some cases. 

Borax, a feeling as if pushed from right to left and somewhat forward ; 
on descending or being moved downward. 

Bovista, in the morning with loss of consciousness and pressing pain 
in head. 

Byron., like whirling on sitting up, standing and walking; burning in 
stomach and vomiting; distention, passage of offensive flatus and constipa- 
tion; bronchial catarrh; emphysema; dilatation of right ventricle. After 
suppressed haemorrhoids; bodily overexertion. 

Calc. carb., stupefying; epileptic; hyperesthesia of eyes; dimness of 
sight; abdominal congestion, distention, flatus, constipation; amenorrhea, 
which has gradually developed ; climaxis, with flushes of heat and sweat ; 
hypertrophy of left ventricle, with congestion tOAvards head and face ; hypo- 
chondria, hysteria and nervousness ; sleeplessness ; tuberculous disposition ; 
rhachitis; scirrhous tumors. Worse in morning, walking out-doors, espe- 
cially on suddenly turning the head, on stooping and ascending. Brought 
on by mental overexertion ; by reading, fine sewing, etc. ; by sedentary life, 
high living, excess in venere. 

Calc. jod., glandular swellings on neck, goitre. 

Carb. veg., venous stagnation in abdomen, flatus, constipation; from 
sedentary life ; mental exertion ; high living ; spirituous drinks, tea, coffee, 
tobacco, opium. 

Caustic, attacks at 11 o'clock a.m., with stitches in top of head, pain 



VERTIGO. 45 

in back and small of back when rising from a seat ; on looking upwards, in- 
clination to fall towards left side ; on stooping, to fall backward. 

Chamom., fits of anger; congestion in portal system; distention from 
wind. 

China, anaemic from loss of blood or vital fluids ; hysteria and nerv- 
ousness. 

Coccul., intoxication, stupefaction; nausea, pressing and throbbing in 
temples ; alternate going to sleep of either feet or hands ; difficult speech ; 
distention of abdomen from wind ; constipation ; chlorosis. Worse on rising 
and after eating. 

Coffea, hysteria and nervousness; sleeplessness. 

Conium, frequent drowsiness; on bending the head forward, heaviness 
in occiput; dimsightedness ; nosebleed in spring; venous abdominal hyper- 
emia and amenorrhea ; acrid fluor albus ; turbid urine with mucus ; climaxis, 
with flushes of heat and sweat; rhachitis and swelling of lymphatic glands. 

Cyclam., dyspepsia; hyperesthesia of the cutaneous nerves of the ex- 
tremities; hysteria and nervousness. 

Ferrum, anaemic from loss of blood. 

Gelsem., intoxication, confusion, headache; dimness of sight; dilata- 
tion of pupils ; general depression of system from heat. 

Glonoin., congestive; forerunner of apoplexy ; intoxication and heavi- 
ness of head, with bending the head forward ; reeling, trembling, falling ; 
headache; heat in head; redness of face ; photophobia; injection of conjunc- 
tiva; flickering before the eyes; buzzing in the ears; pulsation of carotids. 
Worse on sitting up. 

Graphit., hyperesthesia of eyes; venous stagnation; constipation; in- 
carceration of flatus. From overexertion of the eyes by reading, sewing, etc. 

Hepar, hyperesthesia of smell; decreased peristaltic motion; hard 
feces. 

Hyosc, stupefaction; depressing mental influences; hypochondriacal; 
from the smell of flowers, gas, etheric oils, etc. 

Ignat., epileptic; gastric symptoms; gaping; abdominal congestion; 
flatus; tingling as of ants; jerkings; heaviness of right arm; spinal affection; 
anemia; sleeplessness; hystery and nervousness. Worse from slightest 
motion of head, especially stooping. Brought on by depressing mental in- 
fluences ; fear, anxiety, fright. 

Ipec, malarial headache; loss of appetite and vomiting. In pregnancy, 
with pale, bluish, puffed face, blue lips and nails; undulation of jugular veins. 

Iodum, goitre; hypertrophy of left ventricle, with great congestion 
towards head and face; hysteria and nervousness. 

Kali carb., nausea and vomiting; after eating, with heat in head and 
red face; darkness before the eyes; sometimes one cheek hot, the other cold. 



46 BRAIN. 

Must lie down or he falls down. Before falling stitching pain in forehead, 
root of nose and eyes ; fatty degeneration of heart. 

Kali brom., goitre. 

Kali hydr., glandular swelling on neck; rhachitis. 

Laches., epileptic; can't bear anything coming near him; venous 
stagnation; constipation; flatulency; burning in stomach, vomiting and 
diarrhoea. 

Lycop., head heavy; scathing, roaring and noises in head; fears to 
lose senses; ebullitions from stomach to chest and head; he gets hot, face 
reddens, eyes water and become dim ; constant pain in back and small of 
back; venous stagnation in abdomen ; distention; constipation; incarcerated 
flatus. Worse on stooping; when drinking. 

Mercur., headache, nausea, loss of appetite; in bed and out of bed; 
can't rise and sit up for fear of falling; must lie down; feels like swimming, 
lying in bed. Receded eruption. 

Merc, corr., syphilitic tumors in the brain. 

Merc, jod., syphilitic tumors in the brain. 

Mezer., syphilitic affections of brain. 

Natr. mur., with feeling of fainting; periostitis of skull; dyspepsia; 
abdominal congestion; flatulency; constipation; suppressed hemorrhoidal 
discharge. From sedentary life; depressing mental influences; mental 
exertion; reading, sewing, etc.; high living; spirituous drinks, tea, coffee, 
tobacco, opium. 

Nitr. ac, climaxis; syphilitic taint. 

Nux vom., epileptic; malarial; revolving; sudden, like an electric 
shock ; before vertigo, drawing headache with heat in forehead, yawning. 
Headache, loss of appetite and vomiting ; burning in stomach after eating ; 
dyspepsia; abdominal congestion; flatulency; constipation; hemorrhoids ; 
hysteria and nervousness ; hypochondriacs. Worse after dinner or eating ; 
when stooping and rising ; sometimes at nights, waking out of sleep. Brought 
on by mental exertion or sedentary habits ; high living ; alcoholic drinks ; 
smoking, coffee, opium; from the smell of flowers, gas, etheric oils, etc., 
attended with nausea; suppressed flow of hemorrhoids. 

Opium, stupefaction as after intoxication; drowsiness; red, glossy 
eyes; enlarged pupils; dimness of sight; pale face; decreased peristaltic 
motion, difficult defecation. Worse on sitting up in bed. After fright. 

Phosphor., revolving, as if he would fall; malarial; headache; weight 
and throbbing in forehead on waking; rush of blood to the head; hyper- 
esthesia of smell ; loss of appetite ; nausea, vomiting ; burning in stomach ; 
abdominal congestion with flatulency; during pregnancy pale, bluish, puffed 
face, blue lips and nails, undulation of jugular veins; hypertrophy of left 
ventricle with congestion to head and face ; dilatation of right ventricle ; fatty 



VERTIGO. 47 

degeneration of heart ; emphysema ; bronchial catarrh ; sleeplessness ; atrophy 
of brain in old age; scirrhous tumors; periostitis of skull. Worse morniug 
and evening; after eating; during sitting. Brought on by overexertion of 
the eyes, attended with muscse volantes ; by the smell of flowers, gas, etherial 
oils, turpentine, attended with fainting; by loss of vital fluids. 

Phosph. ac, hypochondriacs after excess in venere ; climaxis with 
flushes of heat and sweat. 

Plat in a, over estimation of self. 

Pulsat., hot head; flickering before eyes; stitch pain in ears and 
tearing in head ; pale face ; painful crawling in stomach ; tearing in limbs ; 
shifting rheumatic pains ; scanty, retarded or suppressed menses ; sleepless- 
ness; chlorosis. Worse when sitting and lying; on getting up from a seat. 
Brought on after anxiety, fear and fright. 

Rhus tox., tipsy feeling ; in aged persons; dilatation of right ventricle; 
emphysema; bronchial catarrh; worse in morning after rising, with uncer- 
tainty in walking, wants to be supported by a cane or another person ; better 
from continued motion ; worse on getting up from lying, on turning, stooping. 
Brought on by bodily overexertion. 

Ruta, overexertion of eyes with muscse volantes; bodily overexertion. 

Sambuc, fatty degeneration of heart. 

Sanguin., vertigo during sleep. 

Sec. corn., hyperesthesia of cutaneous nerves, especially of the spine. 

Sepia, dyspepsia; venous hyperemia in abdomen ; constipation; flatu- 
lency; gradual developing amenorrhcea; hypochondriacs; climaxis with 
flushes of heat and sweat; sleeplessness. Worse when drinking. Brought 
on by mental overexertion ; excess in venere. 

Silic, stupefying; preceded by rush of blood to the head; oppression 
of chest and pit of stomach. Headache; menses too early, too protracted, 
too copious; after menses, fluor albus; venous stagnation in abdomen; con- 
stipation ; incarcerated flatus ; hypochondriacal ; sleeplessness ; tuberculous 
disposition ; rhachitis ; periostitis ; scirrhous tumors. Vertigo during sleep. 
Brought on by overexertion of the eyes from reading, sewing, etc. ; by excess 
in venere. 

Spigel., stumbling and falling as if intoxicated; pressing pain in top 
of head, worse from stooping, walking and talking; better when lying; hy- 
pertrophy of heart ; feeling of fainting. 

Spongia, goitre; hypertrophy of heart. 

Staphis., hypochondriacal; depressing mental influences. 

Stramon., twitching in face; spasm in chest; spasmodic laughing; 
worse at night on lying upon the side. 

Sulphur, constant feeling of wavering in head and body, as if swinging 
and as if the bed were not wide enough to hold him; feeling of tightness in 



48 



BRAIN. 



head, as if bound; dimness of sight; venous stagnation, and feeling of fulness 
in abdomen, constipation, flatulency; suppressed haemorrhoids ; receded or 
suppressed cutaneous eruption ; occasional itching after itch ; periostitis. 

Tart, emet., venous stagnation of abdomen with flatulency; during 
pregnancy pale, bluish, puffed face; blue lips and nails, undulations of 
jugular veins. 

Therid., nausea with vertigo on closing the eyes, worse from noise and 
motion. 

Thuja, epileptic; hair dry and finger-nails ribbed. 

Ver. alb., malarial with headache and loss of appetite; overestimation 
of self; hyperesthesia of hearing ; burning in stomach ; vomiting and diar- 
rhoea; venous stagnation in abdomen with flatulency; during pregnancy 
pale, bluish, puffed face, blue lips and nails, undulation of jugular veins ; 
dilatation of right ventricle ; emphysema ; bronchial catarrh. Brought on 
by spirituous drinks, tea, coffee, tobacco, opium. 

Zincum, in the occiput, with falling to the left when walking. 

Zingib., with heavy limbs. 



Digest to Vertigo. 



CHARACTER. 

Acute and chronic: Bellad. 

Chronic, as if everything were turning 
around: Arg. nitr. 

, as if everything were turning around 

or falling upon him : Arnica. 

Heaving and whirling of objects around : 
Agar. 

As if the head were suddenly concussed : 
Ast. rub. 

pushed from right to left and some- 
what forward : Borax. 

Like swinging, lying in bed : Mercur. 

Wavering in head and body as if swing- 
ing, and as if the bed were not wide 
enough to hold him : Sulphur. 

Like -whirling on sitting up, standing 
and walking : Brywi. 

Sudden, like an electric shock: Nux vom. 

Anaemic : China, Ferrum, Ignat. 

Congestive: Aeon., Glonoin. 

Epileptic: Bellad., Calc. carb., Ignat., 
Laches., Nux vom., Thuja. 

Forerunner of apoplexy: Glonoin. 

Malarial: Nux vom., Phosphor., Ver. alb. 



Malarial, with loss of appetite, vomiting 
and headache : Arsen. 

, sometimes at night, waking out of 

sleep : Nux vom. 

During sleep: Sanguin., Silic. 

In occiput, with falling to the left when 
walking: Zincum. 

Revolving: Bellad., Nux vom. 

, as if he would fall: Phosphor. 

Staggering, reeling, must take hold of 
something: Aeon., Bellad. 

Reeling, trembling, falling : Glonoin. 

Stumbling and falling, as if intoxicated : 
Spigel. 

Tendency to fall forward: Agar. 

Uncertainty in walking, wants to be sup- 
ported by a cane or another person: 
Rhus tox. 

When trying to sit up in bed, the pa- 
tient tumbles over ; he is afraid to rise 
lest he might fall again : Aeon. 

Can't rise and sit up for fear of falling; 
must lie down : Mercur. 

Must lie down, or he falls down: Kali 
carb. 



DIGEST TO VERTIGO. 



49 



Stupefying: Calc. carb., Silic. 
Tipsy feeling: Rhus tox. 

PRECEDED BY: 

Drawing headache with heat in the fore- 
head : Nvx vom. 
Rush of blood to the head: Silic. 

ATTENDED BY: 

Transient unconsciousness: Bellad. 
Loss of consciousness and pressing pain 

in head in the morning : Bovista. 
Feeling of fainting: Natr. mur., Spigel. 
Great forgetfulness: Anac. 
Sees frightful things on shutting eves: 

Bellad. 
Intoxication: CoccuL, Gelsem. 
and heaviness of head with bending 

the head forward: Glonoin. 
Confusion: Gelsem. 
Stupefaction: CoccuL, Hyosc. 

as after intoxication: Opium. 

Shuns people, is bashful: Bellad. 
Can't bear anything coming near him: 

Laches. 
Fears to lose senses : Lycop. 
Anxiety: Bellad. 
Fits of anger : Chamom. 
Overestimation of self: Platina, Ver. alb. 



Headache: Apis, GeUem., Glonoin., Nux 

vom., Phosphor., Silic. 

, malarial: Ipec. 

, pressing, throbbing: Bellad. 

,' nausea, loss of appetite: Mercur. 

Head appears double: Bellad. 
Sometimes sensation as of icy-cold water 

streaming down from head to face: 

Bellad. 
Congestion towards head and face: 

Iodum. 
Rush of blood to head and face: Bellad., 

Phosphor. 
Heat in head: Apis, Glonoin. 

and pain in head : Aeon. 

Hot head : Pulsat. 

, and face red : Ast. rvti. 

Scathing, roaring and noises in head: 

Lycop. 
4 



Pressing pain in top of head, worse from 

stooping, walking and talking: Spigel. 
Stitches in top of head, pain in back and 

small of back when rising from a seat: 

Caustic. 
Stitching pain in forehead, root of nose 

and eyes, before falling: Kali carb. 
Tearing in head: Pulsat. 
Feeling of tightness in head, as if bound: 

Sulphur. 
Heaviness in occiput, on bending the 

head forward: Conium. 
Head heavy: Lycop. 
Weight and throbbing in forehead on 

waking : Phosphor. 
Syphilitic tumors in head: Merc, corr., 

Merc. jod. 

affections of brain : Mezer. 

Atrophy of brain in old age : Phosphor. 



Injection of conjunctiva: Glonoin. 
Dilatation of pupils: Bellad., Gelsem., 

Opium. 
Red, glossy eyes: Opium. 
Partial amaurotic blindness, with floating 

niuscse and vibrating spectra: Agar. 
Hypereesthesia of eyes: Bellad., Calc. 

carb., Graphit. 
Photophobia: Glonoin. 
Dim sight : Anac., Calc. carb., Conium, 

Gelsem., Opium, Sulphur. 
Darkness before the eyes : Kali carb. 
Flickering before the eyes: Glonoin., 

Pulsat. 
and dimness before eves : Bellad. 



Ears, stitch pain in : Pulsat. 

, feel stopped up when speaking, 

swallowing or blowing the nose: Arnica. 

, buzzing: Glonoin. 

, with dulness of hearing: Bellad. 

Hyperaesthesia of hearing: Arsen., Ver. 

alb. . 

Nosebleed: Aeon., Apis, Bellad. 

in spring: Conium. 

Hyperaesthesia of smell : Agar., Hepar, 

Phosphor. 
Sometimes one cheek hot, the other 

cold : Kali carb. 



50 



BRAIN. 



Face pale : Opium, Puhat. 

red: Aeon., Apis, Glonoin. 

Twitching in face: Stramon. 



Partial numbness of left side of tongue: 

Agar. 
Difficult speech : Coccul. 
Goitre: Calc.jod., Iodum, Kali brom., Kali 

hydro]., Spongia. 
and glandular swellings on neck: 

Cole, jod., Kali hydrojod. 



Stitching pain in chest: Bellad. 

Bronchial catarrh : Arsen., Bryon., Phos- 
phor., Rhus tox., Veratr. 

Oppression of chest and pit of stomach: 
Silic. 

Dyspnoea: Arg. nitr. 

Spasm in chest: Stramon. 

Emphysema: Arsen., Bryon., Phosphor., 
Rhus tox., Veratr. 

Tuberculous disposition : Calc. carb., Silic. 

Hypertrophy of heart: Spigel., Spongia. 

of left ventricle : Calc. carb. 

, with great congestion towards 

head and face: Aur. mar., Iodum, Phos- 
phor. 

Dilatation of right ventricle: Arsen., 
Bryon., Phosphor., Rhus tox. 

Fatty degeneration of heart: Kali carb., 
Phosphor., Sambuc. 

Palpitation of heart : Arg. nitr. 

Pulsation of carotids: Apis, Bellad., 
Glonoin. 

Undulation of jugular veins: Arsen., 
Ipec., Phosphor., Tart, emet., Ver. alb. 

Pulse hard, contracted and frequent: Ast. 
rub. 

slow : Bellad. 



Gastric symptoms : Ignai. 

Dyspepsia: Cyclam., Natr. mur., Nux vom , 
Sepia. 

Loss of appetite: Phosphor. 

with headache: Ver. alb. 

and vomiting: Bellad., Ipec, Nux 

vom. 

Nausea and vomiting: Kali carb., Phos- 
phor. 



Nausea, with pressing and throbbing in 

temples: Coccul. 
Vomiting and diarrhoea: Ver. alb. 
Burning in the stomach: Phosphor., Ver. 

alb. 

after eating : Nux vom. 

and vomiting : Arsen., Bryon. 

and diarrhoea: Laches. 

Painful crawling in stomach : Pulsat. 
Ebullitions from stomach to chest and 

head; he gets hot, face reddens, eyes 

water and become dim : Lycop. 
Paralysis of diaphragm : Arg. nitr. 



Congestion in portal system: Chamom. 
Abdominal congestion: Ignat., Natr. mur., 

Nux vom. 

with flatulency : Phosphor. 

, distention, flatus, constipation: Calc. 

carb. 
Venous stagnation : Graphit., Laches., 

Lycop., Sepia, Ver. alb. 
, and feeling of fulness in abdomen: 

Sulphur. 

with flatulency: Tart. emet. 

, flatus, constipation : Carb. veg., Silic. 

and amenorrhcea: Conium. 

Distention: Lycop. 

from wind : Chamom., Coccul. 

, passage of offensive flatus: Bryon. 

Flatulency : Ignat., Natr. mur., Nux vom., 

Sepia, Ver. alb. 
Incarceration of flatus: Graphit., Lycop., 

Silic. 

and constipation: Bryon. 

Constipation: Coccul., Graphit, Lycop., 

Natr. mur., Nux vom., Sepia. 

, flatulency: Laches., Sulphur. 

Obstinate constipation by good appetite : 

Ast. rub. 
Decreased peristaltic motion: Hepar. 

and difficult defecation : Opium. 

Hard feces : Hepar. 
Haemorrhoids: Nux vom. 
Turbid urine with mucus : Conium. 



Menses too early, too protracted, too co- 
pious: Silic. 
scanty, retarded or suppressed : Pulsat. 



DIGEST TO VERTIGO. 



51 



Amenorrhcea, which has gradually de- 
veloped: Cede, curb., Sepia. 

After menses, fluor albus : Silic. 

Acrid fluor albus: Conium. 

Syphilitic taint : Nitr. etc. 

During pregnancy, with pale face, bluish 
puffed face, blue lips and nails and un- 
dulation of jugular veins : Arsen., Ipec, 
Phosphor., Teirt. emet., Verei.tr. 

Climaxis : Xitr. ac 

with flushes of heat and sweat : Cede. 

carb., Conium, Letches., Phosph. etc., Sepia. 



Spinal affection: Ignat. 

Constant pain in back and small of back : 

Lycop. 
Tearing in limbs : Pulsed. 
Shifting rheumatic pains: Pulsed. 
Alternate going to sleep of either feet or 

hands: Coecul. 
Hyperaesthesia of the cutaneous nerves 

of extremities : Cyclam. 
Left half of body very "weak: Arg. nitr. 
"Weakness and trembling of limbs when 

walking: Bellad. 
Trembling weakness brought on by walk- 
ing with shut eyes: Arg. nitr. 
Heavy limbs : Zingib. 
Heaviness of right arm : Ignat 
Left arm or hand heavy and numb: Arg. 

nitr. 
Constant contractions of the muscles of 

the lower limbs: Ast. rub. 
Gait uncertain, because the muscles do not 

obey the will: Ast. rub. 
Periostitis: Silic, Sulp>hur. 

of skull: Xei.tr. mur., Phosphor. 

Gnawing pain in the bonea of the skull, 

face and teeth : Bettad. 
Rhachitis : Cede, carb., Kedi hyelr., Silic. 

and swelling of lymphatic glands: 

Conium. 



Hypochondriasis: Cede, carb., Byosc, 
Nux com., Sepia, Silic, Staph is. 

Hysteria and nervousness: Ageir., Bellad., 
Cede, carb., China, Coffeet, Cyclam., Igned., 
Jodum, Nux vom. 

Jerkings: Ignat. 



Spasmodic laughing: Stramon. 
General depression of system from heat 

Gelsem. 
Anaemia: China, Ferrv.m, Ignat. 
Chlorosis: CoccuL, Pulsed. 



Gaping: Ignat. 

Yawning: Nux vom. 

Drowsiness: Conium, Opium. 

in daytime, sleepless at night : Bellad., 

Sulphur. 
Sleeplessness : Arsen., Cede carb., Igneit, 

Phosphor., Pulsat., Sepia, Silic. 
and restless: Ast. rub. 



Hyperaesthesia of cutaneous nerves, es- 
pecially of the spine: Sec corn. 

Unusual sensitiveness to cold air: Agar. 

Tingling as of ants: Igned. 

Occasional itching after itch: Sulphur. 

Hair dry and finger nails ribbed: Thuja. 

Scirrhous tumors : Cede, carb., Phosphor,, 
Silic 

AGGRAVATED: 

In bed and out of bed: Mercur. 

On closing the eyes: Therid. 

On descending or being moved down- 
ward: Borax. 

When drinking : Lycop., Sepia. 

After dinner or eating: Bellad., Nux vom. 

heat in head, red face : Kedi carb. 

On entering an open place which makes 
his motions uncertain: Arnica. 

On rising: Aeon., Kedi carb., Jlercur. 

On getting up from a seat : Pidsat. 

from lying, on turning, stooping: 

Rhus tox. 

On looking upwards, inclination to fall 
towards left side: Caustic. 

When lying down and closing the eyes: 
Apis, Therid. 

At night on lying upon the side: Stramon. 

Morning and evening: Phosphor. 

Attacks at 11 o'clock a.m.: Caustic 

In morning, in walking out-doors: Cede 
carb. 

From slightest motion of head, especi- 
ally stooping: Ignat. 



52 



BRAIN. 



From noise and motion : Therid. 

On rising from lying, sitting or stooping: 

Bellad., Pulsat. 

and after eating : Coccul. 

On sitting up in bed: Aeon., Mercur., 

Opium. 
On sitting up: Glonoin. 
After rising in morning: Rhus tox. 
When sitting and lying: Pulsed. 

more than when walking: Apis. 

In standing: Bellad. 
On stooping: Lycop. 

to fall backward : Caustic. 

and ascending: Gale. carb. 

— — and rising from stooping, he feels as 

if he were turning to the left: Anac. 
Stooping and rising : Nux vom. 
On suddenly turning head: Calc. carb. 
By -walking in streets with high houses, 

which seem to fall upon him : Arg. nitr. 

AMELIORATED: 

After eating : Phosphor. 

When lying: Spigel. 

In lying, disappearing on stooping : Arnica. 

From continued motion: Rhus tox. 

During sitting : Phosphor. 

CAUSED BY: 
Old age : Rhus tox. 
Habitual blood spitting : Aeon. 
Loss of blood or vital fluids : China, Ferrum, 

Phosphor. 
Depressing mental influences: Hyosc., 

Ignat., Natr. mur., Spigel., Staphis. 
Fear, anxiety, fright: Ignat., Pulsat. 
Fright: Bellad,, Opium. 



Mental exertion: Carb. veg., Calc. carb., 

Natr. mur., Nux vom., Sepia. 
Exciting debate or by protracted mental 

applications : Agar. 
Overexertion of the eyes, attended with 

muscse volantes: Bellad., Phosphor., 

Ruta. 

strong light of the sun: Agar. 

reading, fine sewing, etc. : Calc. carb., 

Graphit., Silic. 
Bodily overexertion or injuries: Arnica. 

overexertion : Bryon., Rhus tox., Ruta,. 

Excess in venere : Calc. carb., Sepia, Silic. 
Hypochondriacs after excess in venere: 

Phosph. ac. 
Receded eruption: Mercur. 

or suppressed eruption : Sulphur. 

Suppressed haemorrhoids: Bryon,, Natr. 

mur., Nux vom., Sulphur. 
Stoppage of menstrual flow from cold, 

fright, fear or vexation : Aeon. 
High living: Calc. carb., Carb. veg., Natr. 

mur., Nux vom. 
Sedentary life: Calc. carb., Carb. 

Natr. mur., Nux vom. 
Smell of flowers, gas ; etheric oils, 

Hyosc, 

with stupefaction: Bellad, 

with nausea: Nux vom. 

with fainting: Phosphor. 

Spirituous drinks, tea, coffee, tobacco, 

opium : Carb. veg., Natr. mur., Nux vom., 

Ver. alb. 
Smoking : Nux vom. 
After taking cold : Bellad. 
typhoid fever: Bellad, 



veg. 



etc. 



The following scheme was prepared by Kafka relating to nervous 
vertigo : 

Vertigo in the morning: Calc. carb., Nux vom., Phosphor., Rhus tox., Natr. 
mur. 

in the evening: Bellad., Pulsat., Cyclam., Sepia, Zincum, Laches. 

when lying down : Pulsat., Cyclam., Arsen., Aurum. 

when rising: Nux vom., Rhus tox., Coccul., Laches., Conium. 

when walking : Pulsat., Lycop., Conium, Capsic, Phosphor. 

when stooping: Calc. carb., Bryon., Sepia, Spigel. 

with an empty stomach : Phosphor., Iodum., Calc. carb., China. 



VERTIGO. 53 

Vertigo after eating: Calc. carb., Nux vom., Natr. rnur., Phosphor., Lycop., 

Sepia. 

after sleeping: Phosphor., Sepia, Nux vom. 

in the fresh air: Nux vom., Silic, Coccul. 

in the room: Silic., Agar., Arsen., Pulsat. 

before the menses: Calc. carb., Pulsat., Sepia, Ver. alb. 

during the menses: Phosphor., Hyosc, Graphit., Lycop. 

after the menses: Nux vom., Phosphor., Graphit. 

Amelioration by motion: Rhus tox., Pulsat., Capsic, Cyclam., Lycop. 

by rest: Nux vom., Natr. mur., Bellacl., Colchic. 

Revolving vertigo: Phosphor., Js T ux vom., Bryon., Arnica. 

Stupefying vertigo: Calc. carb., Silic, Bellad., Hyosc. 

Staggering vertigo: Aeon., Rhus tox., Nux vom., Platiua. 

Vertigo with trembling and uneasiness: Phosphor., Calc. carb., Ignat., 

Arsen. 

with fainting: Phosphor., Nux vom., Natr. mur., Arsen., China. 

with vomiting: Nux vom., Ipec, Ver. alb., Arsen., Pulsat. 

Vertigo with inclination of falling forward: Phosph. ac, Graphit., Cicut. 

vir., Spigel. 
with inclination of falling backward: Rhus tox., Nux vom., Bryon., 

China. 
with inclination of falling sideways : Silic, Sulphur, Ipec. 



Seasickness. — Even here w T e have to study the peculiarities of the 
single case. 

Apomorphia, nausea without any apparent signs of gastricism. Dr. 
Skinner gave it with success. 

Borax, perhaps never given, should be tried on account of its symp- 
toms of aggravation on downward motion. 

Calc. carb. may be indicated by its aggravation on upward motion. 

Coccul. is perhaps the oldest remedy recommended in seasickness. 
Nausea with tendency to faint. 

Colchic, excessive sensitiveness of smell against cooking. 

Nux vom., headache; gastric symptoms ; constipation. 

Opium, great sleepiness; constipation. 

Sepia, headache; desire for sour and refreshing things. 

Petrol, has proved beneficial very often. 

Pulsat., drowsy, thirstless; dizzy, especially on getting up from a seat; 
feels better on deck. 

Some persons are greatly benefited by applying a piece of blotting paper, 
soaked in rum or brandy, upon the pit of the stomach. 



54 BRAIN. 

In all cases it will be well to exert the will-power in order to gain com- 
mand over the body against the motions of the vessel and to harmonize its 
motions with that of the ship. 

Sleep, Stupor, Insomnia. 

The fluids and tissues of the body are constantly undergoing change by 
the ceaseless activity of its various parts as an organized entity. Every 
voluntary or involuntary motion of the muscles, the action of the different 
glands, the working of the entire nervous system is attended with a continu- 
ous retrograde metamorphosis of constituent elements. All this must, at cer- 
tain periods, inevitably result in exhaustion. The consequent necessity for 
reparation of the lost elements manifests itself in active assimilation of new 
material from what has been prepared by digestion ; in other words, the con- 
scious activity of the cerebro-spinal system gives way to the unconscious ac- 
tivity of the sympathetic system — we fall asleep. Sleep, therefore, in its real 
nature consists in the predominant activity of the sympathetic system over 
that of the cerebro-spinal. For this reason, we find during sleep, as Durham 
in his "Physiology of Sleep" observes, "a notable increase of blood in the 
stomach and other abdominal viscera," which is drawn there by the increased 
action of the assimilating system ; for wherever there is greater activity there 
is a greater afflux of blood. But this heightened action of the assimilating 
system has also another effect ; it subdues all other activities. Mentally we 
become unconscious, partly from actual want of exciting elements which have 
been consumed during waking life, and partly from the withdrawal of ex- 
citing elements by the increased action of the assimilating organs ; we find, 
therefore, physiologically corresponding, less blood in the brain, as has been 
demonstrated by Durham, Hammond, and others. Bodily our voluntary 
muscles subside into inactivity, and the amount of work done by the excre- 
tory organs is equally lessened; we find physiologically corresponding respi- 
ration as well as circulation decidedly slower than during waking life. 

All this is the necessary consequence of the increased action of the 
assimilating system. For it is impossible that all our activities could be ex- 
cited at the same time in an equal degree. We see this clearly portrayed in 
the action of our mental life. Even during our waking periods conscious ex- 
citement belongs only to a very small portion of what we mentally possess ; 
the bulk of our possessions lies dormant. Consciousness shifts from one men- 
tal modification to another, sometimes swiftly, even tumultuously; or only 
slowly or evenly, but always involving only parts and portions of our entire 
mental acquisitions. The same holds good when we consider man mentally 
and physically as one whole. During the predominant activity of his cere- 
bro-spinal system, the sympathetic system is in comparative rest, while the 






55 

latter subdues the former, wheu the primary forces have beeu consumed and 
a new supply has to be prepared by its action. How great the force is with 
which the assimilating process assumes its ruling, we all have repeatedly ex- 
perienced ; the eyelids droop, the sounds grow indistinct and irresistibly we 
fall asleep. The restitution of vital forces must be done, and during that 
process all other activities must partially or totally cease. It is erroneous, 
therefore, to say that "the state of comparative repose which attends upon 
this condition (sleep) allows the balance to be restored" (Hammond), since 
in fact this restitution, or more definitely expressed, the assimilating process 
does not allow the accustomed action of the mind, brain and other organs. 
Unconsciousness, partial or total, is a necessary concomitant of sleep, not its 
essential nature, just as the comparative repose of the voluntary muscle and 
excretory organs is the natural consequence of the heightened activity of the 
assimilating system. As long as either reigns, the other must be silent. And 
as an increased activity always causes an increased circulation, and vice versa, 
it is erroneous to say that the loss of consciousness, total or partial, during 
sleep be due to the lessened circulation of blood within the brain, since in 
fact the comparative inability of the mind (unconsciousness) and the conse- 
quent inactivity of the brain as its condition, is the cause of this lessened cir- 
culation. Being not needed in the brain and all other organs which are 
under the control of the cerebro-spinal system, the circulation slackens here 
and increases where a heightened activity calls for it, i. e., in the assimilating 
system. 

PJayfair thinks that sleep is due to "a diminished supply of oxygen to 
the brain" (^Northern Journal of Medicine, ~No. 1, 1844, p. 34; see Hammond 
on Sleep, p. 30); and Preyer holds the opinion "that the oxygen during 
sleep is used up in a different manner than in the waking state. During 
exercise of the brain as well as of the muscles, a kind of peculiar material, 
so-called 'material from weariness ' forms, which accumulates in quantities 
corresponding to the intensity of the activity, is very oxidable, and which 
lays hold of the oxygen during sleep, and thus becomes oxidized " ( Wiener 
Freie Presse, Sept., 1876; North Am. Journal, Feb., 1877, p. 349). These 
views are just as valuable and correct as the idea of a diminished circulation 
of blood in the brain during sleep. For oxygen is certainly a necessary con- 
stituent to healthy blood and of the consequent activity of any kind. But 
when, according to Pettenkofer's experiments, the system accumulates during 
sleep much more oxygen than during its waking state, one cannot clearly see 
why an increasing acquisition of oxygen should just induce sleep, which is 
supposed to be due to a diminished supply of oxygen. Here as elsewhere 
again a condition is taken for the cause. The cause lies in the heightened 
action of the assimilating system, which again replenishes what during the 
activity of the cerebro-spinal is needed and consumed. 



56 BRAIN. 

It will not do, to oppose this truth by reminding of the fact that an ar- 
tificial interruption or suppression of the circulation within the cranium by 
compressing the carotids will cause unconsciousness; for we have never 
stated that healthful circulation of the blood be not required for the func- 
tional activity of the brain, nor that a healthy brain be not a necessary con- 
dition for the legitimate exercise of the mind. A certain amount of healthy 
blood within the brain is a necessary condition for its successful operation, 
but is a condition the cause? Still, if it might be allowed to say that a cer- 
tain amount of opium, chloral, carbonic oxide, etc., causes stupor (uncon- 
sciousness), why should we not likewise consider the lessened circulation of 
blood during sleep as the cause of its attending unconsciousness? Because 
thereby we would not at all explain the lessened afflux of blood to the brain, 
and the question would still remain : What lessens the circulation in the 
brain during sleep? And we have stated the cause : it is the reduced activity 
of the brain in consequence of the heightened activity of the assimilating sys- 
tem. Wave-like do these activities interchange, like ebb and flood, and 
where the one is in the ascendency, the other must go down. The necessity 
of each regulates their periodicity. In the new-born child the vegetative 
sphere is yet so predominant, that in the first six weeks, if well, the child 
sleeps all the time with but short interruptions. Gradually, however, as its 
mentality widens, sleep becomes shorter, until it is reduced to a certain space 
of time necessary for the assimilation of new forces required for action of the 
cerebro-spinal system. Worriment of mind, great passions, etc., may banish 
sleep for a considerable length of time, that is, may subdue by its strength 
the activity of the vegetative system, but not without an adequate cost to the 
whole organism, and yet finally even the strongest passion will have to yield 
to the still greater power of recuperating necessity. 

Stupor, Coma, or whatever a state of unconsciousness, resembling deep 
sleep, may be called, is no sleep. It is caused by a violent interference with 
the conditions necessary for a normal action of the brain. Such Causes 
are various remedial agents, like opium, chloral, carbonic oxide, alcohol and 
others, which vitiate the blood ; or different blood-poisoning diseases, like 
typhus, scarlatina, ursemia and others; or haemorrhage within the brain 
(apoplexy), which compresses the organ so as to make it unfit for a success- 
ful operation of the mind. Sleep and stupor differ, therefore, in this that 
the first is the natural consequence of the predominating activity of the 
assimilating system, while the latter is induced by a direct violence to the 
brain ; there health, here disease is represented. 

The approach of sleep is favored by everything which either depresses 
mental life (cuts off the supply of exciting elements, especially fatiguing 
mental toil, and also listless reverie, want of external excitement), or which 
gives increased impetus to the bodily act of assimilation, such as super- 



SLEEP, STUPOR, INSOMNIA. 57 

abundance of food, hot drinks, great bodily exhaustion, loss of blood, etc. 
Excessive cold does not produce sleep, but stupor, like excessive heat. In 
both cases the effect is congestion towards the brain, which renders this organ 
unfit for the successful exercise of mental action. 

If on the contrary by excessive mental strain, as w T e find it not unfre- 
quently with business men, too eager students, or after great trials, sorrow, 
anxiety, night-watching, etc.— the assimilating process has been unduly 
restricted for a greater length of time— Sleeplessness ( Insomnia) is the 
natural result. Mental and consequently cerebral activity so overbalances 
the process of appropriation, that the assimilating system at last becomes 
weakened, and losing its connative force, leaves the work undone which it is 
destined to do. This necessarily must prove destructive to the entire or- 
ganism, and cause bodily an overwrought condition of the brain (relaxed 
and enlarged blood-vessels), while the mental activities gradually confine 
themselves to fixed ideas or uncontrollable combinations, until at last but an 
insane wreck of a formerly well-balanced constitution is left. 

But there are also a number of Bodily Causes which induce sleepless- 
ness ; they all may be summed up under the one head : Whatever interferes 
with the ptrocess of assimilation. The number of such disorders is large, and 
their pathological specification will appear in the course of this work. In 
general most fevers have this effect, and among the daily used beverages, 
coffee and tea are the most prominent, as they retard, according to physio- 
logical experiments, the process of waste and repair in the tissues. 

THERAPEUTIC HINTS —It is one of the most favorable signs 
when soon after the administration of a remedy, a natural sleep ensues. By 
no means ought such sleep to be interrupted. While it lasts, nature re- 
plenishes and rebuilds what has been spent. It does more good then a repeti- 
tion of medicine, by which indeed the first beneficial effect might be destroyed ; 
the remedy which induces it will quietly work on for the benefit of the 
patient ; it is the remedy. This rule applies only to natural sleep. In case of 
Drowsiness, Stupor, etc., medicine must be repeated just because of this 
state, and it may be one of the leading symptoms for the selection of the 
remedy. 

Apis, sopor with piercing shrieks; meningitis. 

Bellad., heavy sleep with frequent starting, or snoring, screaming or 
singing; with eyes half open; always attended with fever; skin may be dry, 
but is mostly perspiring; face may be flushed, but is often pale. Many 
febrile diseases. Dentition. 

Bryon., drowsy sleep with starting and crying; with chewing and 
swallowiug. Head hot; children cry when taken up or being moved 
Men in seal irritation. 



58 BRAIN. 

Chamom., starting, moaning, screaming, talking, weeping during 
sleep ; mouth open ; face occasionally distorted by convulsive motions ; head 
perspires a great deal. Dentition. 

Laches., great drowsiness attending many complaints; feels bad or 
worse after sleep ; starts when at the point of falling asleep and moans dur- 
ing sleep. 

Lycop., very sleepy during the day with unsuccessful yawning; start- 
ing and jerking of the limbs during sleep ; sudden loud screams daring sleep; 
waking with a peevish mood, scolding, screaming, ugly demeanor, nervous 
irritation. Fevers. 

Nux mosch., unconquerable drowsiness; falls asleep whenever sitting 
down to rest. Long spells of somnolence. Tongue often dry without any 
thirst. In company with many complaints. 

Opium, stupor; snoring; eyes half closed; mouth open. 

Phosph. ac, being roused, answers correctly but goes to sleep again 
at once; typhoid. 

Pulsat., very sleepy with various symptoms of head, stomach and 
bowels. 

Rhus tox., drowsy sleep with murmuring and talking; typhoid. 

Insomnia. 

Aeon., fever-heat, dry skin; tossing about; lamenting; great pain with 
inflammatory processes in teeth, chest, bowels, during menstrual period; 
after fright, fever. 

Bellad., drowsy and yet unable to sleep; anguish; visions; large pu- 
pils ; congestion towards the hgad ; after morphium. 

China, ideas crowd upon the mind; after loss of blood and weakening 
diseases. 

Coffea, nervous excitement; wide awake; not the slightest inclination 
to sleep; after great mental strain, joy, night- watching, acute diseases; den- 
tal irritation. 

Hyosc., drowsy or sleepless; wild expression; delirious; after chloro- 
form. 

Ignat., after grief and depressing emotions; after overstraining the 
mind by racking business. 

Moschus, hysterical sleeplessness; after chloral. 

Nux vom., after mental strain till late at night; abuse of coffee, wine, 
liquor, opium, tobacco. 

Opium, excessive wakefulness, or drowsiness with inability to go to 
sleep. 

Pulsat., indigestion; after quinine, ferrum and strychnine, tea, chloral. 



MENINGITIS. 59 

Sulphur, very important with many and different symptoms; sleepy 
in daytime ; sleepless at night. 

These are the main remedies, of which one or the other may be indicated 
when drowsiness or sleeplessness is one of the leading symptoms of the case. 
However, there are a number of cases where these symptoms, although promi- 
nent and distressing, may entirely lose their rank as guiding symptoms, and 
none of them indeed would prove satisfactory. Then we have to choose our 
remedy irrespectively of these symptoms, which will disappear as soon as the 
main string is touched. For such cases, of course, special therapeutic hints 
cannot be given a priori. 

Meningitis tuberculosa, Hydrocephalus acutus, 

Is in its nature an inflammatory affection of the pia mater, dependent upon 
the development of miliary tubercles. In this it differs from all other menin- 
geal affections. 

The miliary granulations are always found in the immediate neighbor- 
hood of vessels, sometimes especially of those at the convexity, sometimes of 
those at the base ; frequently at the arteries given off from the circle of Wil- 
lis ; they may be spread over large surfaces, or they may be confined to only 
particular portions of the pia. Their number likewise varies as their dis- 
tribution, and so do their stages of development ; they grow in crops. The 
pia shows frequently, especially at the base, yellowish cloudy patches along 
the vessels and swelling of its tissues ; the ventricles are dilated and contain 
hydrocephalic effusion. The quantity of this effusion, however, varies greatly, 
and in many cases is entirely absent- The brain in some cases shows white 
softening, either of only a portion of the fornix and the corpus callosum, or 
of larger portions of its tissue lying upwards and contiguous to these parts. 
In other cases this softening is entirely wanting. The cortex and neighbor- 
ing white substance is in many cases anaemic and of a dry condition, most 
probably a result from the pressure of the hydrocephalic effusion within the 
ventricles. Miliary tubercles are found almost in all other organs of the 
body. It seems then, that scrofulosis as the main spring of tuberculosis, is 
also the main cause of this disease. May it be latent or apparent it always 
has a tendency to bring inflammatory exudations to a cheesy degeneration, 
and when present, irritation of almost any kind: whooping-cough, pneumo- 
nia, measles, and other eruptive diseases, or bronchial or intestinal catarrhs, 
dentition, colds, traumatic lesions of the bones, or periosteum of the joints, 
suppressed eruptions of the head, may lead to that same end. 

The sex attacked most frequently is that of the males; the age that be- 
tween one and six years ; from seven to ten years we find it less often, still 
le.ss from ten to sixteen, and rarely afterwards. 



60 BRAIN. 

The Symptoms may develop slowly or rapidly. It seems that a crop of 
tubercles may be endured without causing marked disturbances ; it is only 
when by some exciting cause an irritation is set up that the disease develops. 
The commencement may manifest itself in a mere indisposition, a change of 
mood, with frequent short naps full of dreams and starting ; loss of appetite ; 
irregularities of the bowels ; febrile conditions towards evening, headache and 
giddiness. This undefined state may last a week and longer. Where there 
is already a developed pulmonary tuberculosis, the superadded meningitis 
may not be suspected until suddenly facial paralysis, loss of consciousness 
and vomiting set in. 

As the inflammation progresses, we find headache ; vertigo ; great sensi- 
tiveness to light and noise ; vomiting of anything taken, or especially when 
being moved ; coming at intervals and disappearing after some time ; consti- 
pation usually, but diarrhoea sometimes to the end. If partial or general con- 
vulsions set in, we have: tremor of the eyeballs; squinting; distortions of the 
face; stiffness of the muscles of the nape of the neck and back; retraction of 
the abdominal muscles, so that the belly looks like a tray or boat. There 
may also be paralysis of the face ; paralysis of the eyelids ; one pupil may be 
larger than the other. The fever rises with evening exacerbations up to 
102.2° or 103° F. The skin is in some cases easily reddened by slight press- 
ure or scratching. And as the internal pressure in consequence of exudation 
increases, the mind becomes clouded ; the patient is drowsy, even comatose. 
We occasionally hear a peculiar piercing shriek which, if heard once, is 
scarcely ever forgotten. Convulsive movements become more frequent, such 
as distortions of the face ; squinting ; chewing ; winking the lids ; grinding of 
the teeth. Paralysis of the one or the other extremity also sets in, while the 
other may still keep up convulsive motions; there may be paraplegia; there 
may be paralysis of the tongue and deglutory muscles. The pulse at this 
stage falls down to sixty and lower, but is easily excited to a hundred and 
over by any exertion; the temperature remains the same or sinks to about 
100° F., although the pulse may have risen from any exertion to 120 or 140. 
Now the fontanelle in children commences to bulge ; the coma increases ; con- 
vulsions and paralysis continue; the pulse rises again to 120 or 140; the 
respiration is irregular ; sometimes the breathing seems to cease altogether, 
followed by a deep, long, sighing respiration. The face frequently changes 
color, now pale, and again red, and sometimes one side is pale and the other 
red. Or red spots appear on the face, coming and going. The blood-vessels 
of the eyes become injected, especially those of the inner canthi. This condi- 
tion of things may last several days. When, however, the skin gets dripping 
with perspiration ; when the abdomen becomes bloated ; when stool and urine 
pass off involuntarily ; when the anterior fontanelle suddenly sinks in, and we 
hear the ominous rattling in the chest, then the scene will be closed within a 
few hours. 



MENINGITIS. 61 

The Prognosis is bad. Is the disease always fatal ? Because there are 
no infallible means to distinguish during life between it and simple meningi- 
tis, those cases which have recovered and were claimed to be tubercular men- 
ingitis are simply set down as errors in the diagnosis ; the real proof — post- 
mortem — is wanting, and therefore, as, in all cases which came under the 
hands of these physicians, the post-mortem proved their diagnosis correct, 
they concluded that all the other cases must likewise be fatal. Against this 
conclusion I allow myself modestly to protest. Might not a different treat- 
ment prevent post-mortem examinations? And are all tubercular affections 
necessarily fatal ? I have lost cases of tubercular meningitis, to be sure, but 
I do believe that I also as well as others have cured some of them. The 
prognosis is bad, that is true. I shall defer therapeutic hints until I have 
spoken of other forms of meningitis. 

Leptomeningitis Infantum; Hydrocephalus Acutus sine Tu- 
berculis; Simple Meningitis. 

Like tubercular meningitis this affection is considered an inflammatory 
process of the pia, although on post-mortem no inflammatory signs, not even 
traces of arterial hyperemia, are found. The pia is unchanged ; it contains 
a moderate quantity of blood, or is anaemic. The cortex and white substance 
are compressed, dry and firm ; the ventricles are usually dilated symmetri- 
cally from hydrocephalic effusion; the softening of the surrounding brain- 
tissue is less extensive than in tubercular meningitis. Only the plexus cho- 
rioidei shows signs of greater hyperemia than the superficial portions of the 
pia. No exudation at the base. The question then, as to its inflammatory 
or hypersemic nature, cannot be answered by anatomical evidence post- 
mortem. 

As exciting causes the following are mentioned: dentition; eruptive 
fevers; acute pulmonary affections; concussions of the brain. The disease 
belongs decidedly to the age of childhood, from one to five years. 

Its Symptoms correspond so closely to those of tubercular meningitis, 
that there is none to enable us to distinguish positively between the two, un- 
less we take the general outspoken tendency to scrofula, if it is outspoken, 
or the hereditary disposition in that direction as a basis for our judgment. 
In many cases, of course, the symptoms vary, but the general type remains 
the same. Usually there are less premonitory warnings; sometimes the in- 
ability to swallow sets in at an early stage; the skin of the body is dry, while 
the head often perspires profusely; facial paralysis and paralysis of the ex- 
tremities are less frequent than in tubercular meningitis, yet they do occur. 
For further particulars compare the foregoing. 

The Prognosis is less fatal than that of tubercular meningitis. 



62 BRAIN. 

Simple Meningitis of the Base. 

Without tuberculous infiltration this inflammatory process causes in 
some cases the formation of dense, hard stripes of connective tissue, or in 
other more acute cases, a fibro-purulent infiltration in the tissue of the pia at 
the base of the brain ; where hydrocephalus is preseut it is generally very 
severe. There is nothing known of predisposing causes; the victims are 
strong persons, between sixteen and thirty years of age ; its duration is from 
seventeen to sixty-four days. 

Symptoms. — Usually commencing with a chill or chilliness, which is fol- 
lowed by heat, sweat, thirst, entire loss of appetite and total unfitness for 
work, its main and most distressing symptom is a persistent headache, all 
over the head ; at times more especially in the occiput. The fever-heat is 
paroxysmal, the temperature rising in an irregular manner to 104° F. and 
above, to fall down again in the morning or forenoon with a sudden leap to 
the normal point. 

In other cases the fever continues throughout the disease, while in others 
still, the temperature shows periods of remarkable low even subnormal 
grades. There is a similar irregularity in the march of all other symptoms. 
Periods of entire consciousness alternate with mild or wild delirious attacks ; 
one paralysis may disappear or give way to another ; contractions and spasms 
may disappear for hours and then reappear again; altogether the motor 
symptoms make their appearance only at a very advanced period ; and in 
some cases they are entirely absent. Death follows during coma. 

These peculiarities distinguish simple basal meningitis almost from any 
other disease. ■ Its sudden beginning in healthy individuals in the prime of 
life without any tuberculous antecedents; its long duration without any 
marked changes except those stated above; the late occurrence of paralyses; 
the rareness of spasmodic symptoms ; the persistent headache — all taken to- 
gether make a peculiar type. Typhoid has a different record of temperature 
and almost always enlargement of the spleen ; cerebro-spinal meningitis is an 
epidemic disease and besides has no such long-continued clearness of the sen- 
sorium ; abscess of the brain grows only upon abnormal conditions of the 
body (purulent and ichorous processes, affections of the bones, purulent affec- 
tions of the lungs), and has no such characteristic march throughout. Tu- 
bercular meningitis may sometimes have a similar protracted course; but 
here the tubercular diathesis decides. 

The Prognosis is not favorable, but cured cases are recorded. 

There are still other forms of meningitis, which I shall briefly mention. 

Meningitis of the Convexity 

May come on spontaneously, that is without any known cause, or may be due 



MENINGITIS. 63 

to inflammatory processes in neighboring tissues, such as inflammation of the 
skull bones, caries of the inner ear, puriform softening of a thrombus in the 
sinus, panophthalmitis, erysipelas capitis, carbuncles of face and neck, old 
intracerebral affections. 

Metastatic Meningitis 

Must be considered as a terminal complication of some acute disease, of some 
suppurative processes at a distance. Such are croupous pneumonia with fun- 
goid vegetations; cheesy deposits in the lungs; ulcerative endocarditis; 
pyaemia; acute rheumatism; dysentery; diphtheritis ; measles: scarlatina; 
typhoid fever; Bright's disease. 

Traumatic Meningitis 

Is due either to concussion of the brain or an injury of only the soft parts of 
the skull, or a j3erforating injury, or a necrosis of the skull bones after such 
injury, or the breaking of an abscess of the brain. 

THERAPEUTIC HINTS.— As a general rule the pregnant woman 
ought to be under the watchful eye of her physician during that whole period. 
She may be relieved just during that time of many chronic troubles, better 
than at any other time and her offspring saved of as many serious afflictions. 
But where a mother has lost already one or more children from hydro- 
cephalus, Grauvogl's advice to administer to such a mother during another 
pregnancy Sulphur and Calc. phosph. at suitable intervals, ought never 
to be forgotten. Even after the birth of a child with suspicious hereditary 
joroclivities, we may be able to w r ard off an acute outbreak of meningeal 
inflammation by one or the other of the following remedies: 

Bar. carb., children who do not grow, but pine away, with swelling of 
glandular structures. 

Calc. carb., fat babies with large heads, wide open fontanelles, 
which are often covered with dirty or scurfy skin; fair complexion; they 
are lively, precocious; their head sweats profusely during" sleep, especially 
on the occiput; stomach and bowels are large, sensitive to pressure; bowels 
inclined to be loose; feet damp and cool; dentition slow and troublesome. 

Calc. phosph., flabby, shrunken, emaciated children; skull thin and 
soft, with fontanelles wide open; will not stand any more; do not learn to 
walk; want to nurse all the time; great desire for salt meats and potatoes; 
after eating and drinking, bellyache; retarded dentition with cold tumors, 
emaciation and loose green, at times slimy stools. 

Lycop., children sleep apparently soundly, but scream out suddenly 
in sleep, stare about and cannot easily be pacified. 



64 BRAIN. 

Silic, rickety children; sweat much about the head, especially fore- 
head and face; claw their mouth during dentition; are prone to abscesses, 
glandular swellings and a fetid sweat of the feet. 

Sulphur, children who do not like to be washed ; have pimples, boils 
and other eruptions on head, face and everywhere; pick at nose; have red 
lips ; crave sour things ; feel faint in the forenoon ; may have diarrhoea early 
in the morning; sleep restless; start when falling asleep; cry out during 
sleep; or murmur, moan and whine, or snore; their feet are cold in the morn- 
ing and hot in the evening; they run about, but do not like to stand; sit 
hunched and walk stooping. 

Thuja, children of sycotic and syphilitic taint; they are rather thin 
than fat, are prone to eruptions which, on healing, leave purple spots ; their 
teeth soon turn black and decay at the gums; the salivary glands swell; 
there is sometimes thrush or ranula; offensive discharge from the ears; sore- 
ness of penis or vulva and about the buttocks; frequently recurring morning 
diarrhoea ; pain in the left iliac region ; fetid foot-sw T eats ; often the uncovered 
parts sweat, while the covered parts are dry and hot. Their parents, one 
or both, have a greasy skin, and warts and moles, and crave salt, and the 
little one will by and by show these hereditary symptoms. — ( T. B. Scales.) 

When the real meningeal inflammation has set in, we shall have to 
choose between the following remedies: 

Aeon., in the first state of irritation and in the traumatic form, espe- 
cially where there is fever-heat, dryness of the skin, restlessness and im- 
patience. The pulse is full and bounding or thready ; the breath is short. 

Apis, convulsions; eyes, ears and skin lose their sensitiveness; when 
water is put into the mouth, there is no effort at swallowing; sopor, inter- 
rupted by piercing shrieks; bending back and rolling of the head; muscles 
of neck tense; profuse, sticky sweat on the head, of a musk-like odor; in- 
ability to hold up the head; eyes sunken, half shut; on opening eyelids no 
reaction; squinting; dilated pupils; hearing gone; occasional red streaks or 
crimson spots on the face or different parts of the body ; face pale, of a milky 
blue ; grating of teeth ; scanty, but frequent emissions of a dark and some- 
times of a milky urine, or suppression of urine; no stool, or thin, scanty 
stool, passed but seldom and unconsciously; trembling of the limbs; twitch- 
ing or moving of the limbs of one side and paralysis of the other; irregular, 
slow pulse, or very quick and w r eak. 

Apoc. cann., sutures opened; forehead projecting; sight of one eye 
totally lost, the other slightly sensible; stupor; constant involuntary motion 
of one leg and arm ; urine surpressed. 

Arg. nitr., according to Grauvogl in the last stage. He gives it in the 
6th dilution every two hours, and at the same time Calc. phosph., 2d trit., 
night and morning. 



MENINGITIS. . 65 

Arnica, after a fall causing either concussion, a bruise or a perforating 
wound ; also where there is suppuration in consequence. There are cases 
where the meningeal irritation does not show until several weeks after the 
injury. For such cases Arnica is specific. 

Art. vulg., convulsions of right and paralysis of left side; body cold 
all over ; sopor, and yet drinking and swallowing water eagerly ; face pale 
and oldish looking ; involuntary stools, greenish and thin. 

Bellad., vertigo on sitting up, with nausea or vomiting; redness and 
heat of the face, or alternate redness and paleness ; sparkling, shining eyes, 
with dilated pupils ; rolling and squinting of the eyes ; blindness ; throbbing 
of the carotid arteries ; drowsiness, yet inability to sleep ; or drowsy, restless 
sleep, with frequent startings ; trembling hastiness in taking hold of things 
and sitting up ; spasms affecting eyes and face, or spasms of one side and 
paralysis of the other ; involuntary discharge of urine. During dentition ; 
after taking cold by exposure to a cold north wind. 

Bryon., leaning head against something ; putting hand to the head; 
uncertain, tottering gait; tired; sudden change of disposition; dizziness; 
fall often and strike against things ; sudden change of color in the face; loss 
of appetite ; restless sleep — as premonitory signs. Later : head bent back- 
wards ; very dark red face, " crimson red ;" dry lips ; dry, brownish tongue ; 
hasty, impetuous drinking and ssvallowing; constipation; suppressed or 
painful urination with much straining ; dry heat all over and especially of 
the head ; drowsy sleep ; chewing and swallowing during sleep ; cries when 
being taken up or moved. 

Canthar. may be a rival to Apis. Is important in inflammations of 
serous membranes, why not in meningitis? There are a number of symp- 
toms which hint to it. Compare Condensed Materia Medica. 

Cina, either real or simulating meningitis with so-called worm symp- 
toms. 

Cicuta, rolling of the head from side to side, or boring of the occiput 
into the cushions ; head hot ; eyes closed ; on lifting the lids, eyes stare up- 
wards ; great agitation ; child grasps at one's clothing in a frightened 
manner; jerking of limbs; convulsions with screaming afterwards. 

Cuprum, hot head; deep sopor with twitching and jerking of the 
limbs ; coldness of the hands, and a bluish appearance of the fingers. " Dur- 
ing scarlet fever without eruption ; afraid of and shrinking away from everv 
one who approaches him ; afraid of falling ; clinging tightly to the nurse ; 
won't stay in bed but in the lap ; conscious, knows people." Tongue dart- 
ing forth and back with great rapidity, like a snake's. After catarrhal or 
exanthematic fevers ; during difficult dentition. 

Digit., sopor; unconsciousness; pupils dilated, insensible to light; blind- 
ness; one-half of face convulsed; pulse very slow, often hard, with a corre- 
5 



66 BRAIN. 

sponding powerful stroke of the heart, sometimes intermittent and small; 
breathing heavy, slow and deep ; sleep with frequent startings, and dreams 
of falling ; general convulsions. 

Gelsem., the child wants to be let alone, wants to lie still; head hot, 
hands and feet cool; face red; eyes dull; tongue coated yellowish-white; no 
thirst ; breath hot, sometimes offensive ; sleepy and drowsy, sometimes coma- 
tose ; during sleep, convulsive motions ; creeps and flushes run up the back ; 
more or less moisture of the skin, especially on palms of hands and in the 
axillae; pulse depressed at first, later frequent and soft. During summer or 
warm weather with southerly and southeasterly wind. 

Glonoin., headache; every pulse is felt, as if the head should burst; 
stupefaction; sunken eyes; under the eyes a bluish pallor; red eyes with 
photophobia; optical illusions; lightening black spots before the eyes; blind- 
ness; in the ears pain, fulness, pulsation, ringing, deafness; face is £ale in 
spite of high fever, or red and hot; temporal arteries pulsate violently; heart 
beats strong and laborious ; pulse mostly accelerated, often changing sud- 
denly to slow and back again ; nausea, vomiting with the headache ; sudden 
spasms. 

Gratiola, has been given as extract with good result in a case where 
there was low respiration ; occasional sighing ; gnashing of teeth ; eyes shut ; 
pupils enlarged; slow pulse; unconscious discharge of feces and urine. 

Helleb., great irritability, getting angry easily; vertigo as if drunk; 
eyes staring or rolled up, lids half closed ; squinting ; forehead drawn in folds 
and covered with cold perspiration ; face pale and puffy ; frequent rubbing of 
the nose ; nostrils dry and dirty ; chewing motions with the mouth ; greedily 
swallows cold water; wants food occasionally but rejects it when offered; 
rolls the tongue from side to side; lower jaw sinks; vomits green mucus; 
passes dark urine Avith a sediment like coffee-grounds. Breathing sometimes 
quick, sometimes slow and deep ; sighing ; boring back of the head ; soporous 
sleep with screaming and starting; automatic motions of one arm and one 
leg; convulsive movements of muscles and jerking; exudation. 

Kali hydr., is the remedy of Kafka, for scrofulous and tuberculous 
subjects. The disease develops gradually, and this remedy ought to be given 
at an early stage, although even later with symptoms of exudation it has 
been found to act favorably. 

Laches., is often indicated after Lycop., especially when there is dif- 
ficulty of swallowing ; gagging with throwing up of wind ; hot abdomen. 

Lycop., is one of the most important remedies in tubercular meningitis. 
Generally speaking it corresponds to scrofulosis and tuberculosis, cheesy de- 
generation and dropsical effusion. Special indications: drowsiness, loud 
screams during sleep ; sleep with half open eyes, throwing the head from side 
to side with moaning ; bad humor after sleep ; comatose state ; great emacia- 



MENINGITIS. 67 

tion; pale face; flushes of heat in the face; spasmodic twitching of the face; 
stiffness of the neck; constipation. Also in complications with eruptive 
fevers and pneumonia. 

Merc, sol., drowsy, sleepiness with restless throwing about and oc- 
casional waking with a shrill cry, which is followed again by dozing off. 
The sensitiveness of the eyes to light is diminished ; squinting. Mercury is 
considered as being capable of exciting the process of absorption. 

Opium, soporous condition with half open eyes ; snoring; iris insensible 
to light ; congested face ; suppressed urine. 

Spongia, according to Hering, of great importance on account of its 
relationship to scrofulosis and tuberculosis. Guiding symptoms : congestion 
of blood to the head with pressing, knocking and pulsating in the forehead ; 
redness of face with anxious mien ; better when lying in a horizontal position ; 
heat in the head; bending the head backwards with tension in the neck. 
Eyes staring, lids wide open; double sight; face pale and cold with the 
heat ; alternately red and pale. Twitching of the muscles with the fever ; 
frequent waking with a start ; tossing about ; stupid slumber. 

Stramon., head is thrust forward instead of back; conjunctiva in- 
jected; pupils contracted; desire for light, or bright light and glistening- 
things cause spasms ; calls for his parents who are present but does not know 
them ; violent delirium ; stam merino; ; great drvness of the mouth ; dvsphagia : 
urine suppressed ; trembling and convulsive movements of the limbs ; striking 
with hands and feet ; frequent torsions of the trunk ; screaming ; suppressed 
miliary eruptions. 

Sulphur, heaviness of the head; it sinks backwards; sweat on head of 
musk-like smell; frequent change of color in the face; pale, distorted feat- 
ures; sour smell from the mouth ; turbid urine with red sediment; suppressed 
eruption on head, behind the ears or elsewhere. Often indicated after 
Bryon. or Helleb. See above. 

Zincum, cross and crabby in the afternoon and morning; pain in fore- 
head, better when lying; sensitive to light; dry nose; pale, waxy face; re- 
laxed features; gagging and vomiting and yet a voracious appetite; stool 
retarded, omitting for days; scanty, turbid urine, as if mixed with clay: 
cannot keep the feet still. Heat and fever morning, evening and part of 
night; restless sleep before midnight, after midnight more quiet, and in the 
morning awakes brightly. Complication with scarlatina. 

Digest to Meningeal Inflammations. 

Preventive remedies: Bir. earb., Cole. At suitable intervals to mothers during 
corb., Gale, phosph., Lycop., SUic., Sulphur, pregnancy, who have lost children with 

Thuja. hydrocephalus: Sulphur and Cole, phosph. 



f>8 



BRAIN". 



FORMS, STAGES AND SUCCES 
SION OF SOME REMEDIES. 



symptoms : Cina, 

Traumatic : Aeon. 

After a fall, causing either concussion, a 
bruise or a perforating wound; also 
-where there is suppuration in conse- 
quence: Arnica. 

After exposure to a cold north wind: 
Bellad. 

During summer or warm weather, 
with southerly or southeasterly wind: 
Gelsem. 

During dentition : Bellad., Cuprum. 

scarlatina: Zincum. 

without eruption : Cuprum. 

With eruptive fevers and pneumonia: 
Lycop. 

After catarrhal or exanthematic fevers : 
Cuprum. 

suppressed eruption on head, be- 
hind the ears or elsewhere : Sulphur. 

miliary eruptions: Stramon. 

For scrofulous and tuberculous subjects: 
Kali hydr., Lycop., Spongia, 

Children who do not grow, but pine 
away, with swelling of glandular struc- 
tures: Bar. carb. 

Fat babies with large heads, wide open 
fontanelles, which are often covered 
with dirty or scurfy skin ; fair complex- 
ion : Cole. carb. 

Rather thin than fat children: Thuja. 

Flabby, shrunken, emaciated children; 
great emaciation: Cdc. phosph., Lycop. 

Rickety children : Silk. 

Children of sycotic and syphilitic taint: 
Thuja. 

Parents, one or both, have a greasy skin, 
and warts and moles: Thuja. 

Crave salt, and the little one will by and 
by show these hereditary symptoms: 
Thuja. 

Prone to eruptions which, on healing, 
leave purple spots : Thuja, 

Pimples, boils and other eruptions on 
head, face and everywhere : Sulphur. 

Premonitory signs: Bryon. 



Premonitory loss of appetite; restless 
sleep: Bryon. 

In the state of irritation : Aeon. 

The disease develops gradually, and this 
remedy ought to be given at an early 
stage, although even later with symp- 
toms of exudation it has been found to 
act favorably : Kali hydr. 

During exudation: Helleb. 

Excites the process of absorption : Mercur. 

In the last stage: Arg. nitr., Calc. 
phosph. 

May be a rival to Apis: Canihar. 

Is often indicated after Lycop.: Laches. 

Often after Bryon or Helleb. : Sulphur. 

CONCOMITANT SYMPTOMS. 
Conscious, knows people : Cuprum. 
Unconscious: Digit. 
Stupefaction : Glonoin. 
Lively, precocious : Calc. carb. 
Violent delirium: Stramon. 
Calls for his parents, who are present, but 

does not know them : Stramon. 
Trembling hastiness in taking hold of 

things and sitting up : Bellad. 
Screaming : Stramon. 
Cries when being taken up or moved: 

Bryon. 
Striking with hands and feet: Stramon. 
Clinging tightly to the nurse; won't stay 

in bed but in the lap : Cuprum. 
Children do not like to be washed: 

Sulphur. 
Wants to be let alone, wants to lie still : 

Gelsem. 
Afraid of falling : Cuprum. 
Afraid of and shrinking away from every 

one who approaches him : Cuprum. 
Grasps at one's clothing in a frightened 

manner: Cicuta, 
Sudden change of disposition : Bryon. 
Great irritability, getting angry easily: 

Helleb. 
Cross and crabby in the afternoon and 

morning: Zincum. 
Bad humor after sleep: Lycop. 
Restlessness and impatience: Aeon. 
Great agitation: Cicuta. 



DIGEST TO MENINGEAL INFLAMMATIONS. 



69 



Dizziness: Bryon. 

as if drunk : Helleb. 

on sitting up, with nausea or vomit- 
ing: JBellad. 

Headache: Glonoin. 

, nausea, vomiting: Glonoin. 

Pain in forehead, better when lying: 

Zincurn. 
Every pulse is felt, as if the head should 

burst: Glonoin. 
Congestion of blood to the head with 

pressing, knocking and pulsating in the 

forehead: Spongia. 
Head hot: Cicuta, Cuprum, Gelsem., 

Spongia. 
Forehead projecting; sutures opened: 

Apoc. cann. 
Skull thin and soft, with fontanelles wide 

open : Cede, ph osph . 
Inability to hold up the head : Apis. 
Leaning head against something: Bryon. 
Heaviness of the head, it sinks back- 
wards: Sulphur. 
Boring back of the head : Helleb. 
Head bent backwards; very dark red 

face, "crimson red:" Bryon. 
Bending the head backwards, with ten- 
sion in the neck: Spongia. 
Bending back and rolling head: Ar*en. 
Rolling of the head from side to side, or 

boring of the occiput into the cushions: 

Cicuta. 
Head is thrust forward instead of back: 

Stramon. 
Putting hand to the head: Bryon. 



Red eyes with photophobia: Glonoin. 
Conjunctiva injected: Stramon. 
Eyes shut: Cicuta, Gratiola. 

sunken: Gelsem. 

and half shut : Apis. 

dull : Gelsem. 

sparkling, shining, with dilated 

pils: Bellad. 

staring, lids wide open : Spongia. 

staring or rolled up, lids half closed 

Helleb. 

, rolling and squinting : Bellad. 

, squinting : Apis, Helleb., Mercur. 



pu- 



On lifting the lids, eyes stare upwards : 

Cicuta. 
Pupils contracted : Stramon. 

dilated : Apis, Bellad., Digit., GrotvAa. 

Desire for light : Stramon. 
Sensitive to light: Zincurn. 
Sensitiveness diminished: Apis, Mercur. 
On opening eyelids no reaction : Apis. 
Insensible to light : Digit., Opium. 
Blindness: Bellad., Digit., Glonoin. 
Sight of one eye totally lost, the other 

slightly sensible: Apoc. cann. 
Double sight : Spongia. 
Lightening or black spots before eyes : 

Glonoin. 
Optical illusions : Lycop. 



In the ears pain, fulness, pulsation, ring- 
ing, deafness : Glonoin. 
Offensive discharge from the ears: Thuja. 
Hearing gone : Apis. 

Dry nose : Zincurn. 
Nostrils dry and dirty : Helleb. 
Pick at nose: Cina, Sulphur. 
Frequent rubbing of the nose: Helleb. 



Flushes of heat in the face : Lycop. 
Redness and heat of the face: Bellad. 
Red and hot face : Glonoin. 
Congested face : Opium. 
Face red: Gelsem. 

with anxious mien : Spongia. 

crimson red : Bryon. 

Under the eyes a bluish pallor: Glonoin, 
Face pale : Lycop. 

in spite of high fever : Glonoin. 

and cold with heat : Spongia. 

, with distorted features: Sulphur. 

of a milky blue : Apis. 

and oldish looking : Art. vulg. 

and puffy : Helleb. 

, waxy ; relaxed features : Zincurn. 

Sudden change of color in face: Bryon., 

Sulphur. 
Alternately red and pale face : Belled.. 

Spongia. 
Occasional red streaks or crimson >|i<>tv 

on the face or different parts of the 

body : Apis. 



70 



BRAIN. 



Forehead drawn in folds and covered 

with cold perspiration : Helleb. 
Spasmodic twitching of the face : Lycop. 
Salivary glands swell : Thuja. 
Dry lips: Bryon. 
Red lips: JBellad., Sulphur. 



Great dryness of the mouth : Stramon. 

Sour smell from the mouth : Sulphur. 

Chewing motions with the mouth : Helleb. 

Lower jaw sinks : Helleb. 

Dry, brownish tongue : Bryon. 

Sometimes thrush or ranula: Thuja. 

Tongue coated yellowish-white: Gelsem. 

darting forth and back with great ra- 
pidity, like a snake's : Cuprum., Lycop. 

Rolls the tongue from side to side : Helleb. 

Stammering : Stramon. 

Gnashing of teeth : Gratiola. 

Grating of teeth : Apis. 

Retarded dentition with cold tumors: 
Cede, phosph. 

Dentition slow and troublesome: Cole. 
carb. 

Claw their mouth during dentition : Silk. 

Teeth soon turn black and decay at the 
gums: Thuja. 

Drinking and swallowing water eagerly 

during sopor : Art. vulg. 
Hasty, impetuous drinking and swallow- 
ing : Bryon. 
Greedily swallows cold water: Helleb. 
"Wants to nurse all the time: Calc. 

phosph. 
Difficulty of swallowing : Laches. 
Dysphagia: Stramon. 
"When water is put into the mouth, there 

is no effort at swallowing : Apis. 
Crave sour things : Sulphur. 
Great desire for salt meats and potatoes : 

Calc. phosph. 
"Wants food ocasionally, but rejects it 

when offered : Helleb. 
Gagging with throwing up of wind : 

Laches. 
and vomiting and yet a voracious 

appetite: Zincum. 
Vomits green mucus : Helleb. 



Feels faint in the forenoon : Sulphur. 
After eating and drinking, bellyache: 

Calc. phosph. 
Stomach and bowels are large, sensitive 

to pressure : Calc. carb. 
Pain in the left iliac region : Thuja. 
Hot abdomen : Laches. 
Constipation : Bryon., Lycop. 
Stool retarded, omitting for days : Zincum. 
Bowels inclined to be loose : Calc. carb. 
Diarrhoea early in the morning : Sulphur, 

Thuja. 
Loose, green and at times slimy stools : 

Calc. phosph. 
Involuntary stools, greenish and thin: 

Art. vulg. 
No stool, or thin, scanty stool, passed but 

seldom and unconsciously : Apis. 
Unconscious discharge of feces and 

urine : Gratiola. 






Painful urination with much straining : 
Bryon. 

Suppression of urine: Apis, Apoc. cann., 
Bryon., Helleb., Opium, Stramon. 

Turbid urine with red sediment : Sulphur. 

Dark urine with a sediment like coffee- 
grounds : Helleb., Laches. 

Scanty, turbid urine, as if mixed with 
clay : Zincum. 

, but frequent emissions of a dark and 

sometimes of a milky urine : Apis. 

Involuntary discharge : Bellad. 

Soreness of vulva : Mercur. 

of penis or vulva and buttocks : Thuja. 



Breath hot, sometimes offensive : Gelsem. 

short : Aeon. 

Breathing, sometimes quick, sometimes 

slow and deep : Helleb. 

heavy, slow and deep : Digit. 

Low respiration : Gratiola. 
Occasional sighing : Gratiola, Helleb. 
Heart beats strong and laborious : Glonoin. 
Pulse full and bounding or thready: 

Aeon. 
mostly accelerated, often changing 

suddenly to slow and back again : 

Glonoin. 



DIGEST TO MENINGEAL INFLAMMATIONS. 



71 



Pulse depressed at first, later frequent and 

soft : Gelsem. 
very quick and weak : Apis. 

sometimes intermittent and small: 

Digit. 

slow and irregular: Apis, Gratiola. 

very slow, often hard, with a corre- 
sponding powerful stroke of the heart: 
Digit. 

Temporal arteries pulsate violently, throb- 
bing of the carotid arteries : Bellad. 

Neck, stiffness of: Lycop 

, muscles tense : Apis. 

Coldness of the hands, and a bluish 
appearance of the fingers : Cuprum. 

Hands and feet cool: Gelsem. 

Feet are cold in the morning and hot in 
the evening: Sulphur. 

One foot cold, the other hot : Lycop. 

Feet damp and cool : Cole. carb. 

, fetid sweat : Silic. 

Run about, but do not like to stand: 
Sulphur. 

Will not stand any more, and do not 
learn to walk : Calc. phosph. 

Sit hunched and walk stooping : Sulphur. 

Uncertain, tottering gait, fall often and 
strike against things : Bryon. 

Tired: Bryon. 

Trembling of the limbs: Apis. 

and convulsive movements of the 

limbs : Stramon. 

Eyes, ears and skin lose their sensitive- 
ness: Apis. 

Twitching of the muscles with the fever : 
Spongia. 

Jerking of limbs : Cicuta. 

Convulsive movements of muscles and 
jerking: Helleb. 

Frequent torsions of the trunk : Stramon. 

Sudden spasms : Glonoin. 

Convulsions : Apis, Digit. 

with screaming afterwards: Cicuta. 

Bright light and glistening things cause 
spasms : Stramon. 

Spasms affecting eyes and face: Bellad. 

One-half of face convulsed : Digit. 

Twitching or moving of the lipibs of 
one side and paralysis of the other : Apis. 



Convulsions of right and paralysis of 

left side : Art. vulg. 
Spasms of one side and paralysis of the 

other: Bellad. 
Constant involuntary motion of one leg 

and arm : Apoc. cann., DZelleb. 



Stupid slumber : Spongia. 
Sopor: Digit. 

, interrupted by piercing shrieks : Apis. 

, with half open eyes : Opium. 

> and yet drinking and swallowing 

water eagerly : Art. vulg. 

, with screaming and starting : Helleb. 

, with twitching and jerking of limbs : 

Cuprum. 
Comatose state : Lycop. 
Stupor: Apoc. cann. 
Drowsy sleep : Bryon. 
, restless sleep, with frequent starlings : 

Bellad. 
sleepiness with restless throwing about 

and occasional waking with a shrill cry, 

which is followed again by dozing off: 

Mere. sol. 
Drowsiness : Lycop. 

, yet inability to sleep : Bellad. 

Sleepy and drowsy, sometimes comatose : 

Gelsem. 
Sleep restless : Sulphur. 
Restless sleep before midnight, after 

midnight more quiet, and in the morn- 
ing awakes brightly: Zincum. 
Starts when falling asleep : Sulphur. 
During sleep loud screams : Lycop. 
Children sleep apparently soundly, but 

scream out suddenly in sleep, stare 

about and cannot easily be pacified: 

Lycop. 
Cry out, or murmur, moan and whine : 

Sulphur. 
Snoring: Opium, Sulphur. 
Frequent startings: Digit., Spohgia. 

and dreams of falling : Digit 

Head sweats profusely, especially on the 

occiput : Calc. carb. 
Half open eyes, throwing the head from 

side to side with moaning : Lycop. 
Chewing and swallowing : Bryon. 



72 



BRAIN. 



Convulsive motions: Gelsem. 



Cold all over : Art. vulg. 

Creeps and flushes run up the back: 

Gelsem. 
Fever-heat, and dryness of skin : Aeon. 
Dry heat all over and especially the head : 

Bryon. 
Heat and fever morning, evening and 

part of night : Zincum. 
Profuse, sticky sweat on the head, of a 

musk-like odor : Apis, Sulphur. 
Sweat much about the head, especially 

forehead and face : Silk. 



Uncovered parts sweat, while the covered 
parts are dry and hot : Thuja. 

Fetid foot-sweats : Silic., Thuja. 

More or less moisture of the skin, espe- 
cially on palms of hands and in the 
axillae : 



Better when lying in a horizontal 

tion: Spongia. 
Tossing about : Spongia. 
Cannot keep the feet still : Zincum. 



posi- 



Glandular swellings and abscesses : Silk. 



Hydrocephalus Chronicus 

Develops itself, in grown persons, of acute attacks of different forms of men- 
ingitis, which may have been brought on by irritations of the brain from 
exposure to heat or cold ; external injuries ; the abuse of intoxicating drinks, 
or too great mental exertion. In children, even if it originates after birth, 
it is nevertheless identical with the affection called 



Hydrocephalus Congenitus, 

that form which children are born with. It is probably the consequence of 
an inflammatory process of the lining of the ventricles during foetal life; 
perhaps it is a deficiency in the proper assimilation of calcareous substances 
which form the bones. Why it is, we do not know in either case. Some 
women have given birth to hydrocephalitic children several times in succes- 
sion, without any apparent cause. 

As the water collects in the ventricles while the sutures of the bones have 
not yet united, its constantly increasing bulk drives the bones asunder and 
enlarges the head to an enormous size. Or, if we take the other view, which 
is perhaps the more plausible of the two, we might explain it in this manner: 
The insufficiently-developed bones are not capable of restricting the growing 
brain within its proper limits ; they give way here and there, and the brain 
gains entirely too much space within the skull. As, however, a vacuum can 
never exist, it is at once filled up with the general equalizing medium, water 
or serum. In this way the inner pressure becomes still stronger, and the still 
deficient bony structure becomes still less capable of restraining the increased 
internal pressure; it gives way again and again; and for the same reason the 
effusion of water must increase still more, until at length the whole cranium 
attains to an enormous size. 



HYDROCEPHALUS CONGENITUS AND SENILIS. 73 

The disease can be recognized at once, although it may not have come 
to its full development. There is a disproportion between the size of the 
skull and that of the face; the fontanelles are much wider than usual, and 
the frontal opening may be traced down into the frontal bone; and laterally, 
down between the parietal and frontal bones. The bones themselves feel thin 
under pressure of the fingers ; and externally the veins appear greatly en- 
larged, shining through the skin. 

All these external changes appear only when the collection of water is 
very considerable. There have been found from six to ten pounds of serum 
within the ventricles, which then appear enormously distended and thickened, 
while the substance of the brain in the neighborhood is wasting away. A small 
amount of serum does, of course, not change the external form of the cranium ; 
neither is it changed should the effusion take place at a later period, when the 
sutures of the skull bones have closed ; to this there are a very few recorded 
exceptions. 

Children born with hydrocephalus fully developed, die frequently dur- 
ing birth or soon afterwards. Others show no signs of this malady in the 
first weeks ; even during the whole of the first year it may be overlooked, un- 
til the inability of the child to hold up its head calls attention to it. But even 
then there may be no enlargement of the head visible, yet the child is slow 
in all its mental developments ; it does not make any attempt to talk or walk ; 
it remains uncleanly, and its actions look strangely; when in joy or fear it 
makes antics and straggles with its extremities. Its eyes do not look know- 
ingly at any object; it shows no interest for things; it appears imbecile and 
foolish. Saliva is constantly oozing out of the half opened mouth ; it eats 
greedily, and often is seized w 7 ith spasms. 

The progress of the disease is either a steady one, going on from bad to 
worse, until at last general paralysis ends the scene ; or it is interrupted by 
stationary periods, or it remains for years seemingly unaltered. It is rare, 
however, for such patients to live beyond the age of puberty; a few only 
have been observed to live to the age of twenty. 

THERAPEUTIC HUNTS.— The most important remedies for this 
affection are: Arsen., Calc. carb. and phosph., Helleb. and Sulphur. 

The old school confesses that by diuretica, drastica, iodine-preparations 
and calomel nothing has been achieved ; neither has the compression of the 
skull by adhesive strips, nor a repeated punction or tapping, been of use. 

Hydrocephalus Senilis 

Is that form of hydrocephalus which is found in old age, the second child- 
hood of man. It seems to be developed from the following condition of 



74 BRAIN. 

things : The brain in old age is apt to shrink, which necessarily would cause 
an empty space within the skull. As no vacuum can exist, the would-be 
empty space is at once filled up with serum. The same takes place when, 
from some cause or other, only a portion of the brain becomes atrophied. 
The space which hereby is vacated is at once taken up by an exudation of 
fluid. Hence this sort of hydrocephalus is termed Hydrocephalus ex 
Yacuo. It sometimes happens that the exudation of serum takes place so 
suddenly and so profusely as to cause all the symptoms of an apoplectic stroke, 
when it is called Apoplexia serosa. 

In most cases it is impossible to make a differential diagnosis between it 
and Apoplexia sanguinea; neither have we any distinct signs by which to 
diagnose Hydrocephalus senilis. 

Meningitis Cerebro-Spinalis Epidemica.— Spotted Fever. 

This is an acute, diffusive inflammation of the pia of the brain and 
spinal cord, resulting in an exudation of purulent matter. "It is deposited 
both on the convexity and at the base, especially along the course of great 
vessels, in the folds and depressions of the surface of the brain, in the fissure 
of Sylvius, along the sulci, between the pons variolii and chiasma, and on the 
pons and cerebellum. In rare cases the whole surface of the brain is uni- 
formly covered." In the spinal cord the exudation is found "chiefly in the 
lumbar, less in the cervical region, and almost exclusively on the posterior 
surface of the cord," owing to the tendency of any fluid to flow to the de- 
pendent parts. "The brain substance is sometimes congested with puncti- 
form haemorrhage and secondary development of small spots of softening; at 
other times, when the disease has been hyperacute or very long-continued, it 
is juicy or oedematous, with a smooth, level surface, and of a watery appear- 
ance on section. More rarely the substance is of a tough consistence." (Von 
Ziemssen.) 

Although this disease may have prevailed at times in previous centuries, 
the first epidemic ascertained with certainty, is that in Geneva, from Febru- 
ary to April, 1805. Since then many epidemics have been observed, and in 
all parts of the globe, with the exception of the tropical regions proper. It 
is an infectious disease, but what its disease-germ consists of, is entirely un- 
known. It generally occurs during winter and spring, and especially when 
there is great moisture of the air and great variations of temperature. It 
selects not malarial regions, but rather sandy, dry plateaus, though malarial 
neighborhoods are not exempt. Childhood is most severely attacked, yet no 
age is spared. The disease-germ seems best to thrive where it finds a soil pre- 
pared by insufficient nourishment, damp, overcrowded, badly ventilated 
houses with unclean ground floors. 



MENINGITIS CEREBRO-SPINALIS EPIDEMICA. 75 

Symptoms. — It most always sets in suddenly, commencing with a chill, 
followed by fever ; violent headache ; vomiting ; extraordinary prostration of 
strength and great restlessness. The headache is unusually severe, sometimes 
in the front, sometimes in the back part of the head ; its cessation is a very 
favorable sign. Vomiting is especially excited by rising and rarely absent. 
The fever-temperature is very irregular, varying in the mean from 100.4° F. 
to 104° F., with very irregular variations above and below these points, often 
interrupted by long-continued normal temperatures, while the other symp- 
toms continue unabated. The pulse is likewise irregular; its frequency does 
not always correspond to the height of the temperature, and varies sometimes 
thirty to forty beats in a few hours. A slow pulse is less frequently found 
than in meningitis tuberculosa, and a continued rapidity is unfavorable. In 
severe cases there occur at the start loss of consciousness, coma or delirium, 
or at least somnolence, out of which the patient may be roused by being 
spoken to, answering correctly, but soon relapsing into the same state again. 
Some cases commence with convulsions, and that characteristic stiffness of 
the neck which, in a few hours, may develop into a tonic contraction of all 
the extensors of the spinal column; orthotonus is frequent; opisthotonus is 
rare ; rarest is pleurothotonus or the unilateral contraction of the spinal erec- 
tor muscles. In rare instances, however, the stiffness of the neck is entirely 
absent. There is great aching in all the limbs, and especially in the spine, 
a universal oversensitiveness of the skin; every touch and motion causes 
great pain. Now appear also cutaneous eruptions, herpes on the face, or on 
the extremities ; then erythema, roseola, urticaria and petechias. The name 
of the spotted fever was suggested by those irregular, purplish, ecchymosed 
spots, from the size of a pin's head to larger patches, which appear generally 
on the second day of the disease upon various parts of the body, usually first 
on the upper eyelids, gradually extending to other parts; they do not get 
white under pressure. In some cases they are absent. From the third to 
the fifth day the tongue becomes dry and cracked in comatose cases ; in other 
cases it remains moist but heavily coated. There is sometimes diarrhoea, at 
other times constipation. In other cases the symptoms of irritation are fol- 
lowed by symptoms of depression ; no reaction ensuing ; unconsciousness is 
complete, stools and urine pass off involuntarily, pulse and temperature rise, 
convulsive movements, half-sided paresis, general convulsions, profound coma 
follow each other and death closes the scene. In favorable cases these symp- 
toms of depression do not set in at all, or are not so marked nor lasting. The 
headache, the pains in the limbs and spine continue, but grachially grow 
milder and convalescence begins in from one to two weeks, though sometimes 
later. There are cases especial during the commencement of an epidemic, 
which terminate fatally in from twelve to thirty hours ; and on the other 
hand, there are cases even during the height of an epidemic, which are so 
light, as to allow the patient to continue work. 



76 BRAIN. 

As Sequelae have been observed: "Deafness, derangements of vision, 
chronic hydrocephalus and chronic meningitis, with the consequent impair- 
ment of intelligence, and lesions of motility in the form of paralysis and 
paresis." 

The Diagnosis is difficult in isolated cases and when the disease occurs 
in complication with other acute diseases, especially croupous pneumonia. 
It differs, however, from Tuoerculons meningitis by the suddenness of its 
attack, the irregularity of pulse and temperature, and its peculiar eruptions; 
from Typhoid by the same peculiarities. In the first days a distinction 
between the two may not be possible, but a few days of observation of the 
temperature will decide. When in complication with pneumonia, its 
diagnosis may remain doubtful for some time; however, the stiffness of the 
neck and the painfulness of the spine will lead us to suspect such compli- 
cation. 

Its Prognosis is grave, especially in infancy and old age, and in all 
cases where the symptoms are very violent and the state of depression con- 
tinues without any apparent reaction. Each single case has to be weighed 
by its own peculiarities and even these doubtful cases may take a favorable 
turn, while others prove fatal even under careful treatment. 

THERAPEUTIC HINTS.— Aeon., chill; fever; restlessness; dry 
skin ; great thirst. Still I have not seen, nor found mentioned great achieve- 
ments from this remedy. 

Act. rac, intense pain in the head, as though a bolt were driven from 
the neck to the vertex with every throb of the heart ; pain at the base of the 
brain and up and down the whole length of the spine ; stiffness of neck and 
back; intense pain in the eyeballs; tongue swollen, or raw and red; redness 
of fauces and palate ; soreness and bruised feeling of the muscles generally, 
or sometimes confined to a circumscribed spot, and often changing location, 
and with a feeling as if an abscess were forming; great sensitiveness of the 
skin. Creeping chills in the back; profuse, sometimes cold perspiration all 
over; tonic and clonic spasms; delirium', like delirium tremens; sees cats 
and dogs, etc. 

Apis, often indicated. Compare Meningitis. 

Arg. nitr., recommended by Grauvogl, is undoubtedly of great im- 
portance. It has tremendous headache of all kinds ; vertigo ; photophobia ; 
clouds before the eyes ; double vision ; eyeballs floating in mucus; deafness; 
pale and emaciated face ; lips and nails blue ; white coated tongue, or dry 
and hard tongue, like bark and black; black coated teeth; cannot talk; 
wants to drink sweet things, sugar water, the juice of boiled, sweet prunes; 
stools and urine unconsciously; oppressed breathing; wants to be covered 
all the time and yet wants fresh air, the windows open ; cannot move himself. 



MENINGITIS CEREBRO-SPINALIS EPIDEMICA. 77 

Soporous sleep, with constant murmuring; it is difficult to rouse him, and 
when half roused, the eyes, scarcely opened, fall shut again. The whole left 
side is weak. Emaciation; constant trembling of hands; jerking of single 
muscles. 

Arnica, sopor; cringes when touched anywhere, even during uncon- 
sciousness ; great soreness all over ; diuresis ; during stage of great weakness. 

Ar sen., great restlessness and prostration; arsenic thirst; intermittent 
type. 

Bellad., often indicated by the violent headache, drowsy state, and 
delirium ; dilated pupils ; double sight. 

Bryon., bursting headache; stiffness of neck; great pain in joints and 
limbs, all worse from motion. 

Camphora, cold, deadly pale or blue, almost pulseless from first shock 
of chill without reaction. 

Cann. ind., vertigo on rising with stunning pain in the back part of 
the head; fixed gaze; dilated pupils; sensitive to sounds; cold face, with 
drowsy and stupid look; anguish in the chest with great oppression; pain 
across shoulders and spine; paralysis of lower extremities and the right arm; 
convulsions; emprosthotonus, with loss of consciousness; collapse; stupor; 
pale, clammy and insensible skin; feeble, irregular pulse. (Hale.) 

Chin, sulph., violent throbbing headache; vertigo; heat in the face ; 
involuntary closing of the eyelids from sheer prostration ; intermittent type. 

Cicuta, insensibility; double sight; dilated pupils; staring look; jerk- 
ing of eyeballs, muscles of face, arms and hands ; perfect deafness ; dumb for 
several days; ashy paleness of face; head retracted; rigid spine; dysphagia; 
first diarrhoea then coustipation ; rapid pulse; insensibility to touch and 
pinching; paralysis all over. 

Crotal., horrid headache; delirium with open eyes; pain in all the 
limbs; ecchymosed spots everywhere; convulsions and paralysis. 

Gelsem., feeling as of a tape around the head; great drowsiness; 
itching of head, face and neck; loss of vision and speech; nausea; pulse 
feeble ; respiration labored and feeble ; trembling and complete loss of mus- 
cular power; sweating relieves. 

Glonoin., violent throbbing headache with sense of expansion; blind- 
ness with faintness and nausea; pale face; pain through the whole length of 
spine. 

Hyosc, delirium, muttering or wild; double sight; convulsions. 

Lycop., sopor; sinking of lower jaw; fan-like motion of nostrils; feel- 
ing of tension in chest and abdomen as of a hoop; don't want to be alone; 
jerkings of limbs and body. Compare under Meningitis. 

Opium, stupor; spasms; drawing the body backwards and rolling from 
side to side; deep, slow breathing; very quick, or very slow pulse. After vio- 



78 



BRAIN. 



lent emotions, fear, grief, fright, which acted like a blow, stunning the whole 
nervous system. 

Rhus tox., stupefaction and vertigo; various eruptions, eczema on face; 
nosebleed; dry cough, perhaps bloody sputa; great aching pains all over 
with restlessness. 

Ver. vir., during first stage with coldness of surface; loss of conscious- 
ness; labored, slow and irregular pulse. Later: trembling as if frightened 
and on the verge of spasms ; convulsions ; retraction of head ; rolling of head ; 
rolling up of eyes ; opisthotonus ; very frequent and feeble pulse. 

Protracted recovery hints to : Calc. carb., Carb. veg , Psorin., Silic, Sul- 
phur, Zincum. 

Digest to Spotted Fever. 



Unconsciousness : Arnica, Ver. vir. 

Insensibility : Cicuta. 

Delirium : Bellad. 

, with open eyes : Crotal. 

, muttering or wild : Hyosc. 

, like delirium tremens : sees cats and 

dogs, etc. : Act. rac. 

Does not want to be alone : Lycop. 

After violent emotions, fear, grief, fright, 
which acted like a blow, stunning the 
whole nervous system : Opium. 



Vertigo : Arg. nitr. 

and stupefaction: Rhus tox. 

on rising with stunning pain in the 

back part of the head : Cann. incl. 
and heat in face, violent throbbing 

headache : Chin, sulph. 
Violent throbbing headache with sense 

of expansion : Glonoin. 
Intense pain in the head, as though a 

bolt were driven from the neck to the 

vertex with every throb of the heart: 

Act. rac. 
Pain at the base of the brain and up and 

down the whole length of the spine: 

Act. rac. 
Tremendous headache of all kinds : 

Arg. nitr. 
Violent headache : Bellad. 
Bursting headache: Bryon. 
Horrid headache : Crotal. 
Feeling as of a tape around the head : 

Gelsem. 



Head retracted : Cicuta, Vet 
Rolling of head : Ver. vir. 



Intense pain in the eyeballs: Act. rac. 
Involuntary closing of the eyelids from 

sheer prostration : Chin, sulph. 
Rolling up of eyes : Ver. vir. 
Eyeballs floating in mucus : Arg. nitr. 
Dilated pupils : Bellad., Cann. ind., Cicuta. 
Fixed gaze : Cann. ind. 
Staring look : Cicuta. 
Clouds before the eyes : Arg. nitr. 
Double sight : Arg. nitr., Bellad., Cicuta, 

Hyosc. 
Photophobia : Arg. nitr. 
Loss of vision and speech : Gelsem. 
Blindness with faintness and nausea: 

Glonoin. 



Sensitive to sounds : Cann. ind. 
Deafness : Arg. nitr., Cicuta. 
Nosebleed : Rhus tox. 
Fan -like motion of nostrils : Lycop. 



Face cold, with drowsy and stupid look : 
Cann. ind. 

pale : Glonoin. 

pale and emaciated: Arg. nitr. 

, ashy paleness of: Cicuta. 

Sinking of lower jaw: Lycop. 
Lips and nails blue : Arg. nitr. 



Black coated teeth : Arg. nitr. 
Tongue, dry and hard, like bark 
black: Arg. nitr. 



and 



DIGEST TO SPOTTED FEVER. 



79 



Tongue, swollen, or raw and red: Act. rac. 

, white coated: Arg. nitr. 

Dumb for several days: Cicuta. 
Cannot talk: Arg. nitr. 
Redness of fauces and palate: Act. rac. 
Dysphagia: Cicuta. 



Craves sweet tilings, sugar water, the juice 

of boiled, sweet prunes : Arg. nitr. 
Arsenic thirst : Arsen. 
Nausea : Gelsem. 

First diarrhoea then constipation: CiGuta. 
Stools and urine unconsciously: Arg. nitr. 
Diuresis : Arsen. 



Dry cough, perhaps bloody sputa: Rhus 
tox. 

Respiration labored and feeble: Gelsem. 

Breathing, oppressed: Arg. nitr. 

, great oppression: Cann. ind. 

, deep, slow : Opium. 

Anguish in the chest: Cann. ind. 

Feeling of tension in chest and abdo- 
men as of a hoop : Lycop. 

Pulse feeble: Gelsem. 

and irregular: Cann. ind. 

and very frequent : Ver. vir. 

rapid : Cicuta. 

very quick or very slow : Opium. 

labored, slow .and irregular: Ver. vir. 



Stiffness of neck: JBryon. 

and back: Act. rac. 

Rigid spine: Cicuta. 

Opisthotonus : Ver. vir. 

Drawing the body backwards and rolling: 

Opium. 
Emprosthotonus, with loss of concious- 

ness: C.ina. ind. 
Fain through the whole length of spine: 

Act. rac., Glonoin. 

across shoulders and spine: Cann. ind. 

in all the limbs: Crotal. 

Great pain in joints and limbs, all worse 

from motion: Bryon. 
aching all over, with restlessness: 

Rhus tox. 

soreness all over : Arnica. 

Soreness and bruised feeling 1 of the mus- 



cles generally, or sometimes confined to 
a circumscribed spot, and often changing 
location, and with a feeling as if an ab- 
scess were forming : Act. rac. 
Left side is weak; cannot move himself: 
Arg. nitr. 



Trembling and comjjlete loss of muscular 

power: Gelsem. 

, constant, of hands: Arg. nitr. 

, as if frightened and on the verge of 

spasms: Ver. vir. 
Jerkings of limbs and body : Lycop. 

of single muscles: Arg. nitr. 

- of eyeballs, muscles of face, arms and 

hands: Cicuta. 
Spasms: Opium. 

, tonic and clonic: Act. rac. 

Convulsions : Cann. ind., Hyosc, Ver. vir. 

and paralysis : Cicuta, Crotal. 

Paralysis of lower extremities and the 

right arm : Cann. ind. 



Drowsy state : Bellad. 

Great drowsiness : Gelsem. 

Difficult to rouse him, and when half 
roused, the eyes, scarcely opened, fall 
shut again: Arg. nitr. 

Sopor: Arnica, Lycop. 

Soporous sleep, with constant murmur- 
ing : Arg. nitr. 

Stupor : Cann. ind., Opium. 



Intermittent type: Arsen., Chin, sulph. 
During first stage, with coldness of surface : 

Ver. vir. 
Creeping chills in the back: Act. rac. 
Wants to be covered all the time and 

yet wants fresh air, the windows open : 

Arg. nitr. 
Chill; fever; restlessness; dry skin; great 

thirst: Aeon. 
Pale, clammy skin: Cann. ind. 
Profuse, sometimes cold perspiration all 

over : Act. rac. 
Sweating relieves: Gelsem. 



Great sensitiveness of the skin: Act. 
rac. 



80 



BRAIN. 



Cringes when touched anywhere: Arnica. 
Insensible skin: Cann. ind. 
Insensibility to touch and pinching: 

Cicuta. 

Itching of head, face and neck: Gelsem. 
Various eruptions, eczema on face: 

Rhus tox. 
Ecchymosed spots everywhere: Crotal. 



Collapse : Cann, ind. 



Cold, deadly pale or blue, almost pulse- 
less from first shock of chill without re- 
action: Camphora. 

Emaciation : Arg. nitr. 

Great restlessness, prostration: Arsen. 

During stage of great weakness: Arnica. 

Often indicated : Apis. Compare Men- 
ingitis. 

Protracted recovery hints to : Gale, carb., 
Carb. veg., Psorin., Silic, Sulphur, Zincum. 



Pachymeningitis, Inflammation of the Dura Mater. 

The dura consisting of a periosteal (external) and an inner lamella, 
pathology recognizes: 

1. Pachymeningitis externa, which may be caused by external in- 
juries, separating the membrane from the inner surface of the skull, or 
bruising and tearing it ; or by transmission of inflammation from neighbor- 
ing tissues. It always is confined to circumscribed spots, and seldom recog- 
nizable as a separate affection, because of the ease with which the inflamma- 
tory process may spread to the inner lamella and pia. Pachymeningitis of 
old age is frequently detected post-mortem, without any marked symptoms 
during life. 

2. Pachymeningitis interna may be a mere continuation of inflam- 
matory and suppurative processes of the outer layer. As such it is as little 
recognizable during life as the former. 

3. Pachymeningitis interna Hemorrhagica or Hematoma dure 
matris is in fact not an inflammation, but an extravasation of blood, which 
undergoes the usual changes of a coagulum, and developing from itself a new 
formation. It is found either on the surface of both hemispheres or only on 
one, and principally attacks persons after thirty years of age and upwards, 
although cases under that age are likewise recorded. 

The Symptoms must naturally vary according to the quantity of ex- 
travasation, its location on one or both hemispheres or its spreading from 
one to the other, and its repetition. A sudden and increasing compression is 
indicated by headache, drowsiness, loss of consciousness, fever, slow, some- 
times irregular and towards the end mostly very frequent pulse. The con- 
traction of the pupils, the absence of strabismus and ptosis indicate that the 
convexity is the seat of the lesion ; the simple rigidity, paresis or actual pa- 
ralysis of the muscles, the disturbances of sensation, numbness, formication, 
w T hen present on one side only or on both, or progressing from one side to the 
other, indicate its location on the opposite hemisphere or over both, or its 
spreading from one to the other. Coma, disturbances of respiration, slow- 



ENCEPHALITIS. 81 

ness of pulse, inability to swallow, cessation of reflex movements of the pu- 
pils, indicate a compression of the whole brain, while convulsions of one side 
and then on the other, afterwards paresis of one side with paresis of the facial 
or hypoglossus of the same side, then paresis of the other side show irritation 
of the motor centres of the surface of the brain. The intervals between dif- 
ferent attacks of extravasation are characterized by headache, diminution of 
intelligence, loss of memory, drowsiness, partial paralysis, disturbance of 
speech, sudden mental excitement without cause and frequently mixed symp- 
toms of dementia* paralytica. 

Its predisposing influences are old age, atrophy of the brain from alco- 
holism, atheroma, affections of the lungs, heart and kidneys, chronic psychoses, 
anaemia perniciosa, haemophilia, scorbutus. 

Its duration may extend from one day to one year and longer. 

For therapeutic hints see under meningitis and apoplexy. 

Encephalitis ; Abscess of the Brain ; Red and Yellow Soft- 
ening of the Brain. 

It is a true inflammatory lesion of the cerebral substance, a red softening 
and consequent abscess of the brain. The yellow softening is the consequence 
of a hemorrhagic infarction, through the plugging up of a cerebral vessel, 
which may lead, however, by irritation, to a true encephalitis, and so may, 
vice versa, after its inflammatory stage has passed away, the true encepha- 
litis assume the appearance of yellow softening and even be accompanied on 
the surrounding cerebral tissue by a partial necrosis, so that indeed we may 
find spots of softening in the brain, of which we cannot ascertain the nature 
of the preceding process. True encephalitis is found always only in small 
spots (foci). These foci are red from extravasated blood and swollen; its 
boundaries imperfectly defined. By and by, if they are not absorbed almost 
completely, which small ones of a traumatic nature certainly do in many 
cases, they undergo the well-known destructive and reabsorbing changes; we 
see before us a focus of yellow softening, which gradually becomes more color- 
less, is transformed into a cavity with a thin emulsive fluid, and may, at last, 
lead to the formation of firm sclerotic cicatrices ; or the transformation results 
in a collection of pus — an abscess. Recent abscesses have usually no envelop- 
ing capsule, while old ones have. As they grow they increase the intercra- 
nial pressure and retard the circulation in the brain, or compress the neigh- 
boring vessels in such a degree as to cause yellow softening of the surround- 
ing brain-tissue to a large extent. The abscess may perforate the surface of 
the brain into the ventricles, or open upon the base and give rise to diffuse 
acute meningitis of the base. 

It causes widespread acute oedema and also anaemia of the brain, and 
6 



82 BRAIN. 

when located in the cerebellum in such a position that it lessens the cavity of 
the fourth ventricle, or of the aquseductus Sylvii, hydrocephalus interims 
chronicus. 

It may discharge through the skull into the subcutaneous tissue, or into 
the frontal sinuses and nasal fossse, or through the temporal bone in the 
neighborhood of the processus zygomaticus, under the temporal muscle, or 
into the cavity of the tympanum. 

Abscess of the brain is either single or multiple and varies in size. 

The most frequent Cause of acute inflammation and. recent abscess is 
traumatic injury; but there are also mentioned: Affections of the skull bones, 
tumors in the brain, acute diseases, such as typhoid, scarlatina, affections of 
the heart, suppurating and sloughing processes in different portions of the 
body. These same causes apply to the capsulated and chronic abscess. 

Its Symptoms are not at all well defined. An acute encephalitis, say 
from a non-perforating injury of the head, may run its course without our hav- 
ing a suspicion of its existence. Still, symptoms like the following should not 
be unheeded: Dizziness; headache; vomiting; loss of consciousness; sopor; 
pupils wide and fixed; pulse slow; rolling of the eyeballs; transitory diver- 
gence; paralysis of the face or even hemiparesis or hemiplegia; twitching of 
both hands and feet ; convulsions of the extremities. Its extent cannot be de- 
termined. If not cured, it may result in calcification of ganglion-cells, situated 
under the injured part; in chronic irritable melancholy; in chronic head- 
ache, dizziness, anxiety and hallucinations ; in inability to think, w T ith inter- 
current periods of excitement and illusions of the senses ; in complete imbe- 
cility, in a state resembling dementia paralytica; in epilepsy and tumors. 

The Diagnosis must principally be based on the knowledge of its 
etiology. 

THERAPEUTIC HINTS may be looked after under the preceding 
chapters on the different forms of meningitis. 

Insulatio, Sunstroke, Thermic Fever. 

Whether it be, according to von Grauvogl, a want of water in the 
blood; or according to H. C. Wood, a paralysis of the vasomotor nerves or 
some controlling centre in the brain, which influences the production of heat 
in the body; or according to Hill in JBraithivaite 's Retrospect, 1867, an im- 
perfect decarbonization of the blood ; or according to Huguen, a hyperemia 
of the pia and brain ; or according to Arndt, a diffuse encephalitis ; or ac- 
cording to Nothnagel, a venous hyperemia, dependent upon a diminished 
power of activity of the heart; or according to K. Gregg, a development of 
gas or steam in the brain — we shall leave undecided ; all physicians, however, 



INSULATIO, SUNSTROKE. 83 

agree that it is caused by the influence of excessive heat, and not merely by 
an exposure to the direct rays of the sun. The results of post-mortems are 
meagre; the most important may be gleaned from Dr. H. C. Wood's, Jr., 
Thermic Fever, 1872, in which he states; "Right heart and pulmonary arter- 
ies, with their branches, gorged with dark fluid blood ; venous congestion of 
the lungs and entire body. The heart, especially left ventricle, rigidly con- 
tracted in every case, caused by a coagulation of the myosin, is pathognomic 
of sunstroke. In most cases, however, it is a post-mortem rather than an 
ante-mortem phenomenon. The muscles after death from heatstroke soon 
become rigid, sometimes instantaneously so." As Predisposing Causes are 
enumerated: "Want of acclimatization, lengthened exertions, deprivation of 
water, the free and habitual use of vile drinks, debility, a febrile state, 
fatigue, bad ventilation, improper head covering and clothing, depressing- 
influences." 

Symptoms. — The final "stroke" does not at all set in without warnings. 
At first the wonted work becomes a burden ; the muscles lose their elasticity ; 
there is great debility, loss of appetite, but great thirst. The head grows 
dizzy, achy; the chest feels oppressed, with frequent and short breathing 
and sighing; the throat gets dry, and swallowing painful; the voice becomes 
weak and hoarse; there is a general anxiety and irritableness of the mind; 
numb feeling in the extremities; restless sleep, or great drowsiness; increased 
vertigo, perhaps nosebleed, redness of the conjunctiva, pale face, tottering 
gait, or giving way of the knees. Many complain of a dreadful goneness at 
the pit of the stomach, nausea, vomiting; pain in the bowels, perhaps sudden 
diarrhoea, with profuse cold perspiration. Oftener the bowels remain consti- 
pated. The mind becomes clouded, he answers confusedly. If for such and 
similar indications nothing is done in the vain hope that it be a mere tran- 
sient indisposition, the "stroke" will surely and speedily follow, unless a 
change in the temperature should head it off by a still more rapid turn. 
This last link of a whole chain of more or less pronounced symptoms is very 
appropriately called "stroke " As if felled down by a blow, the patient sinks 
suddenly to the ground, with entire loss of consciousness, and complete insen- 
sibility of longer or shorter duration ; subsultus tendinum ; partial spasms, 
or violent general convulsions ; or paralysis of the spinal cord, so that he 
cannot move a limb. The face at first is very pale, gradually growing 
flushed, suffused, often deeply cyanosed, and finally assuming a leaden hue. 
The breathing is slow and sighing, or rapid ; or deep and labored, often ster- 
torous, with rattling in the trachea. The pulse grows feeble and exceedingly 
rapid ; later irregular, intermittent and thready. 

Such a "stroke" might be mistaken for apoplexy, if it were not for the 
heat of the season and the premonitory symptoms. Apoplexy may occur at 
any season and is often preceded by apparent good health. 



84 . BRAIN. 

Sunstroke is not necessarily fatal and least under homoeopathic treat- 
ment; however, it occasionally leaves very unpleasant after-effects, which 
"consist principally in symptoms of deranged innervation, inability to endure 
heat and sunshine, insomnia, vertigo and weakness, headache which returns 
after exposing oneself to the rays of the sun, or comes at regular times and 
in various parts of the head; chronic encephalitis; insanity; constipation; 
dyspepsia and derangement of the liver." 

THERAPEUTIC HINTS —Man will never be satisfied. Cold water 
he improves by ice. Now-a-days it would be very old-fashioned not to keep 
ice-water summer and winter, and to gulp it down during, after and between 
meals. So dictates fashion, and it is good for the doctors and ice-companies. 
So in the treatment of sunstroke. Plain water, as river or well provide it, is 
entirely out of date. Being a "stroke," it must be dealt with "strikingly." 
Ice-water and ice-bags are the order of the day. Do we cure a frozen limb 
by boiling it? Will you cure a man, nearly boiling, hy freezing him? 
Where is the sense? But fashion has none. When you are called to treat 
a man struck down by the sweltering heat, take water as river or well pre- 
sent it, and bathe his face, head, chest and spine, arms and limbs well with 
it. If you can have it lukewarm, it is better, because it is nearer to his tem- 
perature, and by evaporation will withdraw sufficient heat to cool the body 
down to a natural temperature in a very short time, without shock or malice. 
This alone may restore consciousness in a short time. But we have also 
remedial agents which may prevent the stroke, or shorten its attacks and 
prevent bad consequences. 

Among the remedies of prevention 

Gels em. is the most important. It covers all the symptoms of a man 
who feels "play'd out," as Lilienthal so characteristically designates it. It 
is especially indicated in hot, damp, stifling weather, the exact meteorological 
condition of sunstroke and it has, at least in my practice, proved itself ade- 
quate to the occasion. 

Aeon, and Arsen., are characterized by great thirst, hot and dry skin. 

Ant. crud., by a white tongue, loss of appetite. 

Bryon., by great thirst, gastric derangements and aversion to 
motion. 

Carb. veg., vertigo; heaviness of head; pulsative pain above eyes; 
general debility; obtuseness of sensibility. 

Laches., by great dryness of throat, hoarseness; tightness and oppres- 
sion of chest, and drowsiness. 

Ver. vir., by prostration, febrile motion and accelerated pulse. 

Among the remedies during the attack 

Glonoin. is the most important. Violent headache; vertigo; does not 



APOPLEXIA SANGUINEA. 85 

know the street nor his own house; losing senses and sinking down uncon- 
scious. Conjunctiva reddened ; mist, black spots or visions of light before the 
eyes ; pale and agitated countenance. White tongue as if painted. Thirst, 
pain and throbbing in the pit of stomach with a sense of sinking. Oppressed 
breathing, sighing, constriction and anxiety, Laborious and violent action 
of the heart. Xumbness of limbs; muscular tremor; great prostration; 
sopor; convulsions. 

Amyl nitr., anxiety; longing for fresh air; dull confusion of head; 
giddy, intoxicated feeling ; head feels full to bursting ; eyes protruded, star- 
ing; conjunctiva bloodshot; intense surging of blood to the face; crampy, 
epigastric pain ; burning and pressure in stomach ; dyspnoea and constriction 
of chest and heart ; tumultuous beating of heart ; tremulousness of hands and 
tired feeling in legs ; tottering gait ; weak, relaxed feeling. 

Bellad. , similar to Glonoin. Drowsiness ; dulness of mind ; congestions 
towards head; loss of consciousness; headache; vertigo; anguish; flashes 
before the eyes ; whizzing in ears ; constriction of chest ; worse in summer 
heat. 

Camphora, sinking of the forces; oppression of breathing; embarrassed 
action of the heart; coldness of body, tremors and cramps. 

Opium, unconsciousness; deep coma; eyes glassy and half closed. 

Sequels may be met with by 

Agar., vertigo from sunlight. 

Anac, loss of memory. 

Bar. carb., Laches., Natr. carb., Stramon., heachache from 
being exposed to the sun. 

Apoplexia Sanguinea. 

It consists of an intracerebral haemorrhage, forming clots of various 
dimensions, usually from the size of a hazel-nut to that of a small apple, but 
they may be much larger or much smaller; their shape is either round or 
they are spread out in layers to a greater or less extent ; they may occur 
singly, which is the rule, or in numbers of two, four or more. Their favorite 
seats are the corpus striatum and the nucleus leuticularis, with the neighbor- 
ing parts of the hemisphere, and the thalami optici; in other parts they occur 
only exceptionally, and in the cornu Ammonis, the corpus callosum or the 
fornix scarcely ever. 

Unless fatal after a few hours, these clots and the surrounding tissue 
soon undergo structural changes. By absorptions of the fluid parts the whole 
mass thickens, turns at first dark red and later yellowish, and the surrounding 
tissue becomes soft partly from the inhibition of serum and partly from fatty 
degeneration, or inflames to a greater or less extent. If the patient survives 



86 BRAIN. 

the attack for some time, the clot forms into a cyst which may persist without 
change, or is converted into so-called apoplectic cicatricial tissue. 

Capillary hemorrhages, showing blood-points of the size of a pin's head 
and smaller, are met with in places of softening, or in the cortex cerebri in 
consequence of thrombosis of the venous sinuses; they are secondary processes 
and should not be considered under this head. 

The Cause of these intracerebral haemorrhages is now in general at- 
tributed to a diseased condition of the cerebral vessels, especially the arteries, 
which consists, according to Charcot and Bouchard, in the formation of 
numerous miliary aneurisms, in consequence of chronic periarteritis. They 
may burst spontaneously under an ordinary amount of blood-pressure within 
the cranium, as in cases where the apoplectic attack occurs during sleep or 
in perfect rest, or they may be ruptured by an increased amount of blood- 
pressure during sj)ells of hard coughing, vomiting, laughing, straining at 
stool, or during parturition; in consequence of mental excitement, or bodily 
exertions ; after a full meal and the use of alcohol and coffee and other car- 
diac stimulants. The most frequent occurrence of apoplectic attacks is after 
forty years of age, although childhood is not exempt. 

Symptoms. — In some cases, not in all, the first attack is preceded by 
premonitions for weeks, month, even years. These are: frequently recurring 
dizziness, headache, ringing in the ears, muscse volitantes, alterations in the 
disposition, sudden but transient loss of power to speak without paralysis of 
the tongue ; sudden transient paresis in one arm, or leg, or both ; or a sense 
of stiffness, a feeling of "pins and needles," numb feelings, or sensation of 
heat and cold, or of pain of an indescribable character in the extremities ; 
disturbances of vision, diplopia and even amaurosis; sometimes nosebleed. 

The attack itself is ushered in by a sudden loss of consciousness, in 
many but not in all cases. It may develop itself gradually with. symptoms 
above described, and unconsciousness following only after a lapse of several 
hours or days, especially after venesection; or it may commence with pa- 
ralysis of one side; or with chronic or tonic spasms of certain muscles which 
later become paralyzed, when hours afterwards sopor follows; or conscious- 
ness may not be lost for a moment, although the symptoms which precede 
the attack and those which usually follow and remain permanently after the 
return of consciousness in the usual cases, leave no doubt of an actual intra- 
cranial haemorrhage. In case of complete sopor and relaxation of all the 
muscles in a degree that hemiplegia cannot be recognized in order to distin- 
guish the attack from opium poison, asphyxia, etc., we shall find the eyeballs 
turned toward the non-paralyzed side of the body; this symptom usually 
lasts a few days. The color of the face is not uniformly the same in all 
cases; sometimes it is deep red, even cyanotic; sometimes natural, or again 
quite pale; the pupils may be dilated, of normal size or contracted; one 



APOPLEXIA SANGUINEA. 87 

pupil larger than the other points to a unilateral affection of the brain; the 
pulse varies likewise in different eases ; in most eases it is slow and some- 
times irregular; in others very rapid and regular; the respiration maybe 
quiet and regular as in healthy sleep; it may be labored, stertorous; it may, 
during deep sopor, be a kind of blowing, drawing the cheeks in during in- 
spiration and puffing them out during expiration — the so-called tobacco- 
smoker's respiration ; towards the end respiration becomes intermittent and 
irregular. The temperature is at first usually lowered to 96.3° F., and re- 
mains so in the fulminating form until death. If life endures for from ten to 
twenty-four hours, the temperatures rises rapidly. If life is prolonged to a 
still longer period, the temperature rises only to 99.8° or 100.4° F., where it 
remains ; another sudden rise is a very unfavorable symptom, as it usually 
precedes death. Urine and feces pass off involuntarily during sopor. Ful- 
minating cases terminate in from five minutes (rare cases) to three or four 
days. Recovery rarely takes place after the coma has lasted forty-eight 
hours. But even if the coma ceases, health is by far not restored; now in- 
flammatory reaction sets in; the tennperature rises from a few tenths of a 
degree to two degrees; there is occasional cloudiness of mind, even delirium; 
loss of appetite ; convulsive movements, even tonic contractions with pain in 
these parts. This may last for several days, and then subside for a time, 
when the same symptoms, although in a milder form, reappear again at in- 
tervals of two, four or eight days. But there remain permanent symptoms 
for a long time often through life which depend on the extent and seat of 
the destruction caused by the haemorrhage. These are, with a few excep- 
tions, hemiplegia of that side of the body which is opposite to that in which 
the lesion of the brain occurred; paraplegia if the haemorrhage occurred 
simultaneously in both hemispheres; partial paralysis, for example, of the 
facial nerve, in- connection with extravasation in the optic thalamus, and in 
the corpus striatum; contracture (in the later stages) of the paralyzed limbs; 
anaesthesia of the affected parts, which may or may not diminish or com- 
pletely disappear; hyperalgesia, by which a light touch is felt as pain, and 
which may alternate with anaesthesia or even exist side by side with it for 
years; spontaneous attacks of pain in the partially or totally paralyzed limbs. 

There are also disturbances of the trophic and vasomotor nerves. The 
affected limbs are often hotter and redder for some time than those of the 
unaffected side; they are swollen, cedematous; they sweat profusely; after 
some time, however, they become cold ; or the skin is tending to be dry and 
scaly from the first; the pulse is diminished in its amplitude; bedsores ap- 
pear; the nails become yellowish, ridgy, brittle and curved in both direc- 
tions; the hair grows thicker and longer, and the skin becomes hypertrophied 
— all on the paralyzed side. 

Of the special senses taste is limited to the forepart of the tongue on one 



88 BRAIN. 

side in consequence of an affection of the chorda tympani; this symptom 
usually disappears soon, but may last for a long time. Hearing is sometimes 
slightly affected, and sight in the form of hemiopia frequently. 

Among the mental disturbances deficiency of memory is the most promi- 
nent, especially in regard to recent impressions, while old ones can be re- 
called with unimpaired distinctness. The power of judging may gradually 
weaken until the patient is reduced to childishness or dementia; the dis- 
position often changes to peevishness and irritableness. 

The Prognosis is grave; even if recovery from the shock takes place, 
the consequences of the reactive inflammation are always to be dreaded, and 
there is no safety for a renewed attack at any time thereafter. 

THERAPEUTIC HINTS.— Remedies to prevent the attack ought to 
be studied under hypercemia, to which may be added : 

Sepia, after previous attacks; in men who have been addicted to drink- 
ing and sexual excesses, with a disposition to gout and haemorrhoids. Fore- 
runners : dizziness in walking, with staggering ; things fall out of their hands ; 
forgetfulness ; use wrong words when writing ; cold feet ; intermitting pulse. 

Remedies during the attack and its inflammatory stage: 

Aeon., head hot; carotids throbbing; skin hot; pulse full and hard, but 
not intermittent ; after fright or vexation, or suppressed habitual bleedings. 

Arnica, head hot and rest of body cool; paralysis of left side; pulse 
intermittent or irregular. 

Bellad., red face; dilated pupils; loss of sight, smell and speech; pul- 
sation of carotids; spasms in the face; thick tongue, protruding; difficult de- 
glutition ; involuntary emission of urine ; reaching with the hands to the geni- 
tals ; moaning ; paralysis of limbs, right or left ; coma, sopor. 

Coccul., face red and hot; eyes closed, with the balls constantly roll- 
ing about; pupils dilated; breathing without noise; stupor; left or right ex- 
tremities paralyzed; after night-watching and exhaustion. 

Conium. "Eighty years of age; one side completely paralyzed; sweat 
as soon as he falls asleep, and even with the closing of the eyes." (Nash.) 

Gelsem. and Glonoin., see under Hyperemia. 

Hyosc., sudden falling down with a shriek; soporous condition; face 
red; inability to swallow; involuntary discharge of feces; blood-vessels 
swollen; pulse quick and full; numbness of hands after consciousness 
returns. 

Laches., left side mostly affected; blowing expiration; cannot bear 
anything to touch his neck; when conscious, talks and jumps abruptly from 
one idea to another ; after the use of liquors or mental emotions. 

Lauroc, vertigo; bloated face; jerking of the facial muscles; speech- 
less by full consciousness; palpitation of the heart; scarcely perceptible 
pulse ; cold, moist skin. 



APOPLEXIA SANGUINEA. 89 

Nux vom., snoring; paralysis of lower jaw and (mostly) of the lower 
extremities, which are cold and without sensation; after a hearty dinner, or 
abuse of liquor or coffee. 

Opium, open eyes; dilated pupils; red face; jerking of the muscles of 
the face; sinking of the lower jaw; foam before the mouth; slow, irregular 
or stertorous breathing; convulsive motious of the extremities, or tetanic 
stiffness of the whole body; cold paralyzed limbs; hot sweat on the head. 
After consciousness is restored, the patient cannot retain what he reads ami 
forgets the connection of consecutive thoughts. Old drunkards ; is followed 
well by Xux vom. 

Remedies for subsequent chronic changes: 

Anac, loss of memory; general paralysis. 

Caustic, inability to select proper words; paralysis of face or extremi- 
ties, which latter is complicated with muscular contractions. 

Cuprum, paralysis of tongue, stuttering, deficient speech; the para- 
lyzed limbs grow thinner, but preserve sensation; frequently complicated 
with unyielding contractions or chorea-like paroxysms. 

Plumbum, consciousness blunted; memory deficient ; speech impeded, 
single syllables are omitted or the syllables cannot be combined into words ; 
mimic spasms of face when speaking ; trembling of tongue when it is put out ; 
semi-paralysis of the buccinator muscles and of the velum palatinum, which 
manifests itself by violent snoring ; sleeplessness, fear of death ; the organs of 
the senses are torpid and insensible, the eyes are principally affected; the 
eyelids droop as if paralyzed; the pupils most constantly dilated; all objects 
seem smaller and farther removed from the focus of vision, they may be 
seen as through a gauze ; diplopia ; pulse always slow, 50 to 60 in the min- 
ute; sometimes hard and tense like a wire; all the muscles may be para- 
lyzed, especially of left side ; the paralysis affects equally the motor and sen- 
tient nerves, is often attended with violent pains in the paralyzed parts, and 
considerable contractions, especially of the extensor muscles, which feel as 
hard as wood ; in other cases the spasms are tonic, which, if they reach their 
full development, run into complete epileptic convulsions ; the muscles of the 
affected parts become atrophied. If the paralysis is not complete, the pa- 
tient's gait is unsteady, with particular tendency to fall forward. The para- 
lyzed respiratory muscles often occasion a high degree of dyspnoea. The 
sphincters are scarcely ever paralyzed. (Baehr.) 

Zincum, senses remain disturbed after the attack. 

Besides, compare what has been said under Meningitis. 



90 BRAIN. 

Occlusion of the Cerebral Arteries ; Embolism and Throm- 
bosis ; Softening of the Brain. 

An occlusion of the cerebral arteries takes place either by embolism, 
when the occluding mass is carried by the stream of blood from some other 
parts of the vascular system to a place where, on account of the smallness of 
the vessel, it cannot go any further; or by thrombosis, when the occluding 
mass is produced on the very- spot of the occlusion. 

The emboli consist either of blood clots, masses of fibrine, connective 
tissue growths, or chalky concretions, the principal source of which is endo- 
carditis; and next aneurism of the aorta; seldom thrombotic masses from 
within the lungs. 

Thrombosis takes its origin through structural changes in the vascular 
walls, such as fatty degeneration, or inflammation of the coats of the arteries, 
leading to sclerosis, ossification, or calcification, by which a gradual slacken- 
ing in the speed of the blood current takes place, until an entire stoppage 
ensues. 

The emboli are carried much oftener into the left carotid than into the 
right, and they only exceptionally become lodged below the circle of Willis, 
but are swept into the arteria fossae Sylvii, which is the chief direct prolonga- 
tion of the carotid. Sometimes several arteries become the seat of occlusion 
at the same time. If the seat of occlusion is below or on the cardiac side of 
the circle of Willis, or if the embolus is swept onward into the arterial system 
of the cortex, no anatomical changes follow in the cerebral substance, because 
the circulatory disturbances are readily compensated for by collateral circu- 
lation. When, however, the embolus is lodged in a terminal artery of the 
basal system, or is carried beyond the circle of Willis, it causes first "red 
Softening" of the neighboring brain-tissue, that is, the brain substance 
appears swollen and discolored in different shades of red and is dispersed 
with numerous dots of blood ("capillary apoplexies")- By and by the red 
color fades into yellow, partly from the absorption of the coloring matter of 
the blood, and partly from the ensuing fatty degeneration of the nerve 
elements; this state of things is called "yellow softening." After a lapse 
of several months, if the patient lives that long, the affected tissue is converted 
into a semi-fluid milky substance, which is* termed "white softening." 
At length even this may partially be absorbed, leaving a sort of cyst filled 
with quite thin fluid. 

The Predisposing Cause of embolism is preeminently acute rheuma- 
tism, and it is therefore found oftener in relatively youthful persons, while 
thrombosis has its predisposing cause in a morbid change of the vascular 
system, and is therefore oftenest met with in advanced years. 

Symptoms. — Embolism always sets in suddenly, and very often with a 



OCCLUSION OF THE CEREBRAL ARTERIES. 91 

condition, which resembles precisely that of an apoplectic stroke, without 
any premonitory symptoms. In some cases, however, there is no loss of con- 
sciousness or coma ; there may be delirium, aphasia, vomiting, paralysis — all 
disappearing in a few hours. 

Thrombosis comes on slowly with headache, dizzinesss and a sense of 
general confusion, loss of memory, numbness, coldness and creepings either 
in only one extremity, or throughout the distribution of one nerve, or in one 
entire half of the body; paretic and paralytic symptoms, perhaps with pre- 
ceding slight convulsive movements, likewise confined to certain regions of 
the body and determined by the size and importance of the occluded vessel. 
Finally the total occlusion may manifest itself with all the symptoms of an 
apoplectic fit, or may occur without any loss of consciousness. 

In the further course of development embolism or thrombosis may be 
described conjointly. Either of them may terminate in death or in com- 
plete recovery, or be followed by a repetition, or by a chronic development 
of symptoms as consequences of the structural changes within the brain 
above described. Only these latter symptoms concern us here. The tem- 
perature begins to rise on the second or third day and may quickly reach 
104° F., when after two or three days it rapidly sinks again and finally 
becomes stationary. Indeed the complex of symptoms now developing may 
be regarded as identical with that of cerebral haemorrhage, and need not, 
therefore, be repeated. Aphasia is of very frequent occurrence in this affec- 
tion, because the left Sylvian artery is the most common seat for embolic 
occlusions, inducing functional disturbances in that district of the cortex 
cerebri with which disorders of speech are regularly associated. 

The Diagnosis between embolism . and haemorrhage is very difficult, 
unless we can take the predisposing causes (valvular diseases of heart and 
affections of the lungs) as a starting point. A distinction between throm- 
bosis and haemorrhage is not possible, only that the first occurs much less 
frequently than the latter. 

THERAPEUTIC HINTS —Compare Apoplexy and the various 
forms of meningeal affections spoken of before, to which I add the following 
remarks of Dr. H. R. Stiles: "When the disease shows evidence of inflamma- 
tory action, or is recent, Bellad., Nux vom., Mercur.; where it is evi- 
dently due to atheromatous conditions of arteries, Phosphor., Phosph. 
ac, Anac, Zincum; for hemiplegia, Nux vom., Coccul., Bar. 
carb., Arnica; for vertigo, Iodine (congestive), Sulphur, Digit., (car- 
diac); for sleeplessness, Coffea, Hyosc, or Nux vom., and Chamom., 
if the patient has been addicted to the use of coffee; China, if he has been 
a great tea drinker; for paralysis (general), Phosphor., Conium, Coc- 
cul. (local), Caustic, Aeon., Ignat., Bellad.; for convulsions (simu- 



92 BRAIN. 

lating epilepsy), Bellad., Calc. carb., Cuprum, Strychnine; for emo- 
tional disturbances, Ignat.; headache (active), Aeon., Bellad., Bryon., 
Nux vom., Glonoin. (passive), Gelsem., Opium; for imbecility, Ar- 
nica, Ambra, Selen., Sepia; or sensation of formication, Secale." 
Compare also therapeutic hints under dementia paralytica. 

Aphasia. 

Under this term clinical observers have arranged a variety of deficien- 
cies of speech. 

When there is an incapacity for the motor co-ordination, so that the pa- 
tient, although he understands all that is said to him, and is able to express 
his wishes by writing, is yet unable to express them by words, although his 
organs of speech — tongue, etc. — are in perfect order, it is called ataxic 
aphasia. Here the connection between the idea and the organs of speech 
is interrupted. In some of these cases this does not amount to entire speech- 
lessness, some words of one syllable may possibly be in his reach, and he uses 
them as best he can, making up by writing and gestures what he cannot con- 
vey by words; others utter only a few senseless syllables and words; but none 
can repeat words even if dictated to them. At times ataxic aphasia is com- 
plicated with agraphia, an inability to write either a single letter or a com- 
bination of letters into intelligible words and sentences, although otherwise the 
hands are fit to perform all sorts of other mechanical uses. The speech of 
gestures is seldom implicated in this affection. 

When there is an incapacity for the recollection of words, although the idea 
is present and the articulation is at the service of the word, it is called amnesic 
aphasia. Here the association between the idea and the word (its verbal 
expression) is interrupted. This occurs even during health. Sometimes, 
with our best endeavors, w T e cannot recollect a name ; in the diseased state 
especially nouns, which cannot be roused into consciousness; therefore the pa- 
tient tries to describe what he means by other words, for instance, calling a 
pair of scissors "that which cuts." Or it is only the initial letters which are 
wanting, and he omits them in speaking and writing; or in more profound 
derangements, although the patient may be able, by paying strict attention, 
to repeat what another speaks aloud before him several times, of his own ac- 
cord he cannot utter it at all, or only badly articulated, mutilated and dis- 
torted. So also the letter-signs are either totally forgotten, or applied in un- 
intelligible connections, while on the other hand the reading of written or 
printed matter may not meet any obstacles. 

When there is an inability to understand the words which they hear, or to 
read the words ivhich they see, although sight or hearing and the ability to 
express their thoughts by speech and writing are unimpaired, it is called 



APHASIA. 93 

WOrd-deaftiesS and WOrd-blindliess (Kussmaul). Here the association 
between the word (spoken or written) and the idea is impeded, or in other 
words the external stimulus does not reach the idea, while in the amnesic 
form of aphasia the idea is not capable of exciting its corresponding verbal 
expression. This affection, however, is generally combined with amnesic 
aphasia or agraphia, and patients of this kind have been taken for deaf and 
demented, because their answers did not correspond to the sense of the ques- 
tions, and they used distorted or wrong words. 

When there is an inability to connect the. ideas with their appropriate 
word-expressions, so that instead of the appropriate term, another word of a 
different meaning or altogether strange and unintelligible expressions are 
used, it is called paraphasia. Here the connection between the ideas and 
their proper expressions is loosened, in a way that other words or names of 
ideas similar perhaps in meaning or sound interpose themselves and repress 
the proper ones. This disorder occurs at times without any pronounced 
morbid condition of the brain, when for instance from want of proper atten- 
tion we use a word which belongs perhaps to another train of thoughts, but 
which at that time preoccupies the mind; or in the hurry of excitement, dis- 
place the consonants of certain words and form strange, irregular combina- 
tions, say, for instance, "mood gorning" instead of "good morning," or in- 
stead of "Liebig and Mitscherlich," as an absent-minded professor did, "Mit- 
schich and Liederlich." But in marked states of the brain this paraphasic 
confusion may amount to such total perversion and corruption of words and 
sentences that it is completely impossible for the hearer to understand what 
the patient means. And the same is true of paragraphia. "Royal naval 
medical office, etc.," one wrote in the following manner: "Roydudendd na- 
vendendd oforendendd, etc." 

By numerous post-mortems it is proved that lesions of the left frontal 
lobe, and especially its third frontal convolution, are the most frequent 
Causes of aphasia; the island with the neighboring frontal, parietal and 
temporal districts comes next in frequency. Aphasias, from lesions in other 
regions are exceptions to the rule, as for instance the lesions of the right 
frontal lobe. These latter cause aphasia only in left-handed people, for the 
reason that such persons have exercised for speech and action the right 
frontal lobe; a lesion of the left frontal lobe does not affect their speech, 
since that of the right, which alone has been exercised, remains intact. 
Left-handed people, therefore, become aphasic only when the lesions include 
the right hemisphere; while lesions of the left lobe always cause aphasia in 
right-handed persons. 

These lesions for the most part consist of necrotic softenings from em- 
holism and thrombosis of the artery of the fissure of Sylvius; then follow in 
frequency in the order named hemorrhages, abscesses and tumors of this 



94 BRAIN. 

region. Aphasia is, therefore, merely a symptom of pathological conditions, 
most of which we have already described separately. Its Prognosis de- 
pends entirely on the severity of these conditions, and they ought to be 
studied thoroughly in any case of aphasia. 

THERAPEUTIC HINTS.— Here we must naturally refer to those 
already given under the corresponding chapters. Cases reported have been 
cured by : 

Bellad., compare symptoms under apoplexy. " After excessive fatigue, 
bad nourishment, loss of sleep, prostrated and enfeebled, that he cannot 
answer the simplest question." — (Gallavardin.) 

Conium, parenchymatous nephritis after scarlet fever. 

Glonoin., loss of memory for words and of the power to articulate. 

Kali brom., 3d trit., without symptoms mentioned. 

Lycop., confusion of thoughts; forgetful; mixed up letters and sylla- 
bles of words in writing, or left out part of them. 

Stramon., in several cases used empirically with success. 

For additional hints compare the following collection of symptoms : 
Senseless after waking from a sleep at noon : Conium. 
Forgetful and absent-minded, with headache: Amm. carb. 
Cannot remember things which he wants to remember : Hyosc. nig. 
Forgets names: Anac, Oleand., Sulphur. 

Remembers having seen a person, but cannot remember her name : Crocus. 
Air things appear new to him, after waking, even his friends: Stramon. 
Makes mistakes about time and objects, although they are quite clear and 

visible: Crocus. 
Unable to express himself properly while talking: Conium. 
Cannot talk connectedly: Canthar. 

nor express himself properly, with rush of blood to the head : Arg. nitr. 

Distracted, does not know what to say : Natr. mur. 

Slow remembrance, talks slow, hunts for the words when talking: Thuja. 

Absent-minded and forgetful : Alum., Bellad., Bovista, Coccul., Phosph. ac, 

Platin. 

with awkwardness in talking: Amm. carb., Natr. mur., Sepia, Sulph. ac. 

and awkwardness in writing: Bovista. 

Inability to find the right words : Anac, Arg. nitr., Mercur., Pulsat. 

with stammering: Chamom., Opium. 

with making mistakes in writing : Chamom., China, Graphit., Hepar, 

Ignat., Nux vom. 
With headache uses wrong words : Caustic, Nux mosch., or 
has difficulty in talking: Thuja. 



THROMBOSIS OF THE CEREBRAL SINUSES. 95 

Absent-minded, says what she does not intend : Natr. mur., and 

makes mistakes in writing: Natr. mur. 

Leaves Avords out when writing : Rhodod. 

When he wants to write something down, he loses the ideas : Crocus. 
Forgetful, so that he cannot recall what he was about to write : Natr. mur. 
He can express himself on abstract subjects very well; when talking about 

common things, he gets confused : Lycop. 
He cannot read what he wrote himself: Lycop. 
Difficulty in understanding what he is reading: Conium. 

Thrombosis of the Cerebral Sinuses. 

The sinuses being of a rigid nature and incapable of collapsing, they being 
also traversed by bands of connective tissue, and having no muscular walls 
to promote the flow of blood, it is easily comprehensible, that in them a 
coagulation of blood may readily occcur, if either the 'propelling power of the 
heart, the vis a tergo, should become weakened, or there should form obstacles 
to the flow of blood in the sinuses themselves by inflammation of their walls 
(jyhlebitis). The first usually occurs under conditions as are know by the 
name of marasmus, particularly common among children during their 
first year of life, when they are prone to sudden collapse induced by severe 
diarrhoeas; also in adults through the influence of various conditions which 
induce enfeeblement of the propelling force of the heart, such as profuse sup- 
puration, cancer, marasmus senilis, etc. This form of thrombosis is especially 
found in the longitudinal sinus and in the transverse sinuses, and is called 
marantic thrombosis. 

The second or phlebitic form originates most commonly from disease 
of the cranial bones, especially of the petrous portion of the temporal bones 
which accompanies otitis media ; then its seat is in the neighboring sinuses 
— the sinus transversus and petrosus ; if phlebitis arises from caries of other 
cranial bones, or large furuncles in the face, especially on the upper lip, or 
erysipelas of the head and face, its seat is determined by the location of these 
lesions. 

The Symptoms of marantic thrombosis when accompanying conditions 
of marasmus in children, resemble greatly those of hydrencephaloid, both 
giving rise to cerebral ansemia ; collapse, followed by somnolence and coma, 
is common to both. As a general rule of distinction between the two, the 
following may be laid down: If diarrhoeas, occurring in children a few months 
old, are followed by cerebral disorders of the active motor kind, such as 
rigidity of the muscles of the neck and sometimes of the back, and even of 
the limbs, sometimes nystagmus, the probability speaks for thrombosis of the 
superior longitudinal sinus; whereas the clinical history of hydrencephaloid 



96 BRAIN. 

usually closes with collapse, somnolence and coma, terminating either in 
death or recovery; convulsions or paralysis are only exceptionally met with. 

Marantic thrombosis in adults is in its manifestations still mere indefinite. 
It may show nothing but a slight degree of apathy and general depression, a 
varying complex of symptoms of diffused, undefined cerebral diseases, such 
as headache, delirium, loss of consciousness, disturbance of the motor func- 
tions either of the spasmodic or paralytic kind. In some cases, however, 
symptoms occur in children as well as in adults, which are diagnostic, namely: 
swelling of those veins outside of the skull, which communicate with the affected 
sinuses; epistaxis; tensely filled vessels, running from the anterior fontanelle to 
the neighborhood of the temples and ears on both sides; cyanosis of the face, 
all this in case of thrombosis of the superior longitudinal sinus. 

When the transverse sinuses are affected, there may be ozdema limited 
to the parts behind the ears ; or the internal jugular vein may be found less 
filled on the side of the lesion, than on the other side, but this symptom is 
not often so prominent that it could be turned to account. 

When the sinus cavernosus is the seat of the disease, there usually exists 
hypercemia of the fundus ocidi, oedema of the eyelids and conjunctiva, and prom- 
inence of the eyeball; sometimes on account of the pressure upon the first 
division of the trigeminus, the trochlearis, the abducens, and the oculo- 
motorius, paralysis of the motor nerves, or neuralgia or trophic disturbance 
of the eye may arise. 

Sometimes particles from the thrombi are carried off by the blood-cur- 
rent and become lodged in the lungs. If such pulmonary embolism are found 
under conditions above described, it would be another sign in favor of the 
conclusion, that thrombosis of the cerebral sinuses actually exists. 

The Prognosis of this affection is decidedly unfavorable, and in regard 
to therapeutic hints, I must refer to hydrencephaloid, anaemia, summer-com- 
plaint, inflammation of the inner ear and other affections which are more or 
less related to this affection. 

Hypertrophy of the Brain 

Means an overgrowth of the brain. However, we ought to know, that it is 
not the cerebral substance itself, which develops more largely than naturally, 
but that it consists of an undue growth of the interstitial tissue which binds 
the nervous elements together. It is confined mostly to the cerebrum ; yet 
there are a few cases in which the cerebellum has also been said to be affected. 
Partial hypertrophy is still more rare, and, in part, of very doubtful nature. 
On post-mortem examination the brain is observed to swell out from 
under the removed bone above the skull bones. The adjustment of the re- 
moved bones to their original position is quite difficult. The membranes are 



ATROPHY OF THE BRAIN. 97 

thin and bloodless, and between the arachnoidal spaces there is no cerebro- 
spinal fluid. The convolutions on the surface of the cerebral hemispheres 
are flattened and compressed, and the sulci between them scarcely noticeable. 
The ventricles are narrow and the substance of the brain itself is anaemic, 
but its consistence and elasticity is greater than in a normal brain. 

This abnormal growth is either congenital (and then is frequently com- 
bined with an imperfect growth of the body), or it develops itself after birth, 
mostly during early childhood, rarely afterwards. In the latter case we find 
it frequently associated with rhachitis and enlarged lymphatic glands. Its 
Causes are unknown. Its external Symptoms are: a considerable enlarge- 
ment of the head, if it takes place before the sutures of the skull are perfectly 
closed; a condition entirely similar to that in the enlargement of the head in 
consequence of hydrocephalus. When it takes place after the closure of the 
sutures, such extension is impossible, but the skull bones grow thinner and 
their inner layer becomes roughened by absorption. In the first place it can 
be distinguished from hydrocephalus by this fact: that children having this 
affection are rather forward in their mental development, while in hydro- 
cephalus the reverse always obtains. A hypertrophy after the closure of the 
sutures is never recognizable with certainty. One of its most important 
symptoms, however, are frequent attacks of fits, which resemble epilepsy. 

THERAPEUTIC HINTS cannot be given a priori. Each individual 
case must be studied by itself. Compare Hyperemia. 

Atrophy of the Brain 

Is the opposite of hypertrophy, a shrinking, wasting away of the brain. 

Deficiencies of growth have been found congenital, being confined 
either — 1, to both hemispheres of the cerebrum; or, 2, to both hemispheres 
of the cerebellum; or, 3, to certain parts of the brain which are not developed 
at all. In such cases the children are idiots. In some other cases the defi- 
ciency has been found confined — 4, to one-half of the cerebrum and to the 
opposite half of the cerebellum (the usual condition), or to the corresponding 
half of the cerebellum; then the children are not idiots, but mostly affected 
with hemiplegia of the opposite side and in a great many cases with epileptic 
fits. This deficiency, in the proper development of the brain, the causes of 
which we do not know, is called agenesia. 

Real atrophy is a shrinking — wasting away — of the cerebral substance. 
It occurs, occasionally, in old age, in consequence of marasmus senilis, where 
a want of general nutrition causes a waste of the brain ; the lost substance 
being at once replaced by an exudation of serum, constituting hydrocephalus 
senilis. It also occurs as a result of exhausting diseases and chronic alco- 
holism, almost always leading to general paralysis and imbecility of mind. 
7 



98 BRAIN. 

But it may develop itself in portions of the brain only — partial atrophy 
— when in consequence of apoplexy, inflammation or exudation, as we have 
already seen, by destruction or pressure upon the capillaries or arteries, such 
portions become deprived of the necessary nutrition. Its consequences are, 
in almost all cases, aberrations of the intellect, imbecility of mind, and para- 
lytic affections. 

THERAPEUTIC HINTS.— A deficient development of a portion of 
the brain can not be remedied ; congenital deficiencies are therefore clearly 
out of the reach of any medicine. Where we suspect an atrophy in conse- 
quence of exhausting disease, we must select our remedies according to these 
circumstances. Destroyed portions will ever remain destroyed in spite of 
medicine. 

Dementia Paralytica 

Is understood as "a diffused disease of the brain and often also of the spinal 
cord, which is characterized by a peculiar combination of physical changes 
with motor disturbances in the muscles of different parts of the body, which 
has a chronic course and ends in death." (Hitzig.) 

In the protracted cases post-mortem always shows atrophy of the brain, 
which can be recognized by inspection and frequently by weight. The dura 
lies in folds over the frontal lobes; the pia is either locally or universally 
cedematous; the ventricles are enlarged; the dura often adheres so firmly 
to the skull that it cannot be removed without injuring the brain; it may 
present all varieties of dulness, thickening and deposits upon its surface, also 
innumerable larger or smaller flattened extravasations, which have all shades 
of color between yellow, red and black ; even large hematomas have been 
found ; yet there are numerous other cases in which the dura appeared intact. 
The brain-tissue by microscopical examination reveals a chronic or sometimes 
a subacute interstitial (peri) encephalitis, which in course of time leads to 
destruction of the ganglion cells and to atrophy of the brain. The spinal cord 
presents gray degeneration of the posterior columns or granular cell myelitis ; 
the membranes of the spinal cord undergo, though more rarely, changes 
similar to those of the brain. 

As predisposing Causes heredity has been mentioned. Probably the 
combination of excessive labor with excesses in Baccho and Venere is the 
most common cause, although injuries of the head, constitutional syphilis 
and the influence of acute febrile diseases may also give rise to the develop- 
ment of this disease. It scarcely occurs under the age of twenty ; is most 
frequent between thirty and forty-five or, according to some authors, between 
fifty and sixty years of age. 



DEMENTIA PARALYTICA. 99 

Its Prodromal Symptoms, which sometimes for years precede the 
final outbreak, are the most important for the physician, because then and 
there lies his only chance of preventing greater mischief. Spells of dizziness, 
'which pass over quickly ; of headache, more or less severe and worse in the 
morning,- of rheumatic pains, especially in the lower extremities, changing 
location and coming and going suddenly, worse at night. With these chance 
symptoms appear an unusual irritability of character entirely foreign to the 
patient's former behavior, and a weakness of memory, especially for recent 
events, while past ones are well remembered; he often forgets his hat, his 
cane, or pocket handkerchief, etc. ; the muscles around his mouth occasionally 
are seen to tremble either spontaneously or when other facial muscles are in 
action. The patient is unconscious of it, and recognizes the fact only when 
he sees it in the mirror; his speech becomes nasal, or difficult and imperfect, 
especially in regard to the labials and sibilants; a kind of lisping as if 
slightly intoxicated ; the tongue trembles, and the voice changes. Apoplectic 
attacks are often the commencement of the disease. 

In its further progress the patient shows peculiar exaggerated ideas of his 
own importance or greatness, he possesses a thousand or a million horses, a 
thousand million dollars, etc., and although now it may be proved to him, that 
he is wrong, he immediately forgets all about it, and gradually falls into an 
idiotic silliness from the weakness of memory, which was one of the very first 
symptoms of the disease. He also gradually loses his affection for his family. 
and before his friends may have become aware of his unaccountableness, he 
may have squandered away the very subsistence of his family. Sometimes 
there are outbursts of anger amounting to blind rage, making him dangerous 
to those around him, and in other cases we meet with depressing, hypochon- 
driacal, melancholic states of mind, which again may interchange with con- 
ditions of excitation. So also is kleptomania of frequent occurrence; the 
patients pocket things without in fact knowing it, or carry them away openly, 
because they believe they are making use of their own property. 

The Motor Changes consist either of disturbances of co-ordination — 
staggering when the eyes are shut; jerking, uncertain gait, difficulty of 
turning round, peculiar trembling, jerking handwriting — when there is gray 
degeneration of the posterior columns — or shuffling, awkward, helpless gait, 
unsteadiness on attempting to turn quickly, but no increased swaying of the 
body when the eyes are shut — when there is granular cell myelitis. More 
or less complete, persistent, unilateral facial paralysis is often noticed, and 
if apoplectic attacks repeat, they leave behind hemiplegia which may dis- 
appear again, while the intelligence degenerates so much more quickly; or 
the attack is often combined with unilateral or general epileptiform spasms, 
ending occasionally in death. Anccsthesia, persistent and extreme, is found 
in all cases, when far enough advanced. 



100 BRAIN. 



Senile Dementia. 



"To be perfectly candid, we must confess that there is not a single 
symptom which is so pathognomonic of general paralysis that it may not be 
found also in senile dementia, and excepting the peculiar weakness of mem- 
ory, in alcoholism also ; and even the grouping of the symptoms as a whole 
may, in the two latter diseases, be such as to afford an entire analogy with 
undoubted cases of general paralysis. In senile dementia the course of the 
affection itself often enough furnishes no definite conclusion, while alcoholism 
certainly affords a much more favorable prognosis." 

" Only those cases can with certainty be considered as senile dementia 
in which advanced age, want of motor disturbances, or the presence of very 
marked hemiplegia, and, finally, absence of the extravagant delirium of 
grandeur, are all found associated. The delirium of old age is, as a rule, 
almost invariably of a more childish nature, while it is concerned with the 
most diverse subjects. Besides, epileptiform attacks almost never occur in 
the dementia of age, and the apoplectic attacks of these old people are accom- 
panied with serious permanent paralysis, if they do not end in death. Finally, 
the course of senile dementia is regular, less broken by remissions and inter- 
missions. Nevertheless, that is an uncertain criterion, and the same may be 
said to a still higher degree of all the other diagnostic points mentioned 
above." (Hitzig.) 

Amm. carb., gloomy and uneasy mood, aggravated by cloudy weather ; 
low spirits, with considerable excitement ; very forgetful, and headache when 
reflecting ; absence of mind, with anxiety ; speaks and writes incorrectly ; 
women lose all taste for dress and nearly their intelligence; weight and con- 
fusion of the head ; vertigo, as from intoxication ; great lassitude, and disin- 
clination to all work; most severe muscular contractions, spasms; violent 
rheumatic drawing pains through all the limbs, hands, feet, nape of the 
neck, head, etc. (Lilienthal.) 

Aurum. — We here find hypochondriasis, but not melancholia so much ; 
the epilepsy rests upon a very material basis; the exhaustion is a natural 
consequence of premature senility, hence the disgust of life, and we mention 
it only as having many symptoms in common with the prodromal stage, but 
the causes being so often different, it will be only in rare cases of real benefit. 
It may alleviate, but will not stay the ravages of this disease. 

Bellad., after excessive fatigues, bad nourishment, loss of sleep, pros- 
trated, enfeebled, imbecile; dilatation of pupils. (Gallavardin.) 

Caustic, great melancholy, looking on the dark side of everything; 
facial neuralgia and facial paralysis ; weakness of voice, and other paralytic 
affections. Hypochondriac depression of spirits; peevishness; dull, gloomy; 
pressure on the brain making the head feel obtuse; vertigo; incipient amau- 



SENILE DEMENTIA. 101 

rosis ; roaring and buzzing in the ears ; rheumatic and arthritic affections of 
all kinds; tremulous weakness; epileptic convulsions; prosopalgia; para- 
lytic affections, especially of one side. Tearing, lancinating pains of the ex- 
tremities; muscular twitchings, and excessive weariness in both limbs, espe- 
cially in the morning in bed; attacks of spasms, in the morning in bed, 
sometimes with consciousness, at other times with unconsciousness; peevish, 
irritable mood, fretfulness, indolence ; slow succession of thoughts, absence of 
mind with loss of ideas; weakness of memory; vertigo, forward and sideways, 
at night in bed; vertigo, almost like a loss of consciousness, while sitting he 
nearly fell; constrictive pressure in the forehead; tensive headache arising 
from the nape of the neck; indistinct vision, it seems as though a thick cloud 
hovered before the eyes; spasmodic sensation in the lips, etc. (Lilienthal.) 

Cuprum. — What Zincum is for later stages, Cuprum might be for the 
prodroma. According to Schmid, of Vienna, all the cerebral disorders cured 
by Cuprum are of the reflex order, which would limit the applicability of 
Cuprum in dementia paralytica to very rare cases; still, Kademacher's in- 
dication, when there is premature exhaustion of strength in illness, may point 
towards its use in patients of neurotic temperament, especially where heredity 
can be shown. 

Laches., for persons with a melancholic or choleric temperament, with 
a phlegmatic, spongy constitution ; with dark eyes and disposition to lowness 
of spirits and indolence; for acute and chronic rheumatism, recurring every 
year; for emaciation and exhaustion; for hemiplegia; for convulsions and 
epilepsy. Among its symptoms we read: Indolent, taciturn, brooding and 
melancholic; he considers himself too feeble to do anything, with aggrava- 
tion of the symptoms every other day ; great absence of mind ; great weak- 
ness of memory, he forgets entirely what he had been hearing a moment be- 
fore ; frequent mistakes in writing ; vertigo, with staggering to the left side, 
early in the morning after rising ; deep stinging through the whole head ; 
deep seated headache ; sensitiveness of the eyes to light ; dim and weak eyes ; 
very sensitive to noise ; prosopalgia ; distortion of mouth and lips ; difficulty 
of speech, as if the tongue were too heavy ; rheumatic pains extending from 
the back to the limbs; difficulty of falling asleep for weeks; no sleep in spite 
of great lassitude; constant exhausting sleeplessness; aggravation of all com- 
plaints after sleeping ; painful wandering of the pains from one part to another ; 
awkward, stumbling gait; hemiplegia; typical recurrence of the aggravations. 
(Lilienthal.) 

Natr. mur., "brain-fag from overwork; difficulty in thinking; sad; 
angry at trifles; called up all the past grievances and loved to dwell upon 
them ; headache as though the head would burst, worse in morning on awak- 
ing, from thinking and reading; sweating at times; neuralgic pains occasion- 
ally running up back of neck, like stitches; frequent attacks of uncontrol- 



102 BKAIN. 

able weeping, during which any attempt at consolation is met by a violent 
outburst of anger; flares up at the merest nothing, followed by weeping; 
forgetful; omits words in writing; tells the same story over and over again. 
Eyes sensitive to light ; blur as soon as he attempts to read ; eyeballs feel 
stiff when moving them ; humming in the ears ; speech drawling, with numb- 
ness and stiffness of tongue, especially in the morning; appetite good, often 
ravenous; sometimes cramp in stomach, better from tightening clothes; 
tongue slightly coated white, in morning feels dry and sticky (but is not so), 
and burns, especially at tip ; more or less loss of taste ; posterial nasal catarrh 
with loss of smell and hawking of clear mucus in the morning; when first 
awaking, mouth is dry, burns a little, and feels sore; lips dry; very thirsty, 
especially towards night; wants all his food very salt; empty eructations, 
especially after eating; bowels constipated; stools light brown or yellow, 
crumbling, very difficult owing to actual contraction of anus, as well as in- 
activity of rectum, followed by burning and smarting at anus ; urine clear, 
light-colored, and passed too frequently ; any excitement causes immediate 
desire to urinate ; bruised, lame pain in small of back, as though he could 
not stand straight, relieved by pressing something hard against it; hands tend 
to go to sleep; unrefreshed and dizzy in the morning; itching and pricking in 
various parts, skin unhealthy ; sweats very easily with great relief; skin of 
face has greasy look. Attacks intermittent; painful sensations in various 
localities ; better in open air." (F. F. Laird, Hahnemannian Monthly, April, 
1882.) "Haggard eyes, dull features, just intelligence enough to ask me to 
cure him, in senile dementia; formerly subject to haemorrhoids." "Begin- 
ning general paralysis; unjustifiable antipathy against certain persons, with 
increasing awkwardness." (Gallavardin.) 

Nux vom. exactly suits such cases which owe their origin to sexual 
excesses and immoderate intellectual exertion, and also to persons of middle 
age, especially when they have changed their former busy life for a quiet one. 
Among its symptoms we find : Periodical affections of the nervous system; 
tearing, drawing-tensive rheumatic pains, with weakness and feeling of numb- 
ness in the affected parts ; hyperesthesia of the nerves of the senses ; tonic 
spasms and convulsions; emotional epilepsy; central softening of the spinal 
cord (here also the gray matter) ; paralysis of the upper and lower extremi- 
ties ; periodical headache, gradually increasing, and after reaching its acme, 
gradually decreasing; dulness of mental powers; obscuration of sight; pa- 
ralysis of the tongue, with difficult and indistinct speech, in consequence of 
cerebral apoplexy. The irritable temper of Nux is well known, and even 
for the second stage of the disease we find corresponding symptoms, as awk- 
wardness, he easily stumbles against something; makes mistakes in speaking 
and writing (certainly cerebral functions) ; compression of the head as from 
nightly revelling; chronic vertigo, with obscuration of sight and buzzing in 






DIGEST TO DEMENTIA PARALYTICA. 103 

the ears; twitching of the facial muscles; distortion of the mouth to one side, 
etc. (Lilienthal.) 

Phosphor, is the grand remedy for a weak, exhausted brain. Here 
we have to deal with a disease whose whole tendency is to degeneration of 
the nerve-mass, to atrophy of the brain, and we might with certainty expect 
some benefit from a remedy which causes fatty degeneration throughout the 
body. Among its symptoms we find : Great lowness of spirits ; great irrita- 
bility ; forgetful and dizzy ; vertigo ; dull, stupefying headache ; constrictive 
headache every other day ; frequent attacks of sudden blindness in the day- 
time, and sensation as if a gray cover were hanging over the eyes ; constant 
buzzing in the ears ; pale, sickly complexion ; great weariness in the extremi- 
ties ; sleeplessness and restlessness ; heaviness of mind and body ; exaggerated 
ideas of his own importance ; monomania le grandeur et de la richesse ; for- 
gets names and what has happened recently; unconnectedness of ideas when 
writing or talking ; lastly silliness ; idiocy. 

Silic. — Carroll Dunham, in his usual masterly manner (N. A. J. of 
H., xx, 361), thus describes the action of Silicea on the nervous system : 
"With evidence of exhaustion, furnished by sensation of weakness, paralysis, 
etc., there is an exalted condition of susceptibility to nervous stimuli; the 
special senses are morbidly keen, the brain cannot bear even moderate con- 
cussion, and the whole surface is unnaturally tender and sensitive; cold 
aggravates and warmth relieves. There is an erethism, conjoined with ex- 
haustion, which is not evanescent, but endures for some time." Certainly 
such a remedy promises much in the prodromal stage of our disease, and 
carefully studied and applied in the right case may fulfill this promise and 
lead to a cure. (Lilienthal.) 

In addition I may recommend to compare corresponding chapters, pre- 
viously treated of, and also chronic alcoholism. 

Digest to Dementia Paralytica. 

STAGES. Loss of memory: A rg. nitr. 

For prodromal stage: Cuprum, Nux vom., 

Silic. 
For the second stage with symptoms 

like: awkwardness, he easily stumbles 

against something; makes mistakes in 

speaking and writing; compression of 

the head as from nightly revelling; 

chronic vertigo, with obscuration of 

sight and buzzing in the ears; twitching Forgets entirely what he had been hear- 

of the facial muscles; distortion of the ! ing a moment before: Laches. 

mouth to one side: Xux vom. 
For later stage : Zineum. 



Weak memory : Cirb. veg., Cxustk. 
for what has happened : Graph it., 

NaJtr. mur., Phosphor., Sulphur. 
for words and names : Baryta, Lycop., 

Phosphor., Sulphur. 

on awaking : Staanum. 

with debility : Nitr. ac. 

with headache: Kalmia, Moschus. 



Forgetfulness: Amm.carb., Capsic, Cms- 
tic, Mezer., Jloschus, Natr. mur., Viol. od. 



104 



BRAIN. 



Forgetfulness, and dizzy : Phosphor. 

Unconnectedness of ideas when writ- 
ing or talking : Phosphor. 

Speaks and writes incorrectly : Amm. 
carb. 

Frequent mistakes in writing: Laches. 

Omits words in writing : Natr. mur. 

Incapable for doing business : Arg. nitr. 

Awkwardness : Natr. mur. 

Great absence of mind : Laches. 

Loses the train of ideas : Amm. carb., 
Caustic. 

Absence of mind, with anxiety : Amm. 
carb. 

Tells the same thing over and over again : 
Natr. mur. 

Calls up all past grievances to dwell upon 
them : Natr. mur. 

Heaviness of mind and body: Phosphor., 
Phosph. ac. 

Slow succession of thoughts : Caustic. 

Obtuseness of intellect with obscuration 
of eyes : Carb. veg. 

Dulness of mental powers : Nux vom. 

with prostration : Alum., Anac, 

Aurum, Digit. 

Difficulty of thinking : Natr. mur. 

Mental listlessness and nervous affection: 
Nux mosch. 

and physical prostration in the morn- 
ing : Laches., Phosphor. 

Nearly loses intelligence: Amm. carb., 
Natr. mur. 

Bodily and mental infirmity : Natr. carb. 

Silliness, idiocy: Phosphor. 

Prostrated, enfeebled, imbecile after ex- 
cessive fatigues, bad nourishment and 
loss of sleep : Bellad. 

Idiotic condition before the attacks: 
Ciustic. 

exaggerated ideas of his own import- 
ance, monomania le grandeur et de la 
richesse: Phosphor. 

Doxomania, conceited mania: Platina, 
Cuprum, Hyosc, Laches., Lycop., Stramon., 
Veratr., Alum., Arnica, China, Conium, 
Ferrum, Ipec., Paris, Phosphor., Secale. 

Mania de grandeur: Cuprum, Platina, 
Lycop., Laches., Stramon., Veratr. 



Periodical mania : Arg. nitr. 



Weeping spells, during which any at- 
tempt at consolation is met by a violent 
outburst of anger: Natr. mur. 

Kleptomania: Sulphur, Pulsat., Arsen., 
Pry on., Kali, Lycop., Nux vom., Sepia. 

Extravagance : Ammon., Bellad., Caustic, 
Chinin., Iodine,Petrol.,Phosph. ac., Platina, 
Stramon., Sulphur, Veratr. 

Indisposed to work or walk: Zincum. 

Great lassitude and disinclination to work : 
Amm. carb. 

Lassitude with irritability : Ambra, Cole, 
carb., Carb. veg., Ciustic. 

No ambition, soon tires : Nux vom. 

Loses all interest in work and business: 
Arg. nitr. 

Indolence : Caustic. 

taciturn and brooding : Laches. 

Sad : Natr. mur. 

Great lowness of spirits : Phosphor. 

and indolence ; with dark eyes : Laches. 

with considerable excitement: Amm. 

carb. 

Women lose all taste for dress: Amm. 
carb. 

Melancholy : Arg. nitr., Laches. 

looks on the dark side of everything : 

Caustic. 

with a phlegmatic spongy constitu- 
tion: Laches. 

Gloomy and uneasy mood, aggravated by 
cloudy weather : Amm. carb. 

Hypochondriasis : Aurum. 

Fear, by noise in the street : Caustic. 

Disgust of life: Aurum. 

Great irritability: Nux vom., Phosphor. 

and discontented : Nux vom. 

Peevish, irritable mood, fretfulness: 
Caustic. 

Fretful, discontented, complaining : Arsen. 

Angry at trifles : Natr. mur. 

Flares up at the merest nothing, followed 
by weeping : Natr. mur. 

Antipathy against certain persons: Natr. 



Vertigo : Arg. nitr. 



DIGEST TO DEMENTIA PARALYTICA. 



105 



Vertigo on walking with shut eves : Arg. 
nitr. 

on seeing high houses ; it makes him 

stagger: Arg. nitr. 

as from intoxication : Amm. carb. 

almost like a loss of consciousness, 

wliile sitting he nearly fell: Ciustic. 

dull, stupefying headache: Phosphor. 

forward and sideways, at night in bed : 

Caustic. 

Avith staggering to the left side, early 

in the morning after rising: Laches. 

and unrefreshed in the morning : Xatr. 

mur. 

Congestions to the head: Arg. nitr. 

Headache with diminished intellectual 
power: Phosphor., Xux mosch., Sarsap. 

with ill-humor, and especially in the 

forenoon: Amm. carb., Kreos., Platina, 
Petrol., Stannum (gradual increase and 
gradual decrease), Calc. phosph., Phosphor. 

from reflecting: Amm. carb. 

as though head would burst: Xatr. 

mur. 

worse in morning on awaking : Xatr. 

rnur. 

worse from thinking or reading : Xatr. 

mur. 

worse from reflecting: Amm. carb. 

Periodical headache, gradually increas- 
ing, and after reaching its acme gradu- 
ally decreasing : Xux vom., Stannum. 

Deep-seated headache: Laches. 

Pressing pain all over the head, some- 
times only on the left frontal bone, better 
by external pressure: Arg. nitr. 

Pressure on the brain making the head 
feel obtuse: Ciustic. 

Constrictive pressure in the forehead: 
Ga ustic. 

headache every other day : Phosphor. 

Tensive headache arising from the nape 
of the neck: Caustic. 

Weight and confusion of the head : Amm. 
carb. 

Deep stinging through the whole head: 
Laches. 

Sensation in forehead as if the skin were 
too tight, with anxiousness : Phosphor. 



The brain cannot bear even moderate 
concussion: Silic. 



Eyeballs feel stiff when moving them: 

Xatr. mur. 
Dilatation of pupils: Bellad., Calcar., 

Crocus, Hyosc, Xux vom., Opium. 
The special senses are morbidly keen: 

Silic. 
Sensitive to light : Arsen., Laches., Xatr. 

mur. 
Dim and weak eyes: Laches. 
Indistinct vision, it seems as though a 

thick cloud hovered before the eyes: 

Ciustic 
Blur as soon as he attempts to read: Xatr. 

mur. 
Sees objects cloudy, sometimes double: 

Arg. nitr. 
Obscuration of sight: Xux vom. 
Frequent attacks of sudden blindness in 

the daytime, and sensation as if a gray 

cover were hanging over the eyes: 

Phosphor. 



Oversensitiveness of hearing: Carb. 

veg. 
Noise unbearable, with anxiety: Aurum, 

Capsic, Caustic, Petrol., Pulsat. 
Very sensitive to noise : Laches. 

with ill-humor : Bellad, Phosphor. 

Humming in ears: Xatr. mur. 
Roaring and buzzing in ears : Caustic. 



Posterior nasal catarrh with loss of smell : 
Xatr. mur. 



Face looks old, and of earthy color: Arg. 

nitr. 

emaciated, colorless : Arg. nitr. 

Haggard eyes and dull features: Xatr. 

mur. 
Pale, sickly: Phosphor. 
Greasy look: Xatr. mur. 
Prosopalgia : Caustic, Laches. 
Distortion of the mouth : Bellad., Graphit., 

Laches., Lycop., Xux vom., Opium, Phosph. 

ac, Secale, Siramon. 
Spasmodic sensation in the lips: Caustic. 



106 



BRAIN. 



Lips dry : Natr. mur 



Mouth dry ; burning and sore in morning : 
Natr. mur. 

Tongue feels dry and sticky, but is not so : 
Natr. mur. 

burns at tips : Natr. mur. 

slightly coated white : Natr. mur. 

Loss of taste : Natr. mur. 

Speech drawling, with numbness and 
stiffness of tongue, especially in morning : 
Natr. mur. 

Difficult speech : Bellad., Caustic, Laches., 
Nux vom., Opium, Sulphur, Stramon., 
Veratr. 

Paralysis of the tongue, with difficult and 
indistinct speech, in consequence of cere- 
bral apoplexy : Nux vom. 

Cannot move the tongue right, with anx- 
iety: Caustic. 

As if tongue were too heavy: Laches. 

Cannot talk : Arg. nitr. 

Hawking of clear mucus in morning: 
Natr. mur. 

Hoarse voice: Arg. nitr. 



Appetite good, often ravenous : Natr. mur. 
Craves all food very salt: Natr. mur. 
Very thirsty, especially toward night: 

Natr. mur. 
Empty eructations after eating : Natr. mur. 
Cramp in stomach, better from tightening 

clothes: Natr. mur. 
Constipation: Natr. mur. 
Stools light brown or yellow, crumbling, 

very difficult owing to actual contraction 

of anus, as well as inactivity of rectum, 

followed by burning and smarting at 

anus: Natr. mur. 
Haemorrhoids formerly : Natr. mur. 
Desire to urinate from any excitement: 

Natr. mur. 
Urine clear, light colored and frequent: 

Natr. mur. 



Rheumatic pains extending from the 

back to the limbs : Laches. 
Violent rheumatic drawing pains through 

all the limbs, hands, feet, nape of the 

neck, head, etc. : Amm. carb. 



Rheumatic and arthritic affections of all 
kinds: Caustic. 

Acute and chronic rheumatism, recurring 
every year: Laches. 

Tearing, drawing-tensive rheumatic pains, 
with weakness and feeling of numbness 
in the affected parts : Nux vom. 

Tearing, lancinating pains of the ex- 
tremities: Caustic. 

Painful wandering of the pains from one 
part to another : Laches. 

Great weariness in the extremities : Phos- 
phor. 

Bruised, lame in small of back, as though 
he could not stand straight, better from 
pressing something hard against it: 
Natr. mur. 

Periodical affections of nerves: Nux vom. 

Creeping as of ants in arms and legs: 
Arg. nitr. 

Hands tend to go to sleep: Arg. nitr. 

Entire insensibility of the body, except 
against cold air : Arg. nitr. 

The whole surface is naturally tender 
and sensitive : Silic. 

Hyperaesthesia of the nerves of senses: 
Nux vom. 

Neuralgic pains like stitches up back of 
neck: Natr. mur. 

Intercostal neuralgia : Arg. nitr. 

Muscular tvvitchings and excessive weari- 
ness in both limbs, especially in the 
morning in bed : Caustic. 

Most severe muscular contractions, spasms : 
Amm. co.rb. 

Attacks of spasms, in the morning in bed, 
sometimes with consciousness, at other 
times with unconsciousness: Caustic. 

Tonic spasms and convulsions: Nux vom. 

Convulsions with or without conscious- 
ness : Kali carb., Lycop., Nux vom. , Platina, 
Plumbum. 

and epilepsy : Laches. 

Epileptic convulsions, paralytic affec- 
tions, especially of one side : Caustic. 

fits as complication: Arsen., Bellad., 

Calcar., Cuprum, Hyosc, Ignat., Laches., 
Mercur., Opium, Nux vom., Plumbum, 
Palsat., Sulphur. 



DELIRIUM TREMENS. 



107 



Emotional epilepsy : Nux vom. 

"Weakness of the whole left side: Arg. 
n itr. 

Beginning general paralysis : Natr. mur. 

Constant trembling of the hands: Arg. 
n itr. 

Trembling of limbs : Arg. nitr. 

Tremulous weakness : Caustic. 

Awkward, stumbling gait: Laches. 

Cannot walk with shut eyes: Arg. nitr. 

Exhaustion, sensation of weakness, pa- 
ralysis, etc., with an exalted condition of 
susceptibility to nervous stimuli : Silic. 

Hemiplegia: Laches. 

Paralysis of the upper and lower ex- 
tremities: Nwx vom. 

Paralytic affections: Caustic. 



Sleepy in daytime, sleepless at night: 

Arg. nitr. 
Sleep disturbed by restless dreams : Arsen. 
No sleep in spite of great lassitude: Laches. 
Difficulty of falling asleep for weeks: 

Laches. 
Sleeplessness before midnight: Arsen., 

Kali carb., Pulsat., Veratr. 
Constant exhausting sleeplessness: 

Laches. 
Sleeplessness and restlessness : Phosphor. 
Aggravation of all complaints after 

sleeping: Laches. 



Sweating at times: Natr. mur. 
Sweats easily with great relief: Natr. mur. 



Itching and pricking in various parts: 
Natr. mur. 

Skin unhealthy: Natr. mur. 

Tired: Arg. nitr. 

Lassitude in the limbs, with indisposition 
to work: Amm. carb. 

He considers himself too feeble to do any- 
thing, with aggravation of the symptoms 
every other day : Laches. 

Emaciation : Arg. nitr., Laches. 

AMELIORATION, AGGRAVA- 
TION AND CAUSES. 
"Wants fresh air, windows open, yet to be 

covered: Arg. nitr. 
Feels worse in open air: Natr. mur. 
Cold aggravates and warmth relieves: 

Silic. 
Intermittent attacks: Natr. mur. 
Typical recurrence of the aggravations: 

Laches. 
Brain-fag from overwork: Natr. mur. 
From immoderate intellectual exertion: 

Nux vom. 
Persons of middle age, especially when 

they have changed their former busy 

life for a quiet one : Nux vom. 
After excessive fatigues, bad nourishment, 

loss of sleep : Bellad. 
Exhaustion: Laches. 
Premature exhaustion of strength in ill- 
ness: Cuprum. 
Exhaustion is a natural consequence of 

premature senility : Aurum. 
From sexual excesses: Nux vom. 



Delirium Tremens. 

Delirium tremens is an acute form of chronic alcoholism, which breaks 
out either during and in consequence of excessive use of alcoholic drinks, or 
follows the sudden deprivation of stimulants in the case of habitual soakers. 

Without any marked prodromal symptoms, it commences with hallu- 
cinations of vision (the seeing of beetles, rats, birds, serpents and the like, or 
other horrid images such as great black beasts, the devil, or a persecuting 
officer, etc.), hallucinations always characterized by their unsteadiness and 
horrid nature. If the sense of hearing is affected, its hallucinations are like- 
wise of a horrid nature, although in some cases music, songs and other pleas- 
ant things are heard. Sometimes the patients feel as if they were enclosed 



108 BRAIN. 

in a fine net of spun glass or of some textile fabric, or as if little insects were 
crawling under their skin. They move their hands and fingers objectlessly 
about, or act as if they were removing small objects from their body or bed. 
Their eyes look unsteady and wild and sometimes they even have nystagmus. 
Consciousness they lose seldom or only for a very short time, and therefore 
answer questions for the most part correctly. They are very restless, are 
very much troubled by their hallucinations, and sleep never touches their 
eyes. In some cases they become violent, destructive, maniacal. Tremor, 
more or less extensive and violent, is present in some and absent in other 
cases, as also tetanic and eclamptiform convulsions have been observed in 
some cases. Individual cases, however, vary greatly. All symptoms are 
worse during the night, and the attack lasts from a few days to a fortnight. 
Post-mortems have shown pigmented and thickened mucous membranes of 
the stomach, fatty degeneration of the liver and kidneys, pachymeningitis, 
and dryness and anemia of the brain. 

THERAPEUTIC HINTS. -If the attack sets in during debauch, it 
may be well to apply the stomach-pump, in order to rid the stomach of its 
alcoholic contents. It is also beneficial to urge the patient to drink cold 
water and skimmed milk as much and as often as possible, in order to thin 
the alcoholic poison. One or the other of the following remedies w T ill then 
act so much the more favorably. 

Act. rac, restlessness and fear of death. Hale: "nausea, retching, 
dilated pupils, tremor of the limbs, incessant talking and changing from one 
subject to the other; sleeplessness; imagines strange objects, as rats, sheep, 
etc.; quick, full pulse, and peculiar wild look out of the eyes." 

Agar., no clinical cases as yet, but its symptoms call loudly for its 
mention in this place. 

Arsen., great restlessness, anxiety and oppression with cold perspira- 
tion; hallucination, especially at night; pale or yellowish color of face; 
eyelids red on edges; no appetite, great thirst; vomiting every morning; 
region of liver painful and swollen ; stool retarded and as if burned, or violent 
diarrhoea. For sots who have had attacks before. 

Bellad., young persons with congestion to the head and excitability of 
the sensorium ; want of memory ; sparks like lightning before the eyes ; anx- 
ious and unsteady, walks about as if busy and cannot be persuaded to desist 
of doing different things ; imagines he sees water running over the table, or 
panes of glass, cats, etc. ; wants to extract a tooth, and reaches for that pur- 
pose in his mouth ; stammering, indistinct speech with a constantly smiling 
face; dry feeling in the throat, with difficult deglutition and violent thirst. 
Jerking of limbs ; cramps in the calf of the leg ; trembling of hands. 

Calc. carb., hallucinations of fire, murder, rats, mice, etc.; red face, 



DELIRIUM TREMENS. 109 

dilated pupils; hallooing, screaming, restless; pulse soft, full and frequent; 
skin moist ; tongue coated whitish ; constipation. 

Cann. ind., when the illusions both of sight and hearing are charac- 
terized by taking the form of tremendous magnitude, so that a step ajDpears 
to him as an enormous distance, or a small noise as a tremendous sound. 

Coffea, thinks he is not at home; walks restlessly about; no sign of 
feeling sleepy ; quick pulse and trembling hands. 

Crotal., constant drowsiness, with inability to sleep, after Hyosc. had 
failed. 

Digit., in cases which come on slowly with gradually increasing pain 
in pit of stomach, continuous nausea, thirst, palpitation of the heart, gastric 
headache, vertigo and paleness of face. 

Gelsem., produced sleep, after morphia had failed. 

Gratiola, successful in cases where the delirium assumes the character 
of anger rather than of anxiety, in subjects not yet greatly exhausted. 

Hyosc, epileptiform fit precedes the attack; continuous talking at 
night ; wants to run away for fear of being persecuted by the police ; tremor 
of limbs. 

Ignat., chorea-like and epileptiform convulsions; paresis; anaesthesia 
combined often with hyperesthesia of the legs; subsultus tendinum; jerking 
of the limbs ; trembling of the tongue. 

Kali brom., in first stage with horrid illusions, flushed face, red eyes 
and hard and quick pulse. (Crude doses.) 

Nux vom., most frequently applied. Indescribable anxiety; finds no 
rest in any place; sees different images; congestion to the head; face pale 
and bloated; tongue coated white or brown, dry and thirsty; nausea and 
bitter vomiting; vomiting in the morning; pressing pain in stomach and 
region of liver; trembling, cannot bring the glass to his lips without spilling 
its contents; aversion to coffee; constipation or diarrhoea. 

Opium, preceded by epileptiform fits; imagine they see frightful ob- 
jects, and are in great fear; believe themselves to be murderers or criminals 
who shall be executed; want to run away. Staring look; twitching of the 
muscles of the face and mouth; lockjaw; tremor. Reduced subjects. 

Stramon., frightful visions of animals which appear to jump up at 
his side ; imagines one-half of his body being cut off; hallucination of hear- 
ing, as if on the right side of the occiput a loud voice were abusing and in- 
sulting him; wants to run away; uses wrong words when talking; glisten- 
ing, staring eyes, with enlarged pupils; tremor of all the limbs. 

Tart, emet., after excessive drinking of young persons; gnawing pain 
in the stomach. 

Zincum, great fear, as if persecuted by men or the devil, on account 
of crimes which he has never done; is afraid of becoming imprisoned, or 



110 BRAIN. 

poisoned, or shot, or buried alive, with great excitation, pappy taste, whitish 
coated tongue, eructations, loss of appetite, retarded stool, vertigo and heat 
in head and face. 

Chronic Alcoholism; Dipsomania. 

It is without exception the consequence of long-continued and continuous 
abuse of spirits, and although persons of this category are seldom seen in a 
state of actual drunkenness, still their whole system is shattered and shaken 
to its very foundation. They lose their character ; their craving for drink 
overrules their best intentions; they continually struggle with temptation 
and yield continually to it ; they feel themselves in a continuous conflict and 
dissension with their own better selves, and gradually fall in a state of deep 
melancholy and suicidal tendency from which only a fresh resort to their 
one remedy, w T hisky, liberates them for the time being. And as they grow 
from bad to worse, the higher they stood, the lower they fall, until at last 
they do not shrink from committing crimes in order to gratify their un- 
governable craving. 

Dipsomania occurs in the form of a repeatedly recurring rage for 
drinking, which often is preceded by unpleasant sensations in the lower 
part of abdomen, nausea, vomiting, want of appetite, general depression, 
gone feeling all over, and trembling sensation about the heart. This condi- 
tion often terminates in an attack of madness. 

The psychical degeneration, which differs in different patients, produces 
varied forms of insanity: sometimes forms of exaltation with changing and 
absurd delusions, sometimes forms of melancholy with religious mania, delu- 
sions of persecution, and sometimes mere tranquil dementia. Besides these 
psychical disorders we find others affected with different degrees of paralysis 
of motion and sensation. Paralytic dementia is one of the commoner termi- 
nal diseases of chronic alcoholism, as also apoplectic and epileptic attacks 
occasionally occur during its course. In some patients color-blindness of 
green and bluish-green, amblyopia and amaurosis in various degrees with 
atrophy of the optic nerve has been observed. The chief ailment, however, 
is a chronic gastric catarrh, which makes digestion almost an impossibility 
and interferes entirely with the general nutrition of the body. We therefore 
find the liver almost always affected, ending in cirrhosis ; the kidneys suffer 
with morbus Brigbtii, and some patients die with anaemic symptoms. The 
sexual functions are at first little affected ; in one case, I know of, the sexual 
desire is almost heightened to satyriasis ; in the later stages, however, sterility 
attacks both sexes. The children of alcoholic parents exhibit very often a 
predisposition to psychical disorders and inherit a badly constituted nervous 
system. Children begotten in drunkenness are said to be epileptics from 
their birth. 






CHRONIC ALCOHOLISM. Ill 

The post-mortem appearances vary greatly; there have been found: 
pachymeningitis hemorrhagica ; atrophy of the cortical substance; fatty 
degeneration of the ganglionic cells, of the voluntary muscles, of the heart, 
liver and kidneys ; thickening of the coats of the veins ; thickening of the 
mucous membrane of the stomach and sacrum; flat erosions, hypersemic ves- 
sels and increased pigmentation of the mucous membrane of the stomach ; 
granulated condition due to interstitial development of increased connective 
tissue or cirrhosis of the liver. 

THERAPEUTIC HINTS.— Confirmed drunkards are no doubt hard 
cases to manage. Some we will not be able to reform, unless we can take 
them entirely out of their wonted associations and submit them to moral 
treatment ; others probably may be approached if we succeed in producing 
in them a disgust for whisky, and accustom them to the use of milk as main 
diet. Still others, perhaps all, will be relieved of many of their symptoms 
by a careful selection of one or the other of the following remedies. 

Angelica, in 15 drop doses of the tincture, three times a day, has 
caused disgust for liquor. 

Amm. carb. et caust., in nervous, torpid asthenic cases; in periodi- 
cal hallucinations ; in amblyopia. 

Arnica, during the delirium, when he imagines that he will be arrested; 
also when, after the cessation of trembling, formication and subsultus tendi- 
num, there still remains a weakness or sense of being asleep of the whole mus- 
cular system, slowness of comprehension, ringing in the ears or fog before the 
eyes. Taken in the first dilution, it has also caused a decided disgust for 
liquor. 

Arsen., cachectic paleness; habitual redness of the conjunctiva; sud- 
den loss of strength ; anxiety in pit of stomach ; great restlessness ; affections 
of the heart; oppression of the chest, even suffocative spells, especially on 
moving and at night ; emphysema of the lungs ; dry cough, or difficult, tough 
expectoration. Nausea and vomiting ; great thirst ; tongue dry and intensely 
red at least on point and edges, or whitish coated; watery diarrhoea, worse 
after midnight. Tobacco chewers. 

Carb. veg., digestive troubles, with burning in stomach; heartburn, 
acidity, belching of rancid taste, all worse after eating; retarded stool, hard 
and insufficient; cachectic paleness of face; chilliness. 

Caustic, "a great smoker and lover* of coffee and liquors; morose, un- 
obliging, stingy, making his wife's life miserable." (Gallavardin.) 

China, lienteric diarrhoea ; dropsical affection; exhaustion. 

Ferr. met., earthy paleness of the face, or bloated face, easily flushing; 
roof of mouth always pale. Vomiting of food undigested ; hydrsemic condi- 
tions. 



112 BRAIN. 

Kali bichr., especially in complaints of beer-drinkers. 

Kali brom., headache, with dizziness; staggering as if intoxicated; 
stupefaction; sopor; muscular weakness; anaesthesia of pharynx and velum 
palati and external skin ; sight weakened and hearing impaired. Gastralgia ; 
vomiting; colic; constipation. 

Kreos., habitual vomiting of undigested food; of large quantities of 
sour, acrid fluid, or of white, foamy mucus; diarrhoea profuse, colorless, or 
greenish watery, fetid. 

Laches., worse in the afternoon or after sleep; constant talking and 
jumping from oue subject to another; cannot bear anything tight around the 
neck; great weakness; tremor of hands; liver affections. "Wicked, sullen, 
jealous, neglects business and children." (Gallavardin.) 

Natr. mur., hypochondriacal melancholy; headache (migraine); thin, 
nervous individuals prone to outbursts of passion ; craving for liquor ; diges- 
tion easily disturbed by slight dietetic or mental causes, with furred tongue, 
or map tongue ; great thirst ; slow digestion ; vomiting of clayey substances ; 
stool hard and retarded; venous congestion of liver, pancreas and uterus; 
fluttering of heart; cutting pain in urethra after urination. 

Nux mosch., dulness, heaviness and pressure in the head; dizziness 
and sleepiness; heavy sleep, with clairvoyance and performance of accus- 
tomed work without any recollection when awaking; mind absent, knows not 
where he is or what to answer ; dryness of skin, nose, mouth and throat ; 
flatulency ; retarded stool, or diarrhoea ; liver troubles ; strangury after beer ; 
dyspnoea ; chilliness. Worse from cold and damp air. 

Phosphor., great mental and physical exhaustion; trembling of the 
limbs when trying to use them; jerking of single muscles; arms powerless, 
legs paralyzed; vertigo, with loss of consciousness; indifference even towards 
the dearest friends ; forgetfulness and stupidity in a measure that the patient 
does something else than what he intended ; monomania de grandeur et de la 
richesse; idiocy. Inclined to diarrhoeic stools and flatulency; dry, scaly skin. 
Worse in cool and damp weather. 

Pulsat., is a better antidote to whisky than even Nux vom. (Hering.) 

Selen., craving for liquor. When Sulphur seems indicated and does 
not help. 

Sulphur, very important for many complaints, as its known symptoms 
of the head, stomach, intestinal canal, liver and kidneys abundantly show. 
Drinking on the sly. 

Sulph. ac, vomiting in the morning; acidity of stomach; burning in 
oesophagus and stomach ; sour, acrid or foul eructations. It has been success- 
fully used in subduing the craving for liquor by taking for two or four weeks, 
daily three times, from 10 to 15 drops of Acid. Halleri, which is a mixture 
of one part of sulphuric acid with three parts of alcohol. 



OPIUM AND MORPHIXE-POISOXING. 113 

Tart, emet., gastric catarrh, with great uneasiness in the stomach; 
nausea and vomiting of tough, slimy and bilious matter; watery diarrhoea 
in small quantities ; fulness of pit of stomach and abdomen, with pressure as 
of stones; great thirst; loss of appetite, even disgust for any nourishment; 
tongue moist and whitish coated; bad taste and frequent eructations. 
Bronchial catarrh, with mucous rattling, tough and difficult expectoration ; 
oppression of the chest necessitating the patient to sit up in bed. 

Opium and Morphine-Poisoning. 

The habitual use of opium has in thousands of cases been brought about 
by the criminal ignorance and recklessness of physicians, who know not what 
they are doing, when they prescribe laudanum or morphine for any or every 
little pain, or use it as hypodermic injections. The habit of opium eating has 
so alarmingly increased, that it is necessary to mention here also this arti- 
ficially induced misery of frail human nature. It is not necessary to go into 
the details of Opium symptoms; they can be found in our provings. Its 
chronic effects may be summed up in the following: "General emaciation, 
pale, shrivelled complexion, dry skin, looking like fish-scales, relaxation of 
the muscles, failure of appetite, disturbed digestion; at the commencement 
obstinate constipation, followed later on by dysenteric diarrhoea. Superadded 
are fanciful, discontended temper, giddiness, headache, sleeplessness, all pos- 
sible eccentric neuralgias, failure of memory, understanding, energy and will ; 
patients become untrustworthy and are very regardless of truth, especially 
when they are questioned about their habit ; also paralysis and diseases of the 
bladder." All this is gradually produced by the direct influence of opium 
upon the substance of the nerves, and it is therefore in accordance with the 
nature of opium-action, when post-mortems do not show any particularly 
characteristic anatomical changes. Hyperemia of the brain is most constant ; 
sometimes an accumulation of fluid is found in the subarachnoid spaces and 
in the ventricles; sometimes, also, sanguineous effusions of greater or less 
extent in different parts of the brain. The bladder is generally found dis- 
tended. All other anatomical conditions seem accidental and not due to 
opium-poisoning as such. 

THERAPEUTIC HINTS.— In acute poisonings the stomach-pump is 
a safer and surer means to remove the poison than any of the usual emetics, 
because the latter often fail to produce vomiting on account of the insensi- 
bility of the nerves of the stomach caused by opium, and also because the pa- 
tient escapes by its application a possible gastritis, which often follows the 
administration of Tart, emet and other irritant substances. By its means the 
stomach can be washed out with green tea, coffee or sage tea, by which a less 
8 



114 BRAIN. 

poisonous compound (tannate of morphine) is formed. In order to prevent 
complete narcosis it is well to make the patient walk about for hours, or to 
apply painful stimulation to the skin, the cold douche-bath and the like. 
After sopor has set in, the walking about forbids itself; we should, however, 
conduct as much fresh air to the face and head as possible. In this state in- 
jections of a tea of oats have been recommended. Recently Dr. Sell, of New 
York, applied and recommended concentrated tincture of oats {Avena saliva) 
in 12 to 20-drop doses, three or four times a day. "A fulness at the base of 
the brain will indicate that the dose must not be increased, and a pain in that 
region suggests that an overdose has been given." 

Bellad. is no doubt the best antidote against acute poisoning. Even 
the old school acknowledges it and uses hypodermic injections of Atropine. 

Chamom., when after abuse of morphine to lull pain, sleeplessness en- 
sues and the suffering grows intolerable notwithstanding. 

Ipec, only lately shown as efficient for the cure of the habit of opium 
eating. Fifteen drops of the tincture were given at a time until improve- 
ment set in. 

Nux vom., often indicated in cough and diarrhoea after previous use 
of so-called cough and diarrhoea mixtures, all of which most generally con- 
tain opiates. 

Tumors of the Brain and its Membranes 

Consist of morbid growths in the connective and epithelial tissues of the 
blood-vessels and their sheaths, which either retain the character of the 
affected tissue, or become altered by modification of the newly-formed ele- 
ments and by changes in their relations to the connective tissue and vascular 
distribution. 

Their Causes seem to be a hereditary predisposition, abuses of spirituous 
drinks, blows and falls of all kinds, syphilis and tuberculosis. They occur 
much more frequently in men than in women. 

Tumors which retain the character of the affected tissue, are: 

Glioma, formed by proliferation of the neuroglia, greatly resembles 
normal brain tissue, and is therefore not easily distinguishable ; when it as- 
sumes a more mucous character, it is soft and closely resembles myxoma; 
when its structure is harder, it resembles and is allied to sarcoma. It grows 
slow T ly, may finally undergo fatty degeneration, and is found usually in the 
white substance of the cerebral hemispheres and especially their posterior 
lobes. 

Hyperplasia of the pineal gland presents a solid, grayish-red, slightly 
lobulated or else smooth, round tumor, which may grow as large as a walnut 
or even larger; its histological elements are somewhat larger and firmer than 
in the normal. 



TUMORS. 115 

Psamiliona or saild tumor is an inflammatory proliferation of the eel- . 
hilar tissue in which a calcareous deposit takes place; it usually grows from 
the dura mater commonly at the base of the skull, is a hard, hemispherical 
tumor, white and smooth and of the size of a cherry-stone. 

Melanoma takes its origin in the pigment cells of the pia, is small in 
size, but may be multiple ; is of rare occurrence. 

Neuroma, a genuine hyperplasia of the gray substance, occurs in sizes 
from a millet-seed to that of a pea aud is found on the ventricular surface, in 
the white substance, or on the outer surface of the brain. 

Hyperplasia of the anterior half of the pituitary gland. 

Cysts may be the result from apoplectic effusions, abscesses and softening. 

Aneurisms are of frequent occurrence, especially upon the large ves- 
sels at the base of the brain, and usually in consequence of atheroma ; when 
bursting they cause fatal apoplexy. 

Cholesteatomata consist partly of hardened epithelial cells and partly 
of epithelial cells which have undergone fatty degeneration; they unite, as 
Rindfleish says, "the structure of an epithelial carcinoma with the harmless- 
ness of a wart or weal." They are generally found in some hollow at the 
base of the skull or in some recess of the brain. 

Tumors by which the affected tissue is changed in its character, are : 

Tubercles, gray, yellow, or yellowish-white, hard tumors, which fre- 
quently grow larger than a hazel-nut; their favorite position is the gray sub- 
stance, especially of the cerebellum; they occur most frequently in child- 
hood. Miliary tubercles are a frequent concomitant or source of meningeal 
inflammation. 

Carcinoma appears usually as primary fungus hsematodes on the outer 
or inner surface of the dura. When starting from the outer surface it 
rapidly softens and pierces the skull bones and then spreads on the external 
surface of the skull (fungus durse matris) ; when originating on the inner 
surface its growth is entirely directed towards the brain ; it never penetrates 
the dura, except at the natural openings for the nerves, such as the olfactory, 
optic, etc., hence the growing in and out of cancers in the orbits on the per- 
forated plate of the ethmoid bone, in the spheno-maxillary fossa and so on. 

Sarcoma is either a hard, dense, homogeneous mass, which can easily 
be detached from the surrounding tissue, or is of a soft, medullary consist- 
ence, which constitutes a transition to a myxoma or glioma. 

Myxoma forms a very soft gelatinous mass, which frequently breaks 
down into cysts containing a mucous fluid; they may attain the size of a 
man's fist, and are met with only occasionally in the cerebral hemispheres. 

Syphilitic tumors are not common; they generally resemble the 
gummata of other parts, being composed chiefly of grayish semi-translucent 
matter, which is liable to become opaque and crumbling on undergoing a 
caseous transformation. 



116 BRAIN. 

Symptoms. — One should suppose that the pressure of any of these 
tumors should manifest itself more or less by various outward symptoms. 
But this is not always the case. Large tumors have been found post- 
mortem, and not a single symptom did betray them during life. It is re- 
markable how the system, even the brain, may become accustomed to an 
abnormal growth, when it is invaded slowly. Yet there are symptoms in 
many cases which should rouse our suspicion in this direction. They are: 
" Depression of spirits, melancholy, rarely maniacal attacks, mental derange- 
ment, aphasia, sleepiness ; amblyopia and amaurosis, with the appearance of 
choked disk and neuroretinitis ; inequality of the pupils ; strabismus ; violent 
headache, often accurately localized ; monolateral anaesthesia, usually in the 
form of anaesthesia dolorosa; neuralgia; monolateral paralysis of varying 
degree, gradually increasing; jerking; quivering; cramps of the affected 
groups of muscles, developing sometimes into epileptoid attacks." Further 
on: "imbecility; total want of energy; sopor, comatose condition; wide- 
spread ansesthesia ; very hesitating speech ; paraplegia ; incontinentia urinse 
et alvi, or else retention; increased temperature of the body; symptoms of 
meningitis ; apoplexy." 

Glioma is to be thought of when there is: "preceding considerable 
injury of the skull; slow progress of the symptoms and hence relatively long 
duration of the illness; intercurrent apoplexies; good state of nutrition." 

Tubercular tumors, when there is "a hereditary predisposition to 
tuberculosis; occurrence in childhood; tuberculosis of other organs; com- 
mencement of the symptoms after acute febrile diseases, for instance, measles; 
complication with meningitis." 

Carcinoma, when there is " a rapid progress of the symptoms ; perfora- 
tion of the bones of the skull ; carcinoma in other organs." 

Notwithstanding all this, the Diagnosis of brain tumors will in many 
cases remain problematic and is often impossible. 

THERAPEUTIC HINTS.— Little can be said. In all cases we must 
be governed by the totality of the symptoms, even if we should suspect a 
tumor. 

When a considerable injury of the skull has preceded, we will have to 
choose a remedy accordingly. 

When tubercles are suspected, compare what has been given under 
meningitis tuberculosa. 

In case of carcinoma, compare: Calc. carb. or phosph., Arsen., Carb. an., 
Bellad., Laches., Phosphor., Silic, and many others. 



DROPSY — HYPERTROPHY — BRUISED HEAD. 117 

DISEASES OF THE CRANIUM AND ITS INTEGUMENTS. 



a. ABNORMAL LARGENESS OF THE HEAD 

May be caused by hydrocephalus, hypertrophy of the brain and by pseudo- 
formations within the cavity of the skull, when they perforate the skull. To this 
are to be added morbid conditions of a more external nature. 

Dropsy of the Scalp. 

This is a collection of serum either in the cellular tissue (cellular dropsy) 
or between the aponeurosis and the pericranium (aponeurotic dropsy). When 
the watery fluid collects in the cellular tissue, it is apt to spread down to the 
face ; and on pressure with the finger it leaves a pit, as is seen on all parts 
of the body, where dropsical effusions exist within its cellular tissue. When 
it is underneath the aponeurosis or the galea capitis, the swelling is tight, 
elastic, fluctuating, and leaves no pit on pressure, and never spreads over the 
ears or eyelids, and this for obvious anatomical reasons. 

Both forms exist without cerebral symptoms, and may be the conse- 
quence of either a general dropsical condition, or of erysipelas, external in- 
juries, stings of insects, eruptions, and so on. 

Hypertrophy of the Skull. 

This may either involve a part only of the cranium, in which case it 
forms exostosis or bony protuberances; or the whole skull, whereby the bony 
walls may attain a thickness of one inch and a half. Both forms cause an 
enlargement of the head, and are mostly found as a concomitant to rhachitis 
or syphilis. When they grow from the inner plate of the skull, they do not 
cause an external enlargement of it, and are therefore not recognizable with 
any degree of certainty. 

The Bruised Head of a Child after Birth, 

Caused by the pressure during birth, is either an extravasation of lymph or 
blood into the cellular tissue, in which case it is called caput succedaneum ; 
or it is an extravasation of blood between the bones and the pjericranium, caus- 
ing the affection called thrombus neonatorum. 

The Caput SUC€£daneum may extend over the fontauelles or sutures of 
the bones; it may even be formed on any part of the head sufficiently ex- 
posed to a great pressure of the pelvis, or the forceps, during labor. It has a 
soft, doughy feel, and the outer skin looks bruised. 



118 CRANIUM. 

The Thrombus, however, is confined generally to the parietal bones, 
and never extends over the sutures of the bones, because there the peri- 
cranium adheres firmly to the skull. It feels elastic and fluctuates, and 
shows no discoloration of the external skin. 

Both forms are bruises in their nature, and ought to be treated, should 
treatment be necessary at all, like bruises. Arnica will usually do what is 
required ; in some cases, however, Bar. mur. and Mercur. have been success- 
fully applied. 

b. ABNORMAL SMALLNESS 

Of the head is found in idiots. It may be partial or general, congenital, or 
caused after birth, before ossification is completed. Always, however, it will 
be found in connection with an imperfect development or derangement of the 
brain. 

c. AFFECTIONS OF THE SKULL WITHOUT ENLARGE- 

MENT. 

The cranium consists of two tables, which run parallel with each other, 
and are separated by an intermediate cellular structure, which is called 
diploe. The whole, however, consists of eight different bones, which are con- 
nected to each other by sutures. Before these sutures consolidate, there are, 
of course, on those places where different bones are to meet, larger or smaller 
openings, which are called fontanelles. At the time of birth, however, as a 
general thing, only one of these fontanelles exist, and that is the anterior 
opening, whilst the posterior and parietal openings have already closed. 

The anterior fontanelle closes normally in the second year of life. If it 
stays open much longer than tw T o years, it shows a want of proper nutritive 
action in the system ; if it grows larger, dividing the frontal bone and parting 
the parietal bones, it is a sign of chronic hydrocephalus, or of hypertrophy 
of the brain. If you lay your hand softly upon it, or watch it closely, you 
will observe a constant motion up and down, a kind of breathing of the brain. 
Screaming or coughing causes momentary distention and protrusion of the 
integument over it. If, however, as in cases of meningitis, this opening 
swells out permanently, it is a sign of exudation of serum in the brain. Its 
suddenly sinking in denotes a collapse of the brain, which is soon followed by 
death. In like manner, the posterior Jontanelle, by a morbid process of ab- 
sorption of the already-formed bony substances, may reopen ; or several holes 
may form near by — the bony structure withering away gradually, leaving 
only the integuments. This is called the Soft occiput or Craniotabes. It 
has been observed mostly towards the end of the first year, especially in 
children of rhachitic or scrofulous parents. It is doubtless a deep-seated, 






ATROPHY OF THE SKULL — ERYSIPELAS. 119 

constitutional disorder, and can be successfully treated only by a careful 
study of all the symptoms. Nevertheless, Sulphur, Calc. carb., Calc. 
phosph. and Silic. might often be indicated. If not checked, it frequently 
becomes complicated with meningitis, or pneumonia, or tuberculosis and 
diarrhoea, which soon end the scene. 
To this I may add — 

Atrophy of the Skull. 

This may be a consequence of internal pressure from carcinoma within 
the cavity of the skull, which may even perforate the cranium ; or from hy- 
pertrophy of the brain; all of which have already been mentioned. 

We also meet with inflammation of the skull or ostitis, with all its sequelae 
— caries and necrosis — which is mostly of a syphilitic or tuberculous origin, 
or is caused by external wounds badly treated. 

THERAPEUTIC HINTS— Caries call for AsaF., Calc. carb., 
Calc. phosph., Fluor, ac, Pulsat., Silic, Sulphur, and other 
remedies. 

d. DISEASES OF THE INTEGUMENTS. 

The integuments of the cranium consist of the following five different 
layers : 

1. The external skin or derma is covered thickly with hair, and contains 
innumerable sebaceous and sudoriparous glands, of which the former secrete 
an oily, fatty substance, and the latter are the organs of perspiration. 

2. The subcutaneous cellular tissue, in which the net-work of the larger 
blood-vessels and nerves lies imbedded, and which conjoins the derma to 

3. The aponeurosis; which is expanded tightly over the cranium. Un- 
der it is found — 

4. The second cellular tissue, which consists of loose meshes and connects 
the aponeurosis only loosely with 

5. The pericranium, which is the immediate covering of the bones, and 
which, although very thin, is nevertheless of great strength. It transmits 
numerous blood-vessels into the bones. 

In diseases of the scalp, all or single of these different layers may be 
affected. 

Erysipelas of the Scalp and Face. 

Erysipelas is an acute febrile disease, characterized by a peculiar in- 
flammation of the skin and enlargement of the neighboring lymph-glands, 
which is accompanied by more or less severe general symptoms. It is con- 



120 SCALP. 

tagious and inoculable, and arises spontaneously under conditions not accu- 
rately determined ; in the latter case it is called Idiopathic. When spread- 
ing by its own contagion, which diffuses itself through the air or is carried 
by linen or instruments previously used for dressing patients with erysipelas, 
or by flies — it is called Traumatic, and is mostly found in the surgical wards 
of hospitals. As the slightest scratch may be the recipient of the poison, the 
disease is often communicated to nurses and physicians. Recent writers on 
this subject do not make any distinction between these two forms, and assert 
that the idiopathic form also arises from some insignificant injury, which only 
could not be discovered ! This is driving the desire for simplification rather too 
far. There are a number of cases, especially on face and scalp, which arise 
without any scratch or wound, and under conditions where infection is entirely 
out of question. In fact the whole complex of symptoms shows that it is not 
a local but a constitutional disease in no less degree than measles, scarlatina 
and other febrile diseases. Da Costa, in an excellent treatise on the internal 
complications of acute erysipelas {American Journal of the Medical Sciences, 
Oct., 1877, p. 321, etc.), admits as much, and also prints a whole series of 
cases observed by himself, in which he found that the idiopathic form was 
almost invariably attended by albuminuria, which in the traumatic form was 
either entirely absent or present only in a decidedly less marked degree. 
Hahnemann considered erysipelas as one of the acute outbursts of a psoric 
taint. He was probably correct even in this. " Erysipelas, like phlegmo- 
nous inflammation, affects the skin in its whole thickness and the subcutane- 
ous cellular tissue. All the layers of the coiium and of the subcutaneous 
cellular tissue are oedematous, swollen, and penetrated by large, finely granu- 
lated, white blood-corpuscles. The meshes of the connective tissue in which 
these cells are imbedded are very decidedly separated by them and by the 
fluid which uniformly permeates the tissues. The most important distinctive 
feature of erysipelas is its disposition to spread only by creeping uninterrupt- 
edly onwards without making jumps," or as Billroth has it, "it spreads like 
water in blotting paper." When on the scalp or face it is limited mostly to 
a more or less extensive portion of the skin of the head and face, and seldom 
descends over the neck to the trunk ; on other parts of the body it is apt to 
spread over larger surfaces. 

Its local Symptoms are frequently preceded a day or two by a feeling of 
general malaise, chilliness and feverishness. Then the part affected begins 
to feel hot and tense ; the skin reddens and swells, and becomes very sensitive 
to the touch. At the same time the adjacent lymphatic glands commence to 
swell. The inflamed portion assumes a red, smooth and shiny appearance, 
which is, however, darker and duller on the scalp than on other parts, and to 
the touch it gives the impression of a hard, stiff, caked mass. The inflamma- 
tion gradually creeps on until it reaches from side to side of the scalp, down 
into the face, and even to the neck and shoulders. 



ERYSIPELAS. 121 

On the second or third day, generally, the redness and swelling reach 
their height, and, at this stage, in some cases, the epidermis becomes raised 
and filled with a yellowish, limpid fluid, sometimes tinged with blood, in the 
shape of large blisters — Erysipelas Ibullosuni — which either dry up, or 
burst and become covered with crusts. 

During the height of the disease, the patient has high fever, with evening 
aggravations ; his sleep is restless and full of dreams ; he sometimes becomes 
delirious. On the fourth day the redness and swelling gradually subside on 
the places first attacked ; while those parts which were invaded later stand 
yet in full bloom. By-and-by, however, they grow paler, softer, and assume 
a wrinkled appearance, as the swelling leaves ; the crusts dry off, and on the 
whole surface the epidermis peels off* in large flakes ; the entire process last- 
ing from about eight days to two weeks. 

But this is not invariably its course. Just in its very nature, to creep 
on, lies its danger. It may, by continuity of tissue, wander to the mucous 
membrane of the nasal and pharyngeal cavities, cause an oedema of the glot- 
tis, and affect the larynx, the bronchial tubes, and even produce pneumonia 
and pleuro-pericarditis. 

An extension of erysipelas to the meninges (erysipelatous meningitis), or 
to the brain tissue (cerebritis; which, on account of the violent brain symp- 
toms, in former days was supposed to be the cause of death in many cases, 
has by later observers not been found, even though numerous post-mortems 
of typical cases have been instituted in search for it. Da Costa found only 
"some fulness of the vessels of the membranes, a kind of venous turgescence, 
yet not extreme," but no sign of any kind of inflammation. An explanation 
of the violent brain symptoms has been variously tried — the assumption of 
blood-poisoning, as in other exanthematic fevers, is probably the most 
rational. 

The tongue usually is covered with a white creamy coat, which dries 
gradually, becomes dirty yellow and, when the fever is protracted, blackish 
and crust-like; there is nausea and vomiting; sometimes diarrhoea and, what 
seems very remarkable, in rare cases profuse intestinal haemorrhage, in con- 
sequence of ulcers in the duodenum, which generally have proved fatal, and 
remind one of similar symptoms which are occasionally observed after severe 
burns of the skin. In almost all idiopathic cases there is albuminuria. The 
fever, accompanying erysipelas, is characterized by a sudden rise of the tem- 
perature to even 101° F. or higher often within from 8 to 12 hours, still ris- 
ing to 105.8° and in some cases to 107.6° F. Exceptionally, however, the 
temperature shows periods, even for the length of a whole clay, of marked 
depression, after which again a sudden rise takes place. When recovery 
approaches, it usually sinks as rapidly as it rose, and may attain its normal 
standard within a few hours, or in a single night; then desquamation of the 



122 SCALP. 

epidermis, in the form of large or branny scales, and wrinkling of the skin 
terminate the local process. However, even after this in some cases a re- 
newed sudden rise of temperature has been observed. The hair usually falls 
out, but quickly grows again. The skin too recovers its normal state ; only 
upon the eyelids, the scrotum, the prepuce and vulva, where it is naturally 
tender, it may in severe cases undergo a more or less extensive gangrenous 
destruction, and its duration be prolonged to several weeks, even months. 

Unlike to other infectious fevers, erysipelas leaves a very great suscep- 
tibility for renewed attacks. Not a few persons are subject to a periodically 
returning form— the so-called Habitual erysipelas, which mostly affects the 
face or lower extremities. 

The nature of its contagium is not all known ; it seems, however, to pos- 
sess great tenacity. 

The Prognosis of erysipelas is favorable, as long as it does not spread 
to internal organs. 

THERAPEUTIC HINTS —The external application of raw cotton 
to the inflamed parts, to keep off the air, as in burns, I have found decidedly 
beneficial. The terrible itching is sometimes alleviated by the application 
of rye-flour. 

Apis, spreading down to the face with great cedematous swelling of the 
eyelids, forming reddish, watery bags under the eyes; stinging, pricking, 
burning ; smooth or blistered ; thirst or no thirst. 

Bellad., especially right side; eruption smooth, shining, streaked, of 
bright red color; brain symptoms prominent; sometimes nausea, gagging, 
retching ; or coughing ; drowsy but cannot sleep. 

Borax, mild form; left side; painful when laughing with sensation as 
if covered by cobwebs. (Bonninghausen.) Pale, red cedematous swelling 
from left lower eyelid down to cheek ; anxiousness ; childbed ; " after Apis 
and Rhus tox. had failed." (Fellger.) 

Euphorb., highly prized by Dr. H. Boskowitz. "It helped after 
Graphit. had failed." (W. E. Payne.) 

Hydrast., wandering from left side of nose to right over whole face 
and scalp; intense pain in the lumbar region; chills down the back; ex- 
tremely restless; disturbed by noise; delirium; urine suppressed. 

Laches., purplish, leaden hue; tongue dry, glossy, tremulous ; visions, 
and delirious talk as soon as he shuts his eyes ; aggravation from noon till 
midnight. 

Pulsat., the ears are especially affected; during damp, wet weather. 

Rhus tox., vesicular form: spreading from left to right; burning and 
itching ; nasal and pharyngeal cavities inflamed ; great restlessness ; pain in 
back and limbs, worse in rest ; after getting wet. 






ECZEMA. 123 

Ver. vir., right side of head and face much swollen and covered with 
large blisters; headache; high fever; no sleep; no appetite; intermitting 
attacks of nausea; occasional vomiting of the water drank. It was applied 
low, externally and internally. Still other remedies may be indicated. 

Arsen., irregular progress; disposition to internal organs; terrible 
restlessness and sinking of strength ; fainting pain in the bowels and haemor- 
rhage, as sometimes occurs in large burns. 

Camphora, great exhaustion; coldness of skin; breathing scarcely 
audible or visible, Bonninghauseu has recommended it for the initial 
symptoms, low and frequently repeated. 

Canthar., large blisters, irritable and burning; after Khus tox. had 
failed. Post-erysipelitic chronic prickling of the skin. 

Chamom., suppuration of the cellular tissue; low externally and in- 
ternally. 

Crot. tigl., cedematous swelling of eyelids; large and small blisters; 
intermediate skin cracked and peeling off; violent burning. 

Cuprum, sudden sinking of the swelling and changing into a bluish 
color ; violent brain symptoms. 

Graphit., tendency to repeated attacks of erysipelas bullosum; also 
when new aggravations come on during the same attack ; constrictive head- 
ache in occiput; perspiration does not relieve. Habitual erysipelas, often 
alternating with tettery eruptions. 

Ipec, retrocession of eruption, with vomiting. 

Kali carb., from right to left side; cedematous swelling under the eye- 
brows. When touched ever so slightly on his feet, he jerks them up much 
frightened ; he talks of pigeons flying in the room, which he tries to catch 
with his hands ; he gets regularly worse about 3 O'clock a.m. After previous 
attacks. 

Sulphur, psoric taint; helps often when all others fail; habitual form. 

Phosph. ac, traumatic form, where the periosteum is affected. 

Ruta, in combination with wounds. 

Silic, when the bones are injured. 

Gangrenous destruction, hints to: Arsen., Carb. veg., Cinchona and 
Sec. cor. 

Schussler recommends Natr. sulph. for the smooth form with or with- 
out vomiting of bile, and Kali mur. for erysipelas bullosum. 

Eczema Capitis, Humid Tetter or Scald. 

"A non-contagious affection, characterized by the eruption of minute 
vesicles in great numbers, and frequently confluent, upon a surface of irreg- 
ular form and usually of considerable extent. The vesicles are so closely 



124 SCALP. 

aggregated in some situations as to give rise to one continuous vesicle of 
great breadth." (Wilson.) 

They dry and form thin scales, or else break and discharge a watery or 
milky fluid of different consistencies, which, by concreting, give rise to 
thinnner or thicker crusts. It is acute and chronic in its nature, and may 
appear on any part of the body. According to its appearance, location, or 
severity and obstinacy, it has received a variety of names, which gives a 
nomenclature most remarkably confused aud confounding. It is called 
ekthema, porrigo, tinea with various adjectives, and, if chronic, psoriasis. In 
order to simplify the whole, we will just remember, that eczema exhibits the 
following characteristics : It is a vesicular eruption, in clusters, often confluent, 
discharging limpid or turbid and milky fluid, which forms crusts of different 
thickness, is acute or chronic, mild or severe, situated here or there. 

It may be confounded with 

Impetigo, 

Because its appearance so closely resembles this latter as to force upon the 
mind the impression that they are the same disease. And, indeed, impetigo, 
derived from ah impetu — a bursting forth with violence — is nothing but a 
pustular eczema; so that, in order to distinguish between the two, we must 
know what is a vesicle and what is a pustule. A vesicle is understood to be a 
very small blister, containing a transparent, limpid fluid ; a pustule means a 
pimple, containing pus. The difference between eczema and impetigo lies 
then in the pyogenetic (that is, pus-forming) character of the latter. If both 
are found together, covering large patches on the scalp, their distinction is 
quite difficult, unless we say : the hardened coverings of the excoriations of 
eczema are thin scabs, because growing out of a limpid, thin fluid — lymph; 
while those of impetigo are tense and thick, greenish-yellow, or brownish crusts, 
on account of their being formed from pus. 

THERAPEUTIC HINTS.— Calcar., Lycop., when the eruption 
yields a thick and mild secretion. 

Arsen., Natr. mur., Rhus tox., when it looks angry, excoriated. 

Bar. carb., Graphit., Natr. mur., Rhus tox., when it causes 
falling out of the hair. 

Lycop., Psorin., when it smells very badly and causes lice. 

Natr. mur., when situated on the boundaries of the hair on the nape 
of the neck. 

Clemat., Petrol., when on the neck and occiput. 

Hepar sulph., when the eruption itches worse in the morning, when 
rising, with burning and smarting after scratching — likewise after external 
application of salves. 



IMPETIGO. 125 

Clemat., Graphit., Hepar sulph., Lycop., Natr. mur., Rhus 
tox., Staphis., Thuja, for moist eruptions. 

Arsen., Calcar., Mercur., Sepia, Silic, Sulphur, for dry crusts. 

Mercur., when the lymphatic glands are inflamed. 

Bar. carb., when the lymphatic glands are swollen and painless. 

Arsen., nightly burning and itching, relieved from external warmth. 

Bar. carb., falling off of the hair; glandular swelling on the neck 
and under the lower jaw. 

Bromium, eruption covering the scalp like a cap; oozing profusely 
and smelling badly ; cervical glands swollen. 

Calc. carb., during teething; scrofulous habit, swollen glands of the 
neck; burning worse after washing; small wounds suppurate easily; sweat 
after eating or drinking anything warm ; worse about new moon. 

•Cicuta, thick yellow crusts. 

Clemat., the eruption looks angry and inflamed during the increasing, 
and is dry during the decreasing moon. 

Crot. tigl., vesicles and erysipelatous inflammation around the crusts; 
itching, and burning after scratching. 

Graphit., eruption with sticky secretion; causing falling out of the 
hair ; commencing behind the ears and spreading over the scalp and face, 
especially on chin; chronic lachrymation ; fluoralbus; worse after washing. 

Hepar, especially back part of head; itching; worse in the morning; 
falling out of hair and leaving bald spots ; crusts dry on some and moist on 
other places with inflamed surface and pus underneath; hard, knotty pimples 
like small furuncles in the face and other parts of the body; scrofulous 
ophthalmia; enlarged glands on nape of neck; frequent urging to stool and 
difficult discharge; sour smelling sweat at nights. 

Hydrast., especially on margin of hair in front; oozing after wash- 
ing ; all secretions tenacious, ropy and profuse. 

Lycop., crusts with lice % between the crevices; underneath oozing of 
bloody or purulent fluid ; badly smelling; sore and moist behind the ears; 
often eruptions on other parts of the body. Skin dry, raw, chapped and 
cracked; disturbed sleep with sudden loud screams; emaciation. 

Mercur., stinging and burning; surroundings inflame after scratching; 
salivation and sore gums. 

Mezer., eruption dry and scaly, extending over forehead, ears and 
neck, or thick leathery crusts with pus underneath, matting the hair, and 
breeding vermin ; violent itching, worse in bed and from touch. 

Natr. mur., raw surface; the discharge is corroding, eating away the 
hair, without forming thick crusts. Especially on the boundary of the hair 
on the nape of the neck. 

Petrol., crusts on scalp; soreness behind the ears; tetter on nape of 



126 SCALP. 

neck, breast and knees ; chapped skin ; hands and fingers full of bloody rha- 
gades during winter. 

Psorin., badly smelling, yellowish, moist crust with lice; terrible itch- 
ing ; sadness ; don't want the head uncovered ; the whole body has a filthy 
smell, even after bathing. 

Rhus tox., often indicated; the crusts are thick with greenish, fetid 
pus underneath and fresh pimples on the surroundings ; stiffness of neck and 
swollen glands on nape of neck and axillae; itching worse at night. 

Staphis., crusts are moist, offensive, and itch violently; on scratching 
the itching is relieved, but appears immediately at some other place. 

Sulphur, dry or moist crusts ; eruptions, pimples on different places of 
the body; eyes inflamed with photophobia; face bloated, pale; cervical 
glands swollen; stool undigested, diarrhoea early in the morning; belly 
bloated; sleepless nights on account of itching; easily bleeding after 
scratching. 

Viol. trie. (Jacea), thick crusts and oozing of profuse yellow fluid, 
matting the hair together; frequent involuntary urination; the urine smells 
like cat's urine. 

Dandruff 

Is an eczema with but scanty exudation, not sufficient to raise the epidermis 
into vesicles ; it merely loosens it, when it dries and peals off in scales. The 
scalp underneath remains congested, and thus new scales are constantly re- 
produced. It may extend over the whole scalp even down to the eyebrows, 
the whiskers and the beard, or be confined to patches only of irregular form 
and variable dimensions. The most effective remedies against small, brany 
scales are according to Jahr: Bryon., Sulphur, Calc. carb., Kali carb., 
Arsen., Alum. For the pealing off of large scales, the same author recom- 
mends: Phosphor., Lycop., Sulphur, Calc. carb., Nitr. ac. 

Seborrhoea Capillittii. 

" The secretion of the sebaceous glands in the foetus is greater during 
intra-uterine life than subsequently, and we meet it at birth on the body 
generally, where it constitutes the vernix caseosa. This abundant secretion 
continues on the scalp during the first year of extra-uterine life, and if the 
sebum is allowed to collect there and gather dirt and dust from without, we 
may have finally crusts several lines in thickness, and the whole hairy scalp 
may be enveloped in a thick layer of sebum. When the crusts remain for a 
long time, the seborrhoea is generally complicated with eczema, for the col- 
lected mass of sebum decomposes, macerates and irritates the skin, and pro- 



FAVUS, ETC. 127 

duces redness and moisture on it. The same disease appears also as thick 
scales, which cause the hair to adhere to one another in little bundles (psori- 
asis amianthacea). In adults it forms one of the commonest varieties of scurf, 
or dry scales, which are formed in large quantities, and in old people it is 
seen in connection with senile decay. The scalp is for the most part devoid 
of hair, and covered with a dirty, yellowish-brown, easily removable crust. 
It may also be a part of syphilis." (Lilienthal's Skin Diseases, p. 118.) 

THERAPEUTIC HINTS.— These crusts are best dissolved by the 
application of oil or grease, and afterwards removed by washing with castile 
soap. The internal use of Sulphur, a dose of a high potency occasionally, 
corrects the disposition for this abundant secretion. For adults Phosphor., 
Calc. carb., Natr. mur., Graphit., Vine, min., Mercur., have been 
recommended. 

Favus, Honey-comb Ringworm, Tinea favosa or Maligna, 
Porrigo favosa or lupinosa, 

Is a vegetable parasite, the achorion Schoenleinii. " It used to be classed 
among the pustular eruptions, because it first appears as a small yellow spot, 
the sheath of the hair being filled with the fungous growth ; but it has no 
tendency to suppurate. It grows with great rapidity, and forms large, hard, 
dry crusts, which have a peculiar mouse-like odor. It is most liable to be 
confounded w T ith impetigo, but it requires only moderate care to determine 
whether the crust be hardened pus or an independent growth. The distinc- 
tion is based upon the presence or absence of secretion ; be the crust of im- 
petigo ever so dry, some trace of purulent secretion is sure to be met with ; 
and if removed by a poultice, the moist, exuding surface cannot be mistaken. 
Knowing this fact we have no need to particularize the rounded form, the 
cracked, broken-looking surface, and all the other characters resembling 
honey-comb, which the older writers were obliged to enumerate." (Bar- 
cley.) The scalp is its most usual place of development, but it is sometimes 
found upon the nape of the neck, or in front of the ear, and even upon the 
arms. 

" The pathology of favus is best understood by considering it essentially 
to be a form of abnormal nutrition, with exudation of a matter analogous to, 
if not identical with, that of tubercle, which constitutes a soil for the germi- 
nation of cryptogamic plants, the presence of which is the pathognomic of 
the disease. Hence is explained the frequency of its occurrence in scrofulous 
persons, among cachectic or ill-fed children, and the impossibility of incubat- 
ing the disease in healthy tissues, or the necessity of there being scaly, 
pustular and vesicular eruptions on the integuments previous to contagion." 



128 SCALP. 

(Bennet, Lilienthal's Skin Diseases.) This view is born, out by actual 
clinical experience. 

Jahr says: "Notwithstanding its parasitic nature it has been cured by 
the sole internal administration of Sulphur, Calc. carb., Rhus tox., and 
Arsen.," and Teste considers the treatment of this affection the triumph of 
Homoeopathy, recommending: 

Sulphur and Dulcam. for the humid form in children of blonde and 
fresh complexion. 

Viol, trie, in alternation with either of the above when the itching is 
very violent. 

Oleand., when there is intense itching and an insupportable nocturnal 
burning after scratching ; affection of the mesenteric glands with swelling, 
hardness and tension of the abdomen, and frequently loose and undigested 
stools. 

Hepar sulph., when extending to the nape of the neck or the face; 
ophthalmia with or without ulceration of the cornea, etc. 

Besides compare Arsen., Bar. carb., Bromine, Calc. carb., 
Dulcam., Graphit., Hepar, Mercur., Mezer., Rhus tox., Petrol., 
Staphis., Sulphur, Viol, trie, under Tinea capitis. 

Crysophanic acid has been recommended by C. E. Fisher. 

Lapp, maj., grayish-white crust over head, face and neck; swelling 
and suppuration of the axillary glands. 

Phosphor., the skin of the denuded scalp is clear, white and smooth. 

Vine, min., spots on head, oozing, matting the hair together; the hair 
falls out in single spots, while hair grows on it. 

Tinea, Herpes tonsurans, or Ringworm of the Scalp. 

The hair falls out in a patch of a circular form, leaving the skin of 
the head perfectly smooth. It is a microscopic fungus, known as tricho- 
phytum tonsurans, that invests the roots of the hair and destroys them. 

Cases are reported as having been cured by Graphit., Phosphor., 
Arsen., Tellur., Sepia, and others. Alcohol is said to destroy the 
parasite. 

The Wen 

Is an encysted tumor of varying size; from that of a small pea to the size of 
a walnut, and even a small orange. 

"The sebaceous or fatty substance in these sacs or cysts is variously 
altered in its qualities and appearance. Sometimes it is a limpid fluid-like 
serum, and contains crystals of stearine; at other times it is soft and white, 






THE IIAIR. 129 

of a pappy consistency; again, it is yellowish, and resembles beeswax. 
Sometimes it contains epidermal scales and hairs. Sometimes the contents 
of the cyst are exceedingly fetid ; and the fetor is increased when the tumor 
inflames." (Wilson). Under the pressure of the finger they feel elastic, 
and are movable under the skin. 

THERAPEUTIC HINTS— Thus far have been successfully applied : 
Bar. carb., Bellad., Calc. carb., Caustic, Clemat., Phytol., 
Silic, Sulphur, Thuja. 

The Teleangiectasia, or Vascular Naevus, Mother's Mark, 

Is a dilatation of a portion of that fine net- work of capillary vessels which 
everywhere pervade the derma, and cellular tissue. Such dilatations may 
occur in either of them. They form red, easily compressible, flat tumors, of 
different sizes. They are sometimes stationary, but more frequently increase 
slowly in size; and we often find enlarged blood-vessels in their vicinity. 
They generally appear on the scalp and still oftener on the forehead, but 
also on other parts of the body. 

THERAPEUTIC HINTS.— Condur., Fluor, ac, Strontian, Sulphur, 
Silic, Thuja. Phosphor., when they bleed easily. Sepia in broad, flat, 
dark venous nsevi, particularly when on the face, head or nose. 

The Hair. 

Alopecia — its falling off— may originate in various conditions. If it 
consists in a total atrophy of the hair-follicles, the hair of course will never 
grow again ; if it is only a partial atrophy, the hair grows thin A transient 
deficiency in the nutrition of the hair-follicles, as it occurs in several ill- 
nesses, such as typhoid fever, pneumonia, puerperal fever, chronic head- 
aches, syphilis, does not hinder the hair from growing again, as soon as 
these disturbances have passed away. 

The Alopecia circumscripta or Porrigo deralcaiis has its cause in 
a parasite, the microsporon audonini, which attacks the hair in isolated 
patches, and the denuded spots are left clean and polished and of a marble 
whiteness ; it is not considered as contagious. 

Alopecia in consequence of erysipelas, seborrhoea and different eruptions 
of the scalp, disappears after these disturbances are healed. 

Cosmetic means also may bring on alopecia. 

Baldness is more or less an attribute of old age; it is found oftener in 
men than in women ; it also is seen in younger individuals in consequence 
of hereditary disposition. 
9 



130 SCALP. 

THERAPEUTIC HINTS.— Kali carb., Natr. mur., with great 
dryness of the hair. Carb. veg. after Kali carb. 

Hepar sulph., Phosphor., Sepia, Silic, after chronic headaches. 

Kali carb., Nitr. ac, after nervous fevers. 

Phosph. ac, after great anxiety and grief. 

Besides these compare Ambra, Amm. carb., Bar. carb., Calc. carb., 
Conium, Fluor, ac, Graphit., Lycop., Natr. mur., Sulphur, Zincum. 

For bald patches: Aloes, Arsen., Phosphor., Vinca min. 

The cutting of the hair is often attended with great effect upon the 
general system. Colds in the head are a very frequent consequence, and in 
children even spasms may result therefrom. But there are also cases on 
record where it proved beneficial to patients, relieving them of headache, and 
in one case even from a sort of mania. 

The changing of color into gray and white is usually a process of 
age ; but grief, sorrow and worriment may bring it on much before its time, 
and sometimes in a.very short time. There are a number of cases related 
where this change took place during one night in consequence of terror, or 
other violent emotions of the mind, so that the poet says : " O nox ! quam 
longa es, quae facis una senem!" But of late, these instances have been 
doubted, because they are not well authenticated. However that may be, so 
much is certain, that strong mental emotions have a great effect upon the 
discoloration of the hair. 

THERAPEUTIC HINTS.— Bad consequences of cutting the hair are 
mostly removed by Bellad. or Bryon. 

The process of growing gray and white we best leave undisturbed, unless 
we choose remedies for its next causes. All of the so-called cosmetic means 
are hurtful, sometimes dangerous; and the vain will be punished for his 
vanity. 

The Plica polonica — matted hair — as is here and there found in 
Poland, is, according to Hebra, an eczema of the scalp, forming crusts, and 
matting the hair together in a most hideous manner. 



EYES. 



Considering the eye as a whole, we find its general appearance fre- 
quently altered by disease. Without dwelling upon the language which the 
mental emotions — fright, terror, joy or sorrow, love or hatred — speak through 
them, we observe: 

An unnatural lustre of the eyes in fevers; and 

A brilliancy in consumptives. 

Glassy eyes are characteristic, in children, of inflammation of the mesen- 
teric glands; and, if accompanied with dark, dry lips and tongue, dry skin, 
and great restlessness, of an acute inflammation of the stomach. In fevers 
they indicate great danger, or critical changes. 

Dull eyes are frequently observed in febrile conditions of the system ; 
during catamenia, in catarrhal and other affections. 

Sunken eyes are the consequence of an absorption of the fat cushions, 
whereupon the eyeballs rest and turn in their sockets. This takes place in 
all diseases which are accompanied with great loss of blood or other vital 
fluids. 

Exophilialmus or protruding eyes, when not congenital, is a characteristic 
sign of Basedow's disease. 

In treating the particular diseases of the eye, I shall condense in a small 
space what is important for the general practitioner in his daily practice ; 
the specialist will necessarily have to consult special works on this subject. 

LIDS AND LACHRYMAL APPARATUS. 

Inflammation of the Eyelids. 

It may be of various character. A simple inflammation may be the con- 
sequence of a cold. It usually commences on the edge and thence spreads 
over the whole lid to the margo orbitalis, where it abruptly ceases. By this 
it is distinguished from erysipelas, which is apt to diffuse itself further and 

(131) 



132 LIDS AND LACHRYMAL APPARATUS. 

further. The lid is hard, swollen and red, sometimes covered with little 
blisters. 

A graver form is the Phlegmonous inflammation, or Abscess of lid. 

Commencing as a little, firm nodule, it often extends over the eyebrow and 
cheek, and the lid may attain the size of a pigeon's egg. If not checked in 
the onset, it terminates in the formation of an abscess which breaks either 
outside or, in rarer instances, perforates the conjunctiva. If this abscess forms 
at the inner angle of the eye, near the lachrymal sac, it has been termed 
Anchylops. The Causes are: injuries (wounds or blows upon the eye); 
severe conjunctivitis, or erysipelas; spontaneous development has also been 
observed. 

A third form is the Tinea tarsi, Ophthalmia tarsi, or Blepharitis 
marginalis, etc., which consists of an inflammation of the edges of the eyelids. 
In its simplest form it shows merely a slight redness of the edges and some 
gluing together of the lids in the morning. This may increase, how T ever, to 
ulceration, thickening and hardening of the whole margin of the lids, when 
it is termed Tylosis. The conjunctiva and the Meibomian glands usually 
participate more or less in this inflammation, and if the ulceration extends to 
the hair-follicles, the lashes loosen and fall out. In places where the destruc- 
tion is not too extensive, the lashes grow T again, but thinner, crooked and 
often inverted, which state is called Trichiasis ; or there forms a double row 
of cilia either along the greater portion of the lid, or chiefly at one point; 
this is called Distichiasis. This faulty position of the cilia is generally ac- 
companied, or soon followed, by a certain degree of inversion of the eyelid, 
and perhaps by a shortening and incurvation of the tarsal cartilage, which 
state is termed Entropium, though in simple trichiasis or distichiasis it is 
not always present. "Entropium may also result from spasmodic contrac- 
tion of the orbicularis muscle, especially in elderly persons, where the skin of 
the eyelids is abundant and lax." (G. S. Norton.) When, however, by ex- 
tensive ulceration of the edges and consequent cicatrization the apertures of 
the Meibomian follicles become closed and obliterated, the lid's margin 
thickens, and shows a tendency to become everted. This grows the more ap- 
parent, when the conjunctiva also is involved in the inflammatory process. 
And, if to all this a certain degree of atrophy and relaxation of the orbicu- 
laris associates, the somewhat everted lid no longer covers the eyeball, but 
sinks away from it and the punctum lachrymale becomes exposed. This 
state of things is termed Ectropium. " Ectropium may also result from 
paralysis of the facial nerves, tumors, caries of the orbit, etc., but the most 
frequent cause is from cicatrices in the vicinity of the lids." (G. S. Norton.) 

Blepharitis marginalis occurs often as a consequence of hypermetropia 
or myopia, but very frequently it is associated either with, or caused by, 
conjunctivitis or corneitis, affections of the lachrymal canal, as stricture, 



INFLAMMATION OF THE EYELIDS. 133 

blennorrhcea, etc. Its intensity is much aggravated by dirt and want, by ex- 
posure to wind, cold, bright glare, or an impure, smoky atmosphere. 

THERAPEUTIC HINTS.— Simple inflammation of the lids is easily 
arrested by : 

Aeon., after exposure to cold winds. 

Apis, with oedematous swelling and stinging pain. 

Bellad., bright, shining redness; right side; photophobia. 

Chamom., red swelling after a cold. 

Puis at., with catarrh in the head. 

Rhus tox., from left to right; dull redness; watery vesicles. 

Phlegmonous inflammation requires besides one or the other of the above: 

Hepar, pricking and throbbing pain, worse from cold and contact; 
anchylops. 

Laches., purplish hue. 

Merc, sol., pain worse at night. 

Pulsat., anchylops. 

Silic, after Hepar, when suppuration has taken place, and the patient 
wants to have his head wrapped up. 

Blepharitis marginalis is often very obstinate and difficult to treat. 
When caused by hypermetropia or myopia, suitable eyeglasses are the 
remedy ; when caused by dirt and want, their removal ought to be attended 
to ; washing and cleaning the lids with luke-warm water is a daily require- 
ment. Remedial agents are quite as necessary. 

Alum., dryness of lids, worse in the morning; absence of lachrymation. 

Arsen., burning, acrid lachrymation, excoriating the lids and cheek. 

Calc. carb. and jod., lids swollen and hard, indurated, also after 
styes; tonsils enlarged. 

Carb. ac, when caused by parasitic fungi, embedded around the hair 
follicles. 

Cinnab., discharge in the morning; dull pain from the inner can thus 
over the eye, or around it. 

Caustic, better in the open air; warts on the eyebrows, upper lid or 
nose. 

Digit., lid-margin slightly swollen and pale red; inside of lids yellowish- 
red; burning of the lid-margin; photophobia; lachrymation and mucous 
discharge. 

Euphras., suppurating lid-margins; constant winking of lids; profuse, 
acrid, burning lachrymation, or very acrid, thick or yellow discharge, ex- 
coriating lid and cheek ; fluent coryza, which is mild. 

Graphit., dry crusts on the cilise, and scales on the margins; the outer 
canthi are often the most affected part ; they crack and bleed easily ; moist 



134 LIDS AND LACHRYMAL APPARATUS. 

eczema on the head and behind the ears, cracking and bleeding. "It is the 
most frequently indicated remedy for chronic ciliary blepharitis, and a more 
rapid cure can usually be effected by its local application at the same time 
of its internal administration. I use it locally in some unguent, as cosmoline, 
about eight grains to the ounce." (G. S. Norton.) 

Hepar, upper lid-margins unevenly rounded, swollen and red; tough 
mucus in lashes and canthi; scleral conjunctiva injected with red vessels 
running towards the cornea, where they form little vesicles with turbid secre- 
tion, lachrymation ; pain in the evening, agglutination in the morning ; right 
eye worse ; small pimples or little furuncles oil the face, or elsewhere, in com- 
plication with tinea. 

Kali carb., swelling of lids; edges, canthi and caruncula red and 
swollen ; lachrymation and pain from bright light ; pressing pain in front of 
head and temples into the eyes, with heat in face and head ; after eating, 
pressure in stomach, belching ; nausea and emptiness in stomach ; gagging 
and vomiting of slime ; pressure and anxious feeling in chest ; face pale, dirty 
gray. 

Magn. mur., when accompanied with pimply eruption on the face, 
which comes and goes, but is worse after supper, in a warm room, and before 
the menses. 

Merc, sol., lids smart, are sore and red, especially upper lids; worse 
at night in bed, from warmth and cold, and from the glare of a fire. 

Merc, corr., indurated lids; secretion thin and excoriating; nocturnal 
aggravation. 

Mezer., accompanied by tinea capitis of thick, hard crusts, from which 
pus exudes upon pressure. 

Natr. mur., after the application of nitrate of silver ; after measles; 
acrid lachrymation, excoriating the lids and cheeks and making the skin 
glossy and shining; eczema. 

Nux vom., after previous drugging and when worse in the morning. 

Petrol., pain in the back of the head, rough skin; diarrhoea only 
during the day. 

Phosph. ac, lid-margins swollen, red and rounded; lashes partially 
falling out; pus particles on lashes and in canthi; itching and burning; sen- 
sitiveness to candle-light; difficult opening of the eyes in the morning. 

Psorin., from right to left; worse mornings and during the day; old 
chronic cases; offensive discharges from the eyes; photophobia; strumous 
diathesis. 

Pulsat., worse in the evening and in a warm room, better in the open 
air; lachrymal apparatus affected; styes, and acne in the face. 

Rhus tox., lids oedematously swollen; copious, acrid and serous dis- 
charge, corroding the adjacent parts of the cheeks. 



INFLAMMATION OF THE EYELIDS. 135 

Sepia, "small pustules, like acne, on the edge of the lids; tight feeling 
in lids; aggravation morn and eve." (G. S. Norton.) 

Silic, objects appear as if seen through a fog, ameliorated by wiping 
the eyes ; fluent coryza, corners of mouth cracked ; offensive sweat of feet. 

Staphis., lid-margins dry, with hard lumps and destruction of the 
ciliary roots; small tarsal tumors. 

Sulphur, lid-margins thick, granulated and rounded; dry crusts in 
lashes; sharp, sticking pains, as if pins or a splinter of glass was sticking in 
the eye; morning agglutination; glandular swellings on the head and neck; 
eruption on the face ; pale and puffed face ; abdomen hard ; disturbed diges- 
tion; worse in the evening and gaslight; cannot bear to have the eyes 
washed. 

Tellur., eczema impetiginoides on the lids, with pustular conjunc- 
tivitis; much purulent discharge from the eyes; offensive otorrhoea. 

Thuja, dry, branny eruption upon the lids, chiefly about the cilice ; 
lashes irregular and imperfectly grown ; eyes weak and watery. 

Anchylops will best be met in the beginning by Apis, Bellad., Hepar, 
Pulsat., or Rhus tox. 

Trichiasis may require operative measures ; but cases have been cured 
without them. 

Aeon., has been successfully applied in a case of trichiasis and entropium. 

Borax, has the symptom, but no verification to my knowledge. 

Graphit., may soften the scars. 

Natr. mur., after abuse of nitrate of silver. 

Sepia, eyelashes gone; edges raw and sore; eversion of puncta; eyes 
full of matter. 

Thuja, dry, branny eruption upon the lids, chiefly about the ciliae; 
lashes irregular and imperfectly grown ; eyes weak and watery. 

Entropium is surely amenable to internal treatment, if recent. 

Aeon., acute inflammation with dryness and burning. 

Calc. carb., has cured cases of senile entropium. 

Merc, corr., Rhus tox. and Sulphur, are oftener indicated than 
Lycop. 

Natr. mur., after abuse of nitrate of silver. 

Sepia, acute blepharitis. 

Ectropium has been cured by : 

Apis, stinging pains and great cedematous swelling of lids and con- 
junctiva. 

Arg. nitr., tear-points greatly inflamed and prominent. 

Hamam., during the course of a severe conjunctivitis — by external 
application of " Pond's Extract." 

Merc, corr., Nitr. ac. and Sulphur, have been successfully em- 
ployed. 



136 LIDS AND LACHRYMAL APPARATUS. 

Rhus tox., sac-like swelling of the conjunctiva; oedematous swelling 
of the lids; cilise fall out; acrid lachrymation in the morning and in the 
open air. Lids are spasmodically closed ; on opening them, protrusion of a 
thick red swelling, and yellow purulent discharge. 

Hordeolum, Stye. 

It is in its nature a small furuncle, forming in the connective tissue 
near the edge of the lid, and has its name from its fancied resemblance to a 
grain of barley. It appears as a red, hard swelling, which rapidly increases 
until it suppurates and breaks, either outside or inside of the lid-margiu. 
In some cases it is attended with considerable pain, and swelling of the 
whole lid. Some persons are subject to repeated outbreaks of this furuncular 
inflammation. We find it most frequently in youthful individuals of rather 
delicate health with a tendency to acne, or in persons addicted to free living 
or dissipation. If by frequent relapses it induces inflammatory changes in 
the Meibomian glands, and is followed by fatty or chalky degeneration of 
their contents, it is called Chalazion. 

THERAPEUTIC HINTS.— Pulsat., most frequently used and indi- 
cated ; it often arrests its growth. 

He par, if Pulsat. has not been sufficient to prevent suppuration. 
Staphis., often found useful and especially when the stye does not sup- 
purate and break, but remains a hard nodule. 

Upper lid: Alum., Caustic, Ferrum, Mercur., Phosph. ac, Sulphur. 
Lower lid: Phosphor., Rhus tox., Senega, Staphis. 
Right side: Calc. carb., Canthar., Natr. mur. 
Left side: Colchic, Lycop., Pulsat., Staphis. 

For removing the disposition: Amm. carb., Calc. carb., Ferrum, Graphit., 
Sulphur, Thuja. 

Chalazion: Calc. carb., Couium, Graphit., Pulsat., Sepia, Silic, Staphis., 
Thuja. 

Tumors of the Lid. 

Chalazion has been mentioned under styes. " It is mostly situated at 
some distance from the free margin of the lid and generally most manifest 
on its inner surface, lying close beneath the conjunctiva. In rarer cases the 
tumor points outwards and lies close beneath the skin, which is frequently 
somewhat reddened and thinned over and around it. It occurs far more 
frequently in the upper than in the lower lid." (Walton.) 

Sebaceous tumors occur most frequently at the outer and upper mar- 



DACRYOCYSTITIS. 137 

gin of the orbit, close to the eyebrow. Their contents are suet-like and seba- 
ceous, consisting of broken-down epithelial cells, fat molecules and hairs; 
sometimes they are softer and more oily. The whole is encased in a cyst 
wall, the posterior portion of which is somewhat thickened and hyper- 
trophied. 

Warts occur occasionally on the edges of eyelids. 

Fatty tumors (wens) are of rare occurrence. " They may be recog- 
nized by their smooth, circumscribed, somewhat lobulated form, and are firm 
and elastic to the touch." 

Epithelioma "is the most frequent in occurrence of all malignant tu- 
mors of the lids; arises as a small nodule near the edge of lid, and is pain- 
less, slow in its progress and at last ulcerates. The skin around the ulcer is 
not swollen and discolored as in lupus. The slowness of its growth and the 
history of the case distinguish from syphilitic ulcer." (G. S. ISorton.) 

THERAPEUTIC HINTS.— Encysted tumors have been cured by: 
Calc. carb., Graphit., Silic, Staphis., Thuja; warts by: Caustic, Thuja; wens 
by: Bar. carb., Graphit.; epithelioma by: Apis, Hydr. ac, Laches. (G. 
S. Xorton.) 

Dacryocystitis 

Is an acute inflammation of the lachrymal sac, which frequently reaches its 
acme in a few days and is very painful. Its swelling may extend to the 
cheek, eyelids and even conjunctiva. In less severe cases, or after the acute 
inflammatory symptoms have passed away, pus may be squeezed out of the 
puncta; but when the swelling and thickening of the lining membrane closes 
the passage, or the opening into the sac becomes somewhat displaced by it, 
the pus cannot escape, and if left alone, will finally force its way through the 
skin. After the discharge of pus, the inflammation subsides either entirely, 
and the opening heals, or there remains a chronic inflammation of the sac, 
with subsequent renewals of acute attacks, or the aperture in the skin does 
not firmly cicatrize, but merely scabs over, while fresh pus is collecting, 
which again forces its way out at the same place, thus finally leaving a fistu- 
lous opening, through which a thin, muco-purulent discharge and the tears 
constantly ooze — Fistula lachrymalis. Or again the sac may undergo 
ulceration at one point and the matter escape into the neighboring cellular 
tissue, thus giving rise to a secondary sac or pouch, which may break, 
whereby another more or less extensive fistulous opening is established, 
often very obstinate and intractable, especially if the bony structure is like- 
wise diseased. Of chronic cases there are instances where several such 
pouches burrow beneath the skin in different directions. 



138 LIDS AND LACHRYMAL APPARATUS. 

The Causes. — This inflammation is often merely an extension of conjunc- 
tivitis, especially the granular form, or of nasal catarrh; it may be produced 
by periostitis and caries of the nasal bones in scrofulous or syphilitic persons, 
or may occur as a primary affection, being then generally due to exposure to 
cold aud wet. " Its most frequent cause is a previous stricture of the nasal 
duct or blennorrhoea of the lachrymal sac." (G. S. Norton.) 

THERAPEUTIC HINTS.— Instrumental aid may be required, but 
often bad cases have been cured by internal treatment alone. For dacryocys- 
titis, at the beginning, Pulsat., or Apis, when there is cedematous swelling 
and stinging pains, but Bellad., Hepar, and Silic. may also be indicated. 
We will, no doubt, have to consider its causes (conjunctivitis, nasal catarrh, 
etc.), and then compare the corresponding remedies. 

Fistula lachrymalis : Bellad., inflammation of the lachrymal duct; 
intolerance of light ; profuse lachrymation ; lid edges inflamed and aggluti- 
nated ; morning and evening a gritting sensation in the lids ; aggravation in 
the evening. 

Bromine, Calc. carb., Caustic, Fluor, ac, Hepar, Laches., Natr. mur., 
Petrol., Pulsat, Sulphur, Silic, disorganization of the walls of the sac; denu- 
dation of the internal horny wall and closure of the nasal canal. 

Blennorrhoea of the Lachrymal Sac 

Is another consequence which may follow acute inflammation of the lach- 
rymal sac, in fact it is a chronic inflammation of that organ by which its 
walls become either thickened and hypertrophied, or thinned and greatly 
distended, secreting constantly a thin, glairy, viscid fluid, which flows down 
the nasal duct, or oozes up through the puncta. When the sac gets filled 
with this secretion, we observe it as a swelling of varying size and hardness. 
On pressure its contents discharge through the puncta, and the finger sinks 
in as the sac is being emptied. During warm and dry weather the patient 
usually experiences very little inconvenience, while on exposure to cold and 
damp winds the trouble increases, inducing fresh inflammatory action. In 
this way it comes to pass that strictures are formed either in some part of 
the nasal duct, or of the canaliculus near its opening into the sac. 

Its Causes are like those of dacryocystitis — conjunctivitis, nasal catarrh, 
periostitis or caries of the nasal bones; also obstructions in the lachrymal 
passages either above or below the sac by a narrowing obliteration, or ever- 
sion of the puncta; or by contraction or stricture of the canaliculus or of 
the nasal duct ; or by polypi or other growths which compress and obstruct 
the duct. 



CATARRHAL OPHTHALMIA. 139 

THERAPEUTIC HINTS.— Compare the previous article and also 
those which treat of its causes. 

Stannum, "is one of the most important remedies, especially if the 
discharge is profuse, thick and of a yellow white color." (Geo. S. Norton.) 

Firm strictures require instrumental aid. 

CONJUNCTIVA. 

Catarrhal Ophthalmia 

Is an inflammation of the conjunctiva which may extend into the Meibomian 
ducts, the canaliculi, and the ducts of the lachrymal gland. In its mild form 
it shows merely a slight hyperemia with a sensation of grit in the eye, itch- 
ing, stiffness and heaviness of the eyelids with or without sticking together 
in the morning; there is only exceptionally some mucus excreted and found 
collected at the inner canthus either fresh or dried into little yellowish or 
brownish crusts. It is aggravated by exposure to cold winds, when lachry- 
mation is produced. Usually of a chronic nature, it is found especially in 
persons of ill health, and is often difficult to cure. 

In its acute form the blood : vessels are much enlarged and appear as a 
vascular net-work of brick-dust, or of bluish or lilac hue, especially on the 
ocular portion of the conjunctiva, while on the palpebral portion it is less 
marked. Often it is accompanied by spots of extravasated blood within the 
meshes of the membrane, which swells, and has, especially on its palpebral 
portion, a villous appearance, being due to the engorged state of the villi, an 
appearance which must not be confounded with granular conjunctivitis. 
At first there is an increased flow of tears which after a while is replaced by 
a secretion of mucus, which by degrees gets thicker and is either whitish or 
yellowish. If it assume a purulent character, the mere catarrhal ophthalmia 
passes into the purulent form. Chemosis is very rare; photophobia, pain 
and impairment of vision do not occur in the catarrhal form. In severe 
cases the eyelids participate in the inflammation; usually both eyes are 
affected, not, however, always simultaneously; the second often becomes in- 
volved when the first is getting well ; it always shows an evening aggrava- 
tion; and is apt to recur. Its Causes are: mechanical and chemical irrita- 
tion; getting cold and wet; excessive strain of the eyes by artificial light; 
extension from inflammatory processes of neighboring parts; measles, scarlet 
fever, small-pox ; sometimes it appears epidemic. It is infectious. 

THERAPEUTIC HINTS— If caused by some foreign body, this 
ought to be removed. 

Aeon., reduces the inflammation caused by a piece of steel or cinder 



140 CONJUNCTIVA. 

and facilitates its removal, if that could not be effected before the inflam- 
mation had fully developed. If there remains still some inflammation after 
Aeon., Sulphur will cure it. Aeon, is also indicated at the beginning of 
any ordinary catarrhal conjunctivitis, where there is great dryness, burning 
and heat in the eye and where it has been brought on by exposure to sharp, 
cold winds. 

Apis, ©edematous swelling of lids and skin over orbits with redness, heat 
and sensitiveness to external covering ; stinging pains. 

Arg. nitr., profuse discharge approaching a purulent character; feels 
better in the open air, worse in warm room. 

Arsen., lids spasmodically closed; conjunctiva of a dark, violet color; 
secretion thin and acrid with burning pain, worse at night. 

Bellad., right eye; throbbing pain, hot tears or dryness of the eyes; 
light k painful ; nose sore from coryza ; headache and similar Belladonna 
symptoms. 

Chamom., often for infants after exposure to cold while bathing and 
washing. The children cry much; have colic and green stools; also during 
dentition. Extravasation of blood sometimes. 

Conium, right eye bloodshot ; aches on lying down to sleep; thirsty; 
sweat on head, face and neck. 

Crocus, feeling in the eyes as after weeping with a corresponding 
appearance, extending from left to right eye ; feeling of something alive and 
moving in the abdomen. 

Digit., chronic; a yellowish redness of the palpebral conjunctiva. 

Euphras., acrid tears and profuse, acrid, thick and yellow discharge; 
blurring of vision relieved by winking; coryza with burning and pain in the 
frontal sinuses ; after exposure to cold and during the first stage of measles. 

Graphit., chronic; thin, acrid discharge; external canthi crack and 
bleed easily ; nose sore and excoriated, with crust on the nostrils. 

Merc, sol., blennorrhea, thin and acrid; great swelling of lids; sensi- 
tive to touch; worse in warm room or in the cold air, and in damp weather; 
also from evening till midnight; no relief from sweat; frequent relapses. 

Nux vom., the inner canthi are more inflamed than other parts; 
bloody exudation; smarting like salt; all worse in the morning. 

Pulsat., bland, moderately profuse,- white discharge; worse in the warm 
room ; in the evening ; from reading ; better in the open air. 

Rhus tox., edematous swelling of the lids; chemosis of conjunctiva; 
great restlessness : after getting wet. 

Sepia, muco-purulent discharge in the morning and dryness in the 
evening; the conjunctiva is of a dull red color with some photophobia and 
swelling of the lids, especially in the morning. 

Sulphur, acute and chronic; sharp, darting pains, like pins piercing 



P*URULENT OPHTHALMIA. 141 

the eye ; severe pain darting through the eye back into the head, from 1 to 3 
a.m., waking the patient from sleep ; feverish and restless at night. 

Zincum, the inner half of the eye is the most affected part, with much 
discharge ; worse in the evening and in the cool air. 
Digest follows at the end of the ophthalmias. 

Purulent Ophthalmia. 

Commencing with mere congestion, itching and dryness, particularly at 
the inner corner, it gradually augments to intense inflammation of the whole 
conjunctiva with considerable mucous secretion, which soon is changed into 
a purulent discharge, dissolved in the tears. The lids swell and become 
slightly everted, the conjunctiva is dark red and the single blood-vessels are 
no longer to be seen. The parts affected feel hot and scalding with neuralgic 
pains which may extend to the temple and forehead. As the disease pro- 
gresses, ClieillOSis sets in, that is an infiltration of the conjunctival and 
subconjunctival tissue, and in addition we observe spots of extravasated blood. 
In this way the conjunctiva swells often to a degree that it overlaps the 
cornea, but shows itself most prominently at the lateral sides of the eyeball, 
where it receives the least pressure from the eyelids. The inflammation 
generally spreads to the areolar tissue of the orbits together with the tunica 
vaginalis oculi, causing a slight protrusion of the eyeball; the eyelids swell 
still more and the upper overlaps the lower, while the protruding conjunctiva 
always averts the lower and sometimes both. The protruding part of the 
conjunctiva is very marked in its villous appearance. If cured in this stage, 
the eye may escape serious injury. But if it goes on the palpebral papilla? 
may undergo a change which is called granulation, of which later; the cornea 
may be rendered opaque by interstitial changes, or it may be destroyed by 
softening and ulceration ; the iris may inflame and adhere to the cornea ; the 
vibrous body, the retina, and the choroid may be partially or quite spoiled ; 
the sclerotica may become softened ; the crystalline lens, when not discharged 
through the perforated cornea, becomes quite yellow ; and all this destructive 
process may run its course in a space of time from a few 7 days to three weeks. 

This dreadful disease is most common and severe in hot climates; in 
temperate latitudes it is found more especially in the army, navy, in work- 
houses, prisons, and among the poor ; it is chiefly endemic and spreads by 
infection. 

Gonorrheal ophthalmia, which has been developed by infection from 
urethral pus, cannot be distinguished from the purulent form, except by the 
history. It is one and the same kind of inflammation, only intensified, de- 
stroying the eye with -great rapidity. 

Ophthalmia neonatorum "is essentially the same disease as purulent 



142 CONJUNCTIVA. 

ophthalmia in the adult, merely modified by the undeveloped tissues of the 
babe, and the activity of the growing processes, the infant organism, but it is 
generally more severe." (Walton.) Usually about three or four days after 
birth it commences with some slight redness of the lids and slight discharge; 
the eyes are kept closed; light is distressing; then gradually the lids swell, 
and the purulent discharge becomes profuse, when the whole train of symp- 
toms, above described, may be considered as fairly set in motion. But fortu- 
nately not all cases are of this virulent nature ; simple catarrhal inflamma- 
tion, caused by chilling the child when bathing or washing it, or using strong 
soap, which irritates the eyes — may as well commence at that time; the pu- 
rulent form originates from leucorrhceal or gonorrheal discharges of the 
mother transmitted to the eyes of the child during parturition. 

THERAPEUTIC HINTS.— As in all three forms of purulent oph- 
thalmia the discharge is poisonous, great care should be taken as to cleanli- 
ness in nursing such cases. 

Apis, edematous swelling of the lids and adjacent cellular tissue; con- 
junctiva congested, puffy, chemosed; lids everted, villous; cornea grayish, 
smoky, opaque; burning, stinging pain: photophobia and hot lachrymation. 

Arg. met., purulent; infant; any effort to separate the lids caused a 
drawing-in of their edges. (After Sulphur and Calc. carb. had been without 
effect.) 

Arg. nitr., Allen and Norton have witnessed the most intense chemo- 
sis with strangulated vessels, most profuse purulent discharge and com- 
mencing haziness of cornea with a tendency to slough, subside rapidly under 
this remedy in its 30th potency internally, and at the same time a solution 
of five or ten grains to two drachms of water of the 1st, 3d or 30th dilution 
as an external application. The very absence of subjective symptoms, with 
the profuse purulent discharge and the bulging lids from a collection of pus 
underneath or from swelling of the subconjunctival tissues, and not from in- 
filtration of the connective tissue of the lids themselves (as in Khus or Apis), 
indicate this drug. 

Arsen. is characterized by a thin and corroding discharge with great 
burning pain and restlessness ; after abuse of nitrate of silver. 

Calc. carb., profuse, yellowish-white discharge; ulceration of cornea; 
oedema of lids; later opacities of cornea; well-known Calcarea symptoms; 
after working in the water. 

Chamom., ophth. neonatorum; lids much swollen; conjunctiva bleed- 
ing when separating the lids; child cries much; wants to be carried about; 
has colicky pains and green discharges. 

Euphras., compare catarrhal ophthalmia. 

Hepar, purulent secretion in scrofulous subjects; lids swollen, spas- 






GRANULAR OPHTHALMIA. 143 

raodically closed, bleeding easily on attempting to open them and sensitive to 
touch; intense photophobia; throbbing pain, better from external warmth, 
worse from any draught of cold air. Ulceration of cornea and hypopion ; 
affection of Meibomian glands. 

Lycop., ophth. neonatorum; copious discharge of pus; the lids are 
puffed out by pus beneath ; the conjunctiva looks like a piece of raw flesh. 

Merc, sol., ophth. neonatorum; thin, excoriating secretion from the 
eyes; green, diarrhoeic stools with straining; soreness of anus; jaundice; 
syphilitic and gonorrheal infection. The other mercurial preparations have 
also been successfully used. 

Natr. mur., especially as an antidote to nitrate of silver, so frequently 
abused. 

Nitr. ac, especially as an antidote to mercurial and syphilitic poison. 

Pulsat., ophth. neonatorum; profuse and bland discharge; from gonor- 
rheal poison ; all worse in the evening and better in the open air. Allen 
and Norton found it of great benefit as an intercurrent remedy when Arg. 
nitr. seemed to give out. 

Rhus tox., edematous swelling of lids, and of conjunctiva; great rest- 
lessness; after getting wet; commences on the left eye. The discharge is 
profuse, or tears are gushing out of the eye. 

Sulphur, often in chronic cases with an outspoken psoric cachexia. 

The gonorrhoeal and syphilitic form may require besides the remedies 
mentioned : Cannab., Cinnab., Carb. veg., Kali bichr., Phytol., Tart, emet., 
Thuja. 

Granular Ophthalmia. 

"Under granular ophthalmia are classed two different forms of conjunc- 
tivitis, follicular and granular. The former is an accumulation of lymphoid 
elements. It never involves the deep structures of the lids or surrounding 
conjunctiva, and, therefore, disappears without leaving cicatricial changes. 
It is characterized by round or oval, pale red prominences, often arranged in 
rows in the oculo-palpebral folds, especially the lower, and is accompanied 
with some catarrhal symptoms of conjunctiva. 

True granular conjunctivitis is a much deeper and more serious form of 
inflammation. It involves deeply the stroma of the conjunctiva (palpebral), 
as is shown by the proliferation of papillae and development of so-called 
granulations. It always leaves scars behind, causes pannus, serious results to 
vision, entropion, trichiasis and other disorders, which is not the case in fol- 
licular conjunctivitis. It also especially involves the upper lid. It may be 
acute or chronic. The two diseases may be found together." (G. S. Norton.) 

By the continual friction of the granules upon the cornea the latter may 
become hazy, rough or semi-opaque and vascular, a state which is known 



144 CONJUNCTIVA. 

under the name of Pannus, though this opacity and vascularity of the cornea 
may also be produced by trichiasis, or any friction of the lid-edges. The 
granular eyelid is usually attended with great sensitiveness to light, cold air, 
wind, dust and smoke; reading, writing and sewing cause pain in the eyes 
and an increase of redness; there is mistiness of sight; rainbow colors appear 
around luminous bodies and finally, when the cornea more and more degener- 
ates and even deeper portions of eyeball become involved in the inflamma- 
tory process, sight may be considerably damaged. 

Causes. — Being not a specific disease, it usually is the consequence of 
neglected conjunctivitis, which has become chronic. We find it, therefore, 
most frequently among the poor, and as in all ophthalmias the secretion is 
infectious, it too is propagated by infection, and consequently most prevalent 
where large masses of people are crowded together. " But the commonest of 
all exciting causes, is the use of nitrate of silver in substance for the primary 
inflammation, or in lotions or salves, of such strength as to be highly irri- 
tating." (Walton.) 

THERAPEUTIC HllVTS — Aeon., in acute aggravations by over- 
heating or exposure to dry, cold winds. 

Alum., upper lids are weak and hang down loosely. 

Arg. nitr., being so often the cause of granular lids, it surely must do 
good, where it has not been abused ; compare the foregoing chapters. 

Arsen., see purulent ophthalmia; lids spasmodically closed; palpebral 
conjunctiva inflamed, raw and suppurating; cornea degenerated; on the face 
a fine eruption ; under the eyes excoriated places by the acrid discharge, 
which are sometimes covered with crusts. 

Aurum, with pannus; great photophobia; hot, burning tears when 
attempting to open the eyes ; excoriation on the cheeks and swollen glands 
on the neck ; after the abuse of Mercury. 

Bellad., acute aggravations with great photophobia. 

Calc. carb., with pannus; caused by working in the water; deafness, 
or ear discharges; sweat on forehead; thick, red nose with acrid discharge, 
or nose stopped up ; swollen upper lip ; swollen glands on neck ; large abdo- 
men ; desire for boiled eggs. 

Euphras., with or without pannus; profuse lachrymation and thick 
discharge, excoriating lids and cheek. 

Kali bichr., with pannus; everything appears slightly red; eyes feel 
better when lying on the face. 

Merc, prsec. rub., with pannus; old chronic cases. 

Merc, protojod., with pannus, and superficial ulceration upon it. 

Merc, bijod., " of great value in old cases of granular lids and pannus." 
(G. S. Norton.) 



PHLYCTENULAR OPHTHALMIA. 145 

Natr. mur., the most important remedy after cauterization, especially 
with nitrate of silver. 

Nux vom., often gives great relief after many other crude drugs have 
been employed. 

Petrol., with pannus; occipital headache; roughness of skin; scrofu- 
lous habit. 

Pulsat., papillary trachoma without pannus in tearful females; with 
evening aggravation and amelioration in the open air. 

Rhus tox., with pannus and profuse lachrymation. 

Sulphur, when other remedies fail to act; often better indicated by 
other than eye-symptoms; the psoric tendency of the patient and his dislike 
to water and the like. 

Thuja, granulations large, wart-like; pain worse at night, after mid- 
night. 

The following remedies are mentioned favorably: Alumen exsiccatum, 
Caustic, Chin, mur., Chin, tan., Cinnab., Conium, Cupr. al., Cupr. sulph., 
Hepar, Merc, sol., Xatr. phosph., Sepia, Tart, emet., Zincum. 

Phlyctenular Ophthalmia. 

The phlyctenula commences as a little vascular patch, at the summit of 
which the epithelium is raised by serum into a vesicle; the conjunctiva 
swells, the vessels enlarge, profuse lachrymation ensues, and a catarrhal dis- 
charge is produced. By this time the vesicle bursts and a little ulcer is 
formed which secretes an opaque grayish substance, under which the ulcer 
may heal, if the inflammation does not extend, before the repair is effected. 
The phlyctenule appear most frequently at the corneo-scleral border, some- 
times also on the cornea, and exceptionally on the oculo-palpebral or pal- 
pebral conjunctiva. They appear either singly or there may be several 
scattered about or in groups, and sometimes disposed in a circular manner, 
partially surrounding the cornea. Ordinarily the redness is only on one side 
of the eyeball, where the eruption is located; sometimes the whole conjunc- 
tiva is inflamed. At its outbreak it is attended with stinging and itching; 
photophobia is not very great, but increases as the inflammation is nearer or 
at the cornea. 

Causes. — 111 health, debility; hereditary weakness, impure air, in- 
sufficient diet and clothing, want of exercise; exposure to wet and cold. 

THERAPEUTIC HINTS include those for pustular keratitis and 
so-called ophthalmia scrofulosa. 

Apis, eyelids puffed; conjunctiva chemosed; cornea grayish, smoky, 
opaque ; pain burning, stinging. 
10 



146 CONJUNCTIVA. 

Arsen., lids spasmodically closed; conjunctiva and cornea pustulous 
and ulcerated; lachrymation and discharge excoriating the surrounding 
parts ; burning pain ; nose and upper lip excoriated by acrid discharges ; great 
restlessness and thirst. 

Aur. met., great photophobia; hot, burning tears; cutting pain 
through the eyes, sensitive to touch ; swollen glands on neck ; after mercurial 
poisoning. 

Bar. carb. and jod., enlarged cervical glands. 

Calc. carb. and jod., scrofulous subjects; from exposure to wet, and 
worse during damp weather ; complication w T ith deafness ; swollen glands, etc. 
See previous chapters. • 

Caustic, pain relieved by external pressure; yellow face; warts on 
nose or eyebrows. 

Chamom., compare under purulent opththalmia. 

Cinnab., pain from inner can thus across the eyebrows or around the eye. 

Conium, great photophobia without much inflammation of the con- 
junctiva. 

Crot. tigl., with a corresponding eruption on face and lids. 

Euphras., compare previous chapters. 

Graphit., often indicated in the chronic and acute form; the external 
canthi are cracked and bleed easily when opening the eyes ; intense photo- 
phobia. 

Hepar, ulcers on cornea; intense photophobia, lachrymation and great 
redness, even to chemosis; pain throbbing, better from external warmth; 
scrofulous, cross children; abuse of mercury. Hypopion. 

Kali bichr. and hydr., absence of pain, of photophobia and redness; 
secretion of a stringy character. 

Merc, sol., ulcers, and chalk-white appearance of the cornea; lids 
swollen and spasmodically closed ; intense photophobia ; excoriating lachry- 
mation ; pain worse at night ; excoriation of nose ; ulcers on tongue ; erup- 
tion on face and head; aching in the bones; syphilitic subjects. These 
symptoms fit more or less to other mercurial preparations, of which there 
have been used with success — 

Merc, corr., when the acridity seems still more intense. 

Merc, nitr., has been used with great success by Dr. Liebold in this 
form of inflammation, whether acute or chronic. 

Merc, prsec. rub., differs little from the others. 

Merc, protojod., when the tongue has a thick, yellow coating at the 
base. 

Natr. mur., lachrymation and discharge acrid and corroding; after 
the abuse of nitrate of silver. 

Nux vom., after much drugging; morning aggravation. 



DIGEST TO THE DIFFERENT FORMS OF OPHTHALMIA. 147 

Psorin., chronic cases with psoric taint. 

Puis at., phlyctenular confined to the conjunctiva. Compare former 
chapters. 

Rhus tox., pimples and vesicles on the cornea; great photophobia 
and intense inflammation; eruption on head and face; swelling of glands 
behind the ears. Compare previous chapters. 

Sepia, complication with uterine affections; aggravation morning and 
evening. 

Silic, suppurating and perforating ulcers on the centre of the cornea, 
without blood-vessels running towards it; neuralgic pain in supraorbital 
nerve; phlyctenules on the boundary of sclera and cornea, recurring often. 
After vaccination. 

Sulphur, very often indicated by the general state of the patient, or 
when other remedies fail to relieve. The pain is sharp and piercing through 
eye into the head ; worse at nights ; eruptions on other parts of the body ; 
swollen glands ; diarrhoea early in the morning ; water and washing aggra- 
vate, and there is a general dislike to being washed. 

Tart, emet., photophobia and herpetic eruptions. 

Tellur., complicated with offensive otorrhcea. 

Zincum, persistent redness, especially at the inner angle and worse in 
the evening and in the open air, remaining after pustular keratitis. 

Still other remedies have been found useful: Arg. nitr., Bapt. tinct., 
China, Chloral, Cupr. al., Ferrum, Ferr. jod., Hyosc, Kreos., Laches., 
Lycop., Magn. carb., Mezer., Nitr. ac, Petrol., Phosphor., Podoph., Sulph. 
jod., Thuja. 

Digest to the Different Forms of Ophthalmia. 

FORMS. I Acrid, thick and yellow, excoriating lids 

Acute or chronic: Graphit., Merc, nitr., and cheeks: Luphras. 

Sulphur. | Bland, profuse, whitish: Pulsat. 
aggravations by overheating or ex- ! Profuse, yellowish-white: Calc. carb. 

posure to dry, cold winds: Aeon. , , or tears gush out of eyes: Rhus tox. 

great photophobia: JBellad. , inner half of eye most affected: Zincum. 

frequent relapses : Merc. sol. Purulent: Arg. met., Arg. nitr., Hepar, 

Chronic: Digit., Graphit., Merc, prcec. rub. Lycop. 

psoric taint: Psorin., Sulphur. Muco-purulent, dry in evening: Sepia. 



Ophthal. neonatorum: Chamom., Lycop., 
Merc, sol., Pulsat. 

DISCHARGE. 
Acrid, excoriating, thin: Arsen., Graphit., 
Merc, corr., Merc, sol., Natr. rnur. 



Stringy : Kali bichr. 

LACHRYMATION. 
Acrid, excoriating: Euphras., Merc, sol., 

Xatr. mur. 
Hot and burning : Arg. met. 

— with burning pain, restlessness and , when attempting to open the eyes: 

worse at night : Arsen. Aurum. 



148 



CONJUNCTIVA. 



Hot, or dryness of eyes: Bellad. 

and photophobia: Apis. 

Profuse : Euphras., Rhus tox. 

PHOTOPHOBIA. 

Great, intense: Aurum, Bellad., Graphit., 

Hepar, Merc, sol., Tart. emet. 
, with intense inflammation : Rhus 

tox. 

, without much inflammation : Conium. 

, with hot lachrymation: Apis. 

PAIN. 

Aching on lying down to sleep: Conium, 

Burning, stinging: Apis. 

Cutting through the eyes and sensitive 
to touch : Aurum. 

Sensitive to touch : Merc. sol. 

Sharp, piercing, like pins through eye 
into the head, i'rom 1 to 3 a.m., waking 
from sleep : Sulphur. 

Smarting, like salt : Nux vom. 

as after weeping with a corresponding 

appearance, from left to right eye: 
Crocus. 

Throbbing: Bellad: 

Pain from inner canthus across the eye- 
brows, or around the eyes: Cinnab. 

Absence of pain, photophobia and red- 
ness : Kali bichr. and hydroj. 

SIGHT. 

Blurring of vision relieved by winking: 

Euphras. 
Everything appears slightly red: Kali 

bichr. 

SIDES. 
Right eye : Bellad.. 
Commences in the left: Crocus, Rhus tox. 

LIDS. 

Bulging from pus beneath or from sub- 
conjunctival tissues, and not from in- 
filtration : Arg. nitr., Lycop. 

Puffed, swollen: Apis, Chamom., Hepar, 
Merc, sol., Sepia. 

CEdema : Apis, Calc. carb., Rhus tox. 

and of adjacent cellular tissue, with 

redness, heat and sensitiveness to external 
covering: Apis. 

and of conjunctiva: Rhus tox. 



Affection of Meibomian glands, and lids 

sensitive to touch : Hepar. 
Drawing-in of edges when trying to 

separate them : Arg. met. 
Spasmodically closed: Arsen., Hepar, 

Merc. sol. 
Bleeding on attempting to open them : 

Chamom,., Hepar. 
Everted, villous: Apis. 
Upper lids hang down loosely: Alum. 
External canthi crack and bleed: 

Graphit. 
Inner canthi more inflamed : Nux vom. 

CONJUNCTIVA. 

Inflamed with dryness, burning and heat 
in eyes : Aeon. 

Dark, violet color: Arsen. 

Dull, red color, with some photophobia 
and swelling of lids, worse in the morn- 
ing: Sepia. 

Persistent redness of inner angle after 
keratitis, worse evening and in open air : 
Zincum. 

Yellowish redness of palpebral con- 
junctiva: Digit. 

Bloodshot : Chamom., Conium, Nux vom. 

Chemosis : Apis, Arg. nitr., Hepar. 

Granulated, with pannus: Merc, bijod. 

, like warts: Thuja. 

, in tearful females: Pulsat. 

Phlyctenules: Pulsat. 

, on boundary of sclera and cornea, 

often recurring: Silic. 

Pustulous and ulcerated: Arsen. 

Raw and suppurating: Arsen. 

Like a piece of raw flesh : Lycop. 

CORNEA. 

Grayish, smoky: Apis. 

Hazy, with tendency to slough : Arg. nitr. 

Chalk-white : Merc. sol. 

Opaque : Apis, Calc. carb. 

Pannus: Aurum, Calc. carb., Euphras., 

Kali bichr., Merc, protojod., Petrol., Rhus 

tox. 
and superficial ulceration upon it: 

Merc, protojod. 
Ulcers : Calc. carb., Hepar, Merc. sol. 
, perforating on centre of cornea, with- 



DIGEST TO THE DIFFERENT FORMS OF OPHTHALMIA. 



149 



out blood-vessels running towards it: 

Silic. 

and hypopion : Hepar. 

Degeneration: Arsen. 

SYSTEMIC SYMPTOMS. 
Child cries much and wants to be carried 

about: Chamom. 
don't want to be washed: Sulphur. 



Headache: Bellad. 

in occiput : Petrol. 

Eruption on head and face: Merc. 

Rhus tox. 
Sweat on forehead : Cole. carb. 
on head, face and neck : Conium. 



Offensive otorrhoea: TeUur. 
Ear discharge : Cede. carb. 
Deafness: Cole. carb. and jod. 



Neuralgic pain in supraorbital nerve: 

Silic 
Excoriation under eyes and surrounding 

parts : Arsen., Aurum, Natr. mur. 
Fine eruption on face: Arsen. 
Corresponding eruption on face and lids : 

Crot. tigl. 
Yellow face : Caustic. 
Swollen upper face: Code. carb. 



Coryza, with burning and pain in frontal 

sinuses: Euphras. 

, with sore nose : Bellad. 

Acrid discharge, with excoriation: Arsen., 

Cole, carb., Graphit, Merc. sol. 
Crust on the nostrils: Graphit. 
Upper lip excoriated: Arsen. 
Nose thick and red, stopped up : Cole. carb. 
Warts on nose and eyebrows: Caustic. 



Glands swollen : Arsen., Aurum, Bar. carb. 

and jod., Cole, carb., jod. and phosph. 
behind the ears : Rhus tox. 



Thick, yellow coating on base of tongue : 

Merc, protoj. 
Ulcers on tongue: Merc. sol. 
Thirsty: Arsen., Conium. 
Desire for boiled eggs: Cole. carb. 



Feeling of something alive moving in ab- 
domen: Crocus. 

Large abdomen: Calc. carb. 

Diarrhoea early in morning: Sulphur. 

Colic and green stools: Chamom. 

Green, diarrhceic stools with straining: 
Mere. sol. 

Soreness of anus: Merc. sol. 

Uterine affections: Sepia. 



Bones aching: Merc. sol. 

Eruptions on different parts of body : Sid- 

phur. 

, herpetic: Tart. emet. 

Roughness of skin : Petrol. 

Jaundice : Merc. sol. 

Scrofulous habit: Cole. carb. and jod., 

Hepar, Petrol. 
Psoric tendency: Sulphur. 
Feverish and restless at night: Sulphur. 
Sweat on head, face and neck: Conium. 

gives no relief: Merc. sol. 

Great restlessness: Arsen., Rhus tox. 

and thirst: Arsen. 

CAUSES. 
Pieces of steel or cinder, etc.: Aeon. 
If there remains still some inflammation 

after Aeon. : Sulphur. 
Getting wet: Calc. carb. and jod., Rhus tox. 
"Working in water: Cah. carb. 
Bathing and washing of infants : Chamom. 
Sharp, cold winds: Aeon., Hepar. 
Exposure to cold and during first stage of 

measles: Euphras. 
During dentition: Bellad., Chamom, Calc. 

carb. 
After vaccination : Silic, Thuja. 
Gonorrhceal poison : Puhat. 

and syphilitic infection : Merc. sol. 

Mercurial and syphilitic poison: Hepar, 

Xitr. ac. 

AGGRAVATION. 
Morning : Nux vom., Sepia. 
Evening : Puhat., Sepia, Zineum. 
From evening till midnight : Merc. sol. 
Night: Mere, sol., Sulphur. 
After midnight: Sulphur, Thuja. 
In warm room : Arg. nitr., Merc, sol., Pul- 

sat. 



150 



CONJUNCTIVA. 



In cold air: Aeon., Merc, sol., Nux vom., 

Zincum. 
Throbbing pain from any draught of cold 

air: Hepar. 
During damp weather: Cede. carb. and jod. 
After working in water: Cole. carb. 
Water and washing: Sulphur. 
From reading: Pulsat. 

AMELIORATION. 
Throbbing pain from external warmth : 

Hepar, Silic. 
In open air: Arg. nitr., Pulsat. 



External pressure: Caustic. 
When lying on the face: Kali bichr. 

RELATION OF DIFFERENT 

REMEDIES. 

Arg. nitr. antidoted by: Arsen., Natr. mur. 

is followed well by : Pulsat. 

Mercurial preparations antidoted by: 

Aurum, Hepar, Nitr. ac. 
Nux vom. after previous drugging. 
Sulphur, when other remedies fail. 
Arg. met., when Sulphur and Calc. carb. 

fail. 



Diphtheritic Conjunctivitis. 

Like diphtheritis of the pharynx, it is an inflammation of the entire 
conjunctiva, which becomes tumefied by a corpuscular infiltration of newly- 
formed cells into the subepithelial connective tissue, so abundant as to com- 
press the blood-vessels and arrest the circulation and nutrition, in conse- 
quence of which the conjunctiva degenerates into a necrotic mass, and is 
thrown off in pus-like secretion. On examining the eye, the conjunctiva 
appears as if covered with a felted flocculent membrane of a pale yellowish 
or grayish hue, especially on the palpebral conjunctiva and on the oculo- 
palpebral fold. The eyelids are swollen, hard, stiff and hot. Often the in- 
ternal parts participate in the inflammatory process. After six to eight 
days the active inflammation subsides, the exudation dissolves and is thrown 
off as a pus-like discharge, when finally the injured parts heal and become 
cicatrized, involving sometimes the cartilage and deeper tissues of the lids, 
and causing entropion, symblepharon, secondary corneal affections, etc. It 
ought to be borne in mind, that the diphtheritic conjunctivitis is the most 
destructive form of external inflammation of the eye and that its discharge 
is extremely contagious. 

Causes. — In Northern Germany it has appeared as an epidemic; in 
this country only sporadic cases have been seen. Some say, purulent oph- 
thalmia may be converted into this form by the improper use of escharotics; 
it may be inoculated and it may be idiopathic, its cause lying in constitu- 
tional conditions, and be complicated with diphtheria in the throat, with 
scarlet and puerperal fevers, and even with measles. It may attack young 
and old. 



THERAPEUTIC HINTS must be more or less identical with those 
given under Diphtheria, which compare. 



CROUPOUS CONJUNCTIVITIS — PTERYGIUM. 151 

Croupous Conjunctivitis 

"Is much more common and should be distinguished from diphtheritic. 
The lids are swollen (usually cedeinatous), but not firm and hard, as in 
diphtheritic. The false membrane is present to a greater or lesser extent 
and more or less adherent, but it is on the surface of the conjunctiva (espe- 
cially palpebral) and does not leave cicatrices behind, while in the diph- 
theritic form the exudation is in the stroma of the conjunctiva and cicatriza- 
tion always results. Croupous conjunctivitis is therefore much less serious 
than diphtheritic, though the former may pass over into the latter. 

THERAPEUTIC HINTS.— Acet. ac. is particularly the remedy 
when the membrane is yellow, white and very dense, tough and adherent. 

Arg. nitr., after degeneration of the membrane has set in and the dis- 
charge is more purulent. 

Kali bichr., if the membrane is loosely attached and comes off in 
strings and threads." (Geo. S. Norton.) 

Pterygium. 

This is a triangular or wing-shaped adventitious growth on the ocular 
conjunctiva. Starting with its broad base at the corner of the eye, it reaches 
with its apex (seldom the middle, and still more seldom crossing the middle) 
of the cornea. It is loosely connected with the conjunctiva. It generally 
makes its appearance at the inner — rarely at the outer — corner of the eye. 
Very rarely it appears on the upper or lower part of the eyeball. These 
growths are of different consistency and color: some look red, inflamed, and 
are full of blood-vessels ; some are quite thin, almost transparent ; and still 
others are thick and of a whitish or yellowish hue. 

Their origin is usually due to a chronic inflammation of the conjunctiva, 
and therefore always preceded by increased vascularity of the spot of the 
conjunctiva in which it appears. Tropical influence is considered as an 
excitant. It appears after the adult period; but there are also congenital 
cases. 

THERAPEUTIC HINTS— Arg. nitr., pink color; discharge from 
the eye; inflammation better in the open air, unbearable in a warm room, 
with pain at the root of the nose. 

Arsen., dryness and burning in the eye; or acrid lachrymation and 
discharge. 

Calc. carb., from exposure to wet and cold. 

Zincum, thick and vascular; conjunctiva injected; lashes inclined to 
turn inward; external canthi sore and cracked; eyes feel sore in cold air, 



152 CORNEA. 

better in a warm room; itching and lachrymation at night; green halo 
around candle-light; rush of blood to the head over face, followed by per- 
spiration over body ; pressure across the root of the nose and supraorbital 
region. (Dunham.) 

Still other remedies have proved useful: Chimaph., Laches., Nux 
mosch., Psorin., Katan., Spigel., Sulphur. 

CORNEA. 

Corneitis, Keratitis. 

Inflammation of the cornea is always attended by some degree of in- 
flammation of the surrounding conjunctiva and sclerotica. Ordinarily its 
epithelial layer is first affected ; it becomes visible by the molecular cloudiness 
of its cell contents and the proliferation of the cells themselves ; this is fol- 
lowed by a subepithelial infiltration which may involve the true corneal 
elements. In this way the cornea swells ; the epithelial layer becomes rough 
and loses its polish, and the anterior portion of the true cornea assumes a 
general dulness or grayish opacity of different degrees. The blood-vessels, 
in a fine net-work superficially arranged, follow the opacity from the circum- 
ference, being formed in the exuded material, whereby the cornea is reddened; 
they communicate with the blood-vessels of the conjunctiva. This affection 
is always accompanied with photophobia, lachrymation, blepharospasm and 
pain ; the amount of interference with vision depends on the amount of the 
opacity over the pupil. Its causes are either mechanical or chemical irri- 
tations. 

When phlyctenules form on the cornea, the affection is usually called 
Strumous or Scrofulous ophthalmia; it is frequently associated with 
phlyctenules or pustules on the conjunctiva, as described under "phlyctenular 
ophthalmia," which compare. 

When the inflammatory symptoms are more chronic in character and 
the destructive effects are deeper and greater, it is termed Diffuse or 
Parenchymatous corneitis. 

" The cornea has then lost its natural polish and resembles a piece of 
glass that has been breathed on. Or it may have a more stippled aspect, 
with greater roughness, whereby there is more haziness. With this there is 
a deep-seated, streaked or speckled whiteness or yellowishness, arising from 
interstitial deposits of materials in the true cornea. The true corneal tissue 
is not long pervaded by opacity in any form, before such opacity commences 
to be injected with blood-vessels, which may be few and isolated, or numer- 
ous and close, looking like a red patch." (Walton.) Pain, photophobia, 
and blepharospasm seldom exist, except in the beginning of the disease. Its 



CORNEITIS, KERATITIS. 153 

spoiling effects may be changes in the curves of the cornea causing myopia 
or astigmatism ; or limitation of vision ; adhesion of the iris to the cornea ; 
changes in the deeper parts of the eye; even atrophy of the eyeball from 
ophthalmia. 

Causes. — External injuries to the cornea and constitutional derange- 
ments, especially hereditary syphilis. 

When by long-continued mechanical irritation from cicatrices of the 
eyelids, from the contact of the cilia in trichiasis and entropium, from gran- 
ular conjunctivitis the cornea becomes inflamed, cloudy and vascular, or even 
vascular granulations appear, especially on the upper half of the cornea in 
consequence of the greater irritation of the upper lid — we have PannilS. 
As the vascularity increases, the cornea is ultimately surrounded by a thick 
tumefied net-work of varicose vessels, interspersed with numerous reddish- 
brown granulations. 

When in consequence of inflammation suppuration takes place between 
the layers of the corneal laminae, we have an Interstitial abscess of the 
cornea, which appears either as a yellowish spot with whitish circumference 
in any part of the cornea, or as a deposit of pus diffused throughout the 
cornea, so that the whole looks yellow. The pus may gravitate to the lower 
margin of the cornea, forming there a curved line which resembles the white 
mark at the root of the nail, hence it is called Onyx. 

When in consequence of inflammatory proliferation of epithelium of the 
posterior elastic membrane of the cornea, an exudation of mucus and pus cor- 
puscles takes place into the anterior chamber, we have Hypopion. The 
quantity of this exudation may be merely recognizable or may fill both 
chambers of the eye. Its color is usually creamy, but it may be streaked 
red with blood, or altogether red from the same. In changing the direction 
of the head from the perpendicular, the loosely lying mass shifts its position 
in the chamber and is therefore readily distinguished from onyx. 

When, however, in consequence of inflammation of the conjunctival 
layer of the cornea, its substance becomes rough and is cast off or exfoliated, 
and the breach constitutes an ulcer, we then have a surface abscess, or, as it is 
termed, Ulceration of the cornea. The ulcer may appear at any part of 
the cornea ; it may be superficial or deep, even penetrating the cornea. The 
surrounding conjunctiva and sclerotica become vascular, and the more so as 
the ulcer is nearer the margin of the cornea. Deep ulceration excavates the 
cornea and the spot becomes covered with a pus-like material ; it may per- 
forate the cornea, when the aqueous humor flows off; it may be associated 
with onyx or hypopion. The subjective symptoms are those of interstitial 
conjunctivitis, and its causes the same. Iritis is no uncommon complication. 
It may result in opacity of the cornea (Lencoma, Macula COrneae), or in 
spherical or conical protrusion of the remaining posterior portion of the cor- 



154 CORNEA. 

neal tissue, and of the posterior elastic lamina, when it is called Ulcerative 
corneal staphyloma; or the ulcerated surface may heal over and cicatrize, 
leaving, however, the cornea still protruding. This is called Cicatricial 
Corneal Staphyloma; its most prominent part is the thinnest and the sur- 
rounding cornea is often curved in several directions and affected with super- 
ficial and interstitial opacity. The staphyloma may burst. When in case of 
perforation of the cornea the iris falls against or into the gap, it either pro- 
trudes through the opening, or in case of cicatrization of the opening, the 
cornea yields in consequence of the intraocular pressure and gradually 
bulges forward, giving rise to a Partial staphyloma of the cornea and 
iris; a total destruction of the cornea by sloughing or ulceration causes 
Total staphyloma of the cornea and iris, in which process mostly the 
neighboring portion of the sclerotica, and in time, the whole anterior half of 
the globe becomes involved. 

THERAPEUTIC HINTS.— Keratitis, when caused by mechanical 
irritation, requires: Aeon., and later Sulphur, Euphras., with a feeling 
as if a hair were hanging over the eye; Symphit., with a feeling as if the 
lid were moving over a ball. Besides may be indicated: Arnica, Calend., 
or Hamam. When caused by chemical irritation we will have to look for 
the corresponding antidotes of the different chemicals. Arnica is most im- 
portant in preventing suppuration. 

Phlyctenular corneitis requires the same treatment as detailed under 
phlyctenular conjunctivitis. 

Diffuse or Parenchymatous corneitis. Merc. sol. and other mercurial 
preparations are the most important. Besides compare: Apis, stinging- 
burning pain and oedematous swelling; Arsen., burning pain and restless- 
ness; Aur. mur., hereditary syphilis; "I have found it more commonly 
indicated than any other remedy." (Geo. S. Norton.) Bar. jod., 
greatly enlarged cervical glands and bone-pains at night; Calc. carb. 
and jod., strumous habit; Cann. sat., Hepar, promotes absorption; 
Sepia, uterine disturbances; Sulphur, promotes absorption. 

Pannus. Apis, Arg. nitr., Arsen., Aurum, Bellad., Cannab., 
Chin, mur., Euphras., Graphit., Hepar, Kali carb., Merc, sol., 
protoj. and praec. rub., Natr. mur., Petrol., Pulsat., Rhus tox., 
Sulphur. For particular indications compare granular ophthalmia and 
the following. 

Ulceration of the cornea. " Bandaging is of the very greatest importance 
in the treatment of ulcers of the cornea. See page 205 Allen and Norton's 
Ophthalmic Therapeutics" (Geo. S. Norton.) 

Act. rac, sharp, neuralgic pains through the eye into the head. 

Apis, stinging-burning pain and oedematous swelling. 



CORNEITIS, KERATITIS. 155 

Arg. nitr., profuse discharge; halo around the light; darting pain 
through eye, morning and evening; better in open air; worse in warm room. 

Arsen., burning, acrid, profuse lachrymation ; photophobia; pain 
worse after midnight ; with restlessness ; better from warm applications. 

Asaf., iris affected with pain in the direction from within outwards; 
better from rest and pressure. 

Aurum, with pannus; great photophobia and profuse, scalding lach- 
rymation; pains go from without inwards; cervical glands enlarged and 
inflamed. 

Calc. carb. and jod., for scrofulous children with large heads, open 
fontanelles, slow dentition ; pot-belliedness ; frequent catarrh of nose and bow- 
els; pale face; enlarged tonsils and cervical glands. 

Chamom., cross, peevish children who want to be carried about all 
the time, etc. 

Chin, mur., with pannus; severe intermitting pains; anaemic con- 
ditions of malarial origin. 

Cimic. See Act. rac. 

Cinnab., pain above the eye, extending from the internal to the exter- 
nal canthus, or running around the eye. 

Conium, superficial ulceration with intense photophobia and a gush of 
tears whenever the spasmodically closed lids were forced open; with all this 
but little redness of the conjunctiva. 

Crot. tigl., pain in the supraciliary region at night and vesicular erup- 
tion on the face and lids. 

Euphras., burning flow of corrosive tears and a feeling of a foreign 
substance in the eye, as of a hair ; blurring of the eyes relieved by frequent 
winking ; is followed well by Calc. carb. and later by Silic. 

Graphit., great photophobia; profuse lachrymation; superficial or 
deep ulcers; hypopion; lids red and sore, covered with scales; chronic ec- 
zema on head, behind ears, on face. The external canthi are prone to crack 
and bleed. 

Hepar, torpid ulceration ; hypopion; also profuse lachrymation or want 
of lachrymation; great redness of cornea and conjunctiva; throbbing pain, 
better by warmth, worse by cold, or uncovering the eye in the evening. 
Strumous, outrageously cross children ; chilliness, desire to be covered ; mer- 
curial poisoniug. 

Kali bichr., indolent ulceration without photophobia or redness; little 
pain; slight (if any) discharge of a stringy character. 

Kali carb., ulcer in centre; no photophobia; pale, fat and flabby 
children. 

Merc, cyan., trachoma with pannus; intense pain in eyeball, orbit 
and supraciliary region and head; worse on lying down; nocturnal pains in 
the joints; syphilitic origin. 



156 CORNEA. 

Merc, protoj., serpiginous superficial ulceration of the cornea; much 
vascularity and photophobia ; tongue yellow at base. (Geo. S. Norton.) 

Merc, sol., and other mercurial preparations compare under phlycten- 
ular conjunctivitis. 

Natr. mur., acrid tears and discharge; sharp piercing above eye on 
looking down ; after cauterization. 

Nitr. ac, is often indicated after Calc. carb., or Pulsat. 

Nux vom., Pulsat., compare previous chapters. 

Rhus tox., after getting drenched; compare former chapters. 

Secale, worse from warm applications. 

Silic, deep ulcers; sloughing ulcers; hypopion; the patient wants to 
have his head wrapped up ; after vaccination. 

Sulphur, acute and chronic form; hypopion; otorrhoea; eczema; affec- 
tion of the bones. Cannot bear being washed. "The pains of Sulphur are 
usually sharp and stitching, as if a needle or splinter were sticking in the 
eye. They do not extend into the head, with the exception of the shooting 
pain through the eye into the head from 1 to 3 a.m." (Geo. S. Norton.) 

Thuja, syphilitic origin; hypopion; pain over the eyes as if a nail 
were being driven in. 

Vaccin., with small-pox and after vaccination; also Variol. 

Opacities have been cured especially by Calc. carb.; but the follow- 
ing have also been successfully employed : Apis, Aurum, Cannab., Chelid., 
Crotal., Cupr. al., Euphras., Hepar, Kali bichr., Natr. sulph., Nitr. ac, 
Phosphor., Pulsat., Rhus tox., Silic, Spongia and Sulphur. 

Staphyloma. — Notwithstanding several denials from persons who did 
not know anything about it, 

Apis did cure, or to say the least, did reduce under my own observa- 
tion, a staphyloma, to a degree that the eye regained its former usefulness. 
Years after the same doubts were thrown upon Dunham's cure of a ptery- 
gium. Although such doubts do not alter the facts, yet they do injury by 
disheartening the young physician from even trying to do his best. It seems 
scarcely necessary to mention, that Apis, in order to be successful, must cor- 
respond with the symptoms of the case. 

Schelling cured a staphylomatous protrusion by Euphras. and Lycop. 
(Allg. Horn. Ztg., 36, 148), and so did Stapf by the gradual administration, 
according to the symptoms, of Sulphur, Calc. carb., Nitr. ac, Pulsat., 
Euphras., and Senega; there remained at last a mere slight opacity of 
the cornea and some distortion of the iris ; the protrusion of the cornea had 
been entirely removed {Arch. 18, 2, 45). 

Bellad., Hepar, Mercur. and other remedies may also be indicated, 
but if we give up before trying, how shall we find out? 

Hypopion has been cured by: Hepar, Silic, Sulphur, Thuja. 



SCLERITIS, SCLEROTITIS. 157 

SCLEROTICA. 

Scleritis, Sclerotitis. 

Inflammation of the sclera takes place around the cornea and is usually 
circumscribed, especially between the insertion of the recti muscles; it is 
characterized by a bluish-red elevation, due to increased vascularity and 
lymphoid infiltration in the episcleral tissue, and by bright red vessels on 
the surface ; it is usually painful to touch. Although at times complicated 
with choroiditis, it is not always a sign of hyperemia of the choroid, because 
there are severe cases of choroiditis without any scleral complication, and 
vice versa severe cases of scleritis without choroidal affection. When the 
uveal tract is involved it is usually the iris or ciliary body and not the cho- 
roid, as both (iris and ciliary body) are supplied by the anterior ciliary .ves- 
sels in common with the sclera. (Norton.) 

Repeated attacks of scleritis tend in time to interfere with the nutrition 
of the sclera, in consequence of which the tunica becomes thin, blue and 
bulging, either in whole or in part, constituting an Anterior staphyloma 
of the sclera and choroid, which again may terminate in suppuration within 
the globe, spontaneous bursting and atrophy of the eyeball. 

THERAPEUTIC HINTS— (Allen and Norton's Ophthalmic Thera- 
peutics.) 

Aeon., acute stage; violent aching, dragging, tearing pains in the eye- 
balls ; contracted pupils ; photophobia. Eye sensitive to touch and feels hot 
and dry. After exposure to cold, dry air, or injuries. 

Kalmia, sclera inflamed; vitreous filled with opacities; glimmering of 
light below one eye, especially on reading with the other. 

Mercur., the sclera is thinned and blue; aching in the eye all the time, 
but worse at night; some pain around the eye if the iris has become involved. 
Flabby tongue, offensive breath, night pains; syphilitic origin. 

Silic, pains severe, extending from the eyes to the head, relieved by 
wrapping up the head; aching in the occiput corresponding to the eye 
affected. 

Thuja, has often shown itself useful in all forms of this affection; the 
sclera becomes soft in consequence of extension of inflammation of the cornea 
and iris; tenderness of the globe; intolerance of light; general cachectic con- 
dition, either scrofulous or syphilitic; long deprivation of fresh air. 

Besides are recommended: Coccul., Pulsat., Spigel. and Sulphur. 

If in spite of these remedies staphylomatous degeneration of the sclera 
ensues, iridectomy must be made, unless still other remedies are found to 
check this morbid process. 



158 iris. 

IRIS. 

Iritis. 

Iritis is of frequent occurrence and is usually uncomplicated with in- 
flammation of the neighboring tissues. It very rarely extends from the cili- 
ary body and the choroid, but may extend to these structures. Tenderness 
of the eyeball to pressure is not marked in iritis, unless the ciliary body is 
involved. 

Simple Plastic iritis is characterized by ciliary neuralgia, almost 
always worse at night, photophobia, lachrymation, dimness of vision, ciliary 
injection, chemosis, iris discolored, aqueous, hazy, sluggish, pupil contracted, 
and adhesion of iris to lens — posterior synochia. 

In Parenchymatous iritis the iris is more swollen and vascular with 
more exudation in pupil. 

In Suppurative iritis the lids are oedematous, there is more chemosis, 
and pus in the anterior chamber. 

In Syphilitic iritis we have secondary symptoms of syphilis and often 
gummata on the iris. 

Rheumatic iritis is like plastic, only the episcleral injection may be 
more marked. 

Traumatic iritis is like plastic. 

Serous iritis is characterized by a deposit of lymph on the posterior 
surface of the cornea, which takes a pyramidal shape with apex toward the 
centre of the cornea, cloudiness and hypersecretion of the aqueous humor, 
dilated pupil, deep anterior chamber and slight photophobia, lachrymation, 
ciliary injection. (Geo. S. Norton.) 

THERAPEUTIC HINTS.— "In the treatment of iritis Atropine is, 

I believe, of the greatest importance. The pupil must be kept dilated, or 
you are almost certain, in the great majority of cases, to have serious results, 
as posterior synochia remaining after the inflammation has heen subdued. 
Dry warmth and rest are also very important aids in the treatment." (Geo. 
S. Norton.) 

Aeon., rheumatic form, after exposure to cold winds with great dry- 
ness and heat in the eye ; traumatic origin, even more important than 

Arnica, rheumatic and traumatic form. 

Arsen., burning pains worse after midnight, better from warm appli- 
cations. 

Asaf., syphilitic form and after overdosing with mercury; severe 
throbbing, or burning, or sticking pain from within outward, better from 
rest and pressure. 



IRITIS. 159 

Aurum, syphilitic form and after the abuse of mercury and potash; 
pain in the orbital bones, pressing from above downwards, or from without 
inwards, worse on touch ; great mental depression. 

Bellad., rheumatic form; pressing pain around the eye, or stitching 
pain above or beside the eye, as if it were torn out or pressed in ; pains come 
and go, with flashes of light or dark spots with light margins, or dark fog 
before the eyes ; severe vertigo and headache even to loss of consciousness. 

Bryon., rheumatic form; the pain is worse from moving the eyes and 
also in the evening and at night ; there is shooting pain in the head, and 
pain as if the head should burst on stooping. 

Calend., traumatic iritis. 

Cedron, supraorbital neuralgia, periodical. 

China, periodical pains ; after loss of vital fluids and of malarial in- 
fection. 

Cinnab., syphilitic form; pain commences at inner canthus, extending 
across the brow, or passing around the eye ; nocturnal aggravation ; inter- 
mitting pain. 

Clemat., pressing pain in the eyes, photophobia and lachrymation, 
worse in the open air ; heat in the eyes. 

Coloc, rheumatic form; around the cornea a bluish- white ring; pho- 
tophobia ; no lachrymation ; tearing pain in eye and surroundings ; worse in 
the evening and at night. 

Conium, excessive photophobia without corresponding redness of eye. 

Euphras. y rheumatic form; aching and occasional darting pain in 
eye, worse at night ; iris adhering. 

Gelsem., serous form with choroidal exudation. 

Hamam., traumatic form with haemorrhage into the anterior chamber. 

Hepar, with corneitis or hypopion. Characteristics see in former 
chapters. 

Kali jod., syphilitic form. After abuse of mercury. 

Mercur. and its various preparations, syphilitic and other forms; 
tearing, boring pains in the bones around the eyes ; worse at night ; sclerotitis 
and conjunctivitis; sweat without relief; bad smell from mouth; frequent 
spitting of saliva ; tenesmus. 

Merc, corr., is commonly indicated by the symptoms of iritis more 
than any other drug. (Norton.) 

Natr. mur., pupil contracted; iris discolored; violent stitches in the 
temples on looking into the light or when the light is changed ; on reading 
or writing the letters run together; sight much impaired. 

Nitr. ac, chronic syphilitic form with very little pain (Norton); also 
after abuse of mercury ; pain worse on any change of temperature, at night 
and on touching the parts. 



160 CHOROIDEA. 

Nux vom., rheumatic and syphilitic form; after drugging; pain worse 
in the morning. 

Petrol., syphilitic form with occipital headache. 

Pulsat., rheumatic form; pain worse in the afternoon and evening; 
cries easily and is worse after crying. 

Rhus tox., rheumatic and traumatic form; lids swollen and spasmodi- 
cally closed; lachrymation ; conjunctiva chemosed; pain worse at night; after 
getting wet ; rainy weather ; after Bryon. 

Silic, with hypopion and corneitis. 

Spigel., rheumatic form; excessive pain in and around the eye, espe- 
cially on moving ; sometimes periodically from morning till noon, and then 
abruptly ceasing. 

Sulphur, rheumatic and other forms; with hypopion; relapsing cases; 
psoric tendency; pain worse in the evening and at night; ears often affected. 

Tereb., rheumatic form; after suppression of perspiration of the feet; 
urinary symptoms. 

Thuja, syphilitic form; condylomata on the iris; wart-like excrescences 
on the iris ; pain better by warmth. 

Besides have been successfully employed: Arg. nitr., Crot. tigl., Hyosc, 
Iodum, Lycop., Plumbum, Stilling., Zincum. 

CHOROIDEA. 

The choroid is a dark brown vascular coat, which lies within and in 
contact with the sclera, and between it and the retina ; its proper structure 
terminates anteriorly where the ciliary body commences, which forms the 
connecting link between it and the iris. 

Choroiditis 

" Is usually found uncomplicated with inflammation of other portions of the 
uveal tract. 

In Choroiditis disseminata the eyes feel weak and vision is blurred. 
The ophthalmoscope shows a yellowish-red nodule in the choroid in the 
first stage which soon atrophies, leaving a white spot surrounded by a rim of 
proliferated pigment. Other spots follow, and as they have a tendency to 
coalesce they form large atrophic plaques. The haziness of the vitreous is 
not marked unless the choroiditis is of the syphilitic variety, when the haziness 
of the vitreous is a very prominent symptom, as is the non-tendency of the 
spots to run together. 

Choroiditis suppurativa (panophthalmitis) is usually the result of 
foreign bodies or injuries and its course is generally rapid, destroying the eye. 



CHOROIDITIS. 161 

Characteristic symptoms are : (edematous swelling of the lids, chemosis, pro- 
trusion of the eye, hypopion, synochia posteriora, white reflex from the fundus, 
tension increased, eye sensitive to touch, loss of vision, very severe pain, fever 
and vomiting. 

Sclerotico-choroiditis posteriora or Posterior staphyloma is found 
in myopia, especially high degrees, and is characterized by a white crescent 
around the optic nerve entrance, especially outer side, which corresponds to 
the bulging of the sclera at that point. It may, however, be irregular and 
extend around the optic disc. When it is progressing the myopia increases, 
vision becomes more impaired, black, floating spots appear before the sight 
and the edges of the crescent are not as well denned. It is a congenital 
trouble and is increased by overuse of the eyes. 

Cyclitis usually passes over into irido-eyclitis or irido-choroidifis. A 
prominent symptom of irido-choroiditis is the increased tension in its early, 
and diminished tension in its late stage." (G. S. Norton.) 

THERAPEUTIC HINTS.— Aurum, serous exudation between the 
choroid and retina; haziness of the vitreous; sensitiveness to light and touch; 
pressive pain in eye from above downward or from without inward ; pain in 
the bones around the eye. After abuse of mercury or potash. 

Bellad., often indicated by congestion towards the head; eyes sensitive 
to light ; halo around the light ; various flashes of light, sparks, etc., before 
the eyes. 

Bryon., serous exudation; following rheumatic iritis; eyeball sore to 
touch and motion ; darting pains through the eye into the head. 

Gelsem., serous choroiditis; iritic complications; vision varies from 
day to day or from hour to hour; sometimes fever, with thirstlessness. 

Kali hydroj., syphilitic origin; disseminate variety. 

Merc. corr. or sol., disseminate form; iritic complication; syphilitic 
dyscrasia; tendency to adhesion; nocturnal aggravation of the pains, both 
in and around the eye. 

Nux vom., after use of stimulants ; aggravation in the morning. 

Phosphor., luminous appearance before the eyes, especially red; after 
sexual excesses ; bright light, natural or artificial, hurts the eyes ; they feel 
better in the twilight. 

Prun. spin., with or without iritic or retinal complication; severe pain 
iu the eyeball, as if it were being pressed asunder, or else shooting and cut- 
ting pain through the eye and corresponding side of head, or crushing pain. 

Puis at., when corresponding to the general disposition of the patient. 

Sulphur, chronic state; sharp, darting pains; after suppression of 
eruptions ; psoric taint. 
11 



162 IRITIS. 

Besides, the following remedies have been useful : Aeon., Arsen., Coloc, 
Hepar, Ipec, Psorin., Ruta, Silic, Sol. nig. 

In Sclerotico-choroiditis posteriora has been found useful : 

Bellad., flushed face and throbbing congested headaches ; photophobia. 

Crocus, pain from the eye to the top of the head ; also pain from left 
eye darting to the right ; sensation of cold wind blowing across the eyes. 

Mercur., usual indication. 

Phosphor., muscse volitantes, flashes of light before the eyes. 

Prun. spin., pains in eye as if pressed asunder, or sharp and darting in 
and around the eye. 

Spigel., sharp, stabbing pains through the eye and around it, often com- 
mencing at one point and then seeming to radiate in every direction. 

Thuja, often called for in strumous and sycotic persons. 

Besides compare: Carb. veg., Kali jod., Lycop., Physost., Ruta and 
Sulphur. 

In Choroiditis suppuratiya compare: Aeon., Apis, Arsen., 
Hepar, Phytol. (traumatic origin, lids very hard, red and swollen ; conjunc- 
tiva chemosed and pus in the interior of the eye; severe pain). Rhus tox. 
is the most important remedy. Lids oedematous, much chemosis, photophobia 
and profuse gush of tears on opening the spasmodically closed lids, hypo- 
pion, pains at night, etc. (Norton.) Also: Asaf, Bellad., Mercur., Sulphur. 

In Haemorrhage compare: Arnica, Bellad., Cinchona, Crotal., 
Hamam., Laches., Phosphor., etc. 

Glaucoma. 

1. Acute form. — Its onset may for hours, days, weeks, months, even 
years, be premonitioned by one or the other, or several of the following 
symptoms : a halo, gray or colored, or a circle or several in the same or dif- 
ferent colors around candle-light or luminous objects; flashes or wheels of 
light in the dark, as well as in the light, with or without intercurrent 
obscurations of sight; periodic dimness of sight, or dimness of a part of the 
visual field; rapid increase of presbyopia, ciliary neuralgia, headaches. The 
attack itself often commences suddenly with severe throbbing pain in the 
eyeball and the corresponding side of the head ; the eyeball is very sensitive 
to touch ; flashes of a vivid red or deep orange color appear before the eyes 
with great photophobia, increased by exertion, or anything that quickens the 
heart's action, even the taking of food. The eyeball shows signs of inflam- 
mation in different degrees of intensity, such as: lachrymation and intoler- 
ance to light; swelling and redness of the eyelids; conjunctivitis with 
serous chemosis, but scarcely any purulent discharge; hyperemia of the 
sclerotica and' congestion of the anterior ciliary veins; the cornea is hazy and 



GLAUCOMA. 1G3 

a little roughened, or even vesicular in spots, or sometimes opaque interstiti- 
ally ; its sensibility is more or less lost in parts or in its entire structure. 
The iris loses its color, acquiring a slate-like aspect and is pushed against the 
cornea; the pupil becomes dilated, irregular and fixed; its color is less black 
than usual, but more of a drab color, showing sometimes even a shade of 
green. The eyeball, on palpation, feels harder than natural. The vision 
gradually grows didler, a thick fog appears before the eye in davlight and at 
night prismatic colors surround the candle-light. The visual field usually 
commences to contract on the inner side and after a while all vision is lost. 
Ophthalmoscopic inspection reveals : haziness of the vitreous body ; in 
hemorrhagic glaucoma, which is rare, there is haemorrhage either from the 
disc, the retina or the choroidea, singly or combined ; excavation of the optic 
disc, called glaucomatous cupping, with dilatation of the retinal veins and 
pulsation of the central retinal arteries. 

2. The subacute form, or chronic glaucoma, shows all the symptoms 
above enumerated, only not so sharp and definitely marked, although lead- 
ing in an insidious and slow manner to the same results. Glaucoma always 
begins in one eye, and is very apt to develop in the other, in the course of 
months or years. Its causes have not been sufficiently explained, and the 
nature of the glaucomatous tension of the eyeball is also not fully established. 

Post-mortem examinations have revealed: obliteration of Schlemm's 
canal (Kniess) ; closure of the drainage channels (Weber) ; atrophy of the 
ciliary body, and atrophy or adhesion of the iris (Brailey), all of which are 
supposed to be more or less concerned in producing the increased tension of 
the globe. 

THERAPEUTIC HINTS.— Iridectomy, first recommended by Dr. von 
Graefe, is by some considered as the only remedy worth speaking of, while 
other eye-surgeons recommend frequent tapping of the cornea, and the 
newest of all is sclerotomy. Whichever may be preferred or deemed neces- 
sary, in this I agree entirely with Walton, when he says: "Treatment by 
practical surgery alone is not enough ; it should be but a part, an auxiliary 
of a therapeutic system, embracing those details which help so much in sub- 
duing the abnormal conditions which are common to other affections and to 
glaucoma. I allude, of course, to the abnormal conditions of inflammation 
of the uveal tract, particularly choroiditis, to neuro-retinitis and hyalitis." 
(Page 1172.) 

Arg. nitr. See Advance, October, 1879. 

Aurum, pressure from within outward, and from above downward in 
eyeball; heavy, dull aching of the globes; upper half of an object invisible; 
showers of bright, star-like bodies appear in the upper dark section; bright, 
floating streaks and dots in gaslight before the eyes. 



164 OPTIC NEUVE AND RETINA. 

Bellad., pain in and around the eye, of a pressing nature, as if the eye 
were being pressed into the head, or sometimes as if the eye were being torn 
out; the eyes feel hot, dry and stiff, as if they might protrude. 

Bryon., the eyes feel as if pressed out, often attended with sharp shoot- 
ing pains through the eyes and head ; they feel sore to touch and on moving 
them. 

Cedron., severe shooting pain along the course of the supraorbital 
nerve. 

Coloc, severe burning, aching, sticking, cutting pain in the eye and 
around, always relieved by firm pressure, and by walking in a warm room, 
worse by rest at night and upon stooping. 

Eserine is much used at present and in some cases seems to act well. 
(Norton.) 

Phosphor., halo around the light, and various lights and colors flash- 
ing before the eyes. 

Prun. spin., severe crushing pain in the eye as if pressed asunder, or 
sharp shooting through the eye and corresponding side of the head. 

Rhodod., periodic pain in and around the eye, worse before a storm 
and better after the storm commences. 

Spigel., sharp and stabbing pains through the eye and head, worse on 
motion and at night. 

Besides should be compared : Arnica, Arsen., Chamom., Coccul., Collin., 
Conium, Crot. tigl., Gelsem., Hamam., Kali carb. and jod., Mercur., Nux 
vom., Phytol., Sulphur and Val. of Zinc. 

OPTIC NERVE AND RETINA. 

The optic nerve and the retina may, each of them, be the isolated seat 
of morbid derangement, the first usually from some cerebral disturbance, the 
latter from intraocular disorder; but either of them, if extensively affected, 
will also affect the other. We speak therefore of 

Neuro-Retinitis 

As an inflammation of the optic nerve, the optic disk and the retina, a 
separation of which into different forms would be of little practical use. 

Its Subjective Symptoms are : haziness or fogginess in various degrees ; 
reduction of acuteness of direct and indirect vision; contraction of the visual 
field; blind spots in the visual field; distortion of objects looked at; sub- 
jective appearance of light, so-called sparks, or flashes, or photopsia; sub- 
jective play of colors, colored spectra, or chromotopsy ; the latter two may 
occur even when the case has proceeded to absolute blindness. Still all 






NEURO-RETIXITIS. 165 

these symptoms may occur also in various other intraocular diseases, and the 
only sure way of making a diagnosis is with the ophthalmoscope. 

The Ophthalmoscopic Symptoms are: optic disc swollen and outlines 
ill-defined, retina hazy and vessels veiled here and there; tortuous appear- 
ance of the veins which are dark and full; usually haemorrhage, most fre- 
quently observed in the retina, seldom in the disc ; occasionally whitish dots 
scattered in groups or dull glistening patches in the semi-opaque retina. 
There are no external objective symptoms, unless other ocular tissues are 
drawn into the morbid process. It may lead to partial or complete atrophy 
of the retina. 

Its Causes are: Albuminuria, and then it is called Retinitis alblimi- 
liurica; haemorrhage into the retina and white spots here and there, especi- 
ally of a stellate arrangement in the macula lutea are characteristic and 
early symptoms of this form. Syphilis, and then it is called Retinitis syphi- 
litica; it can be diagnosed only by the precedence or presence of some other 
mark of constitutional syphilis. Diabetes, and then it is called Retinitis 
diabetica, with similar appearance as retinitis albuminurica ; Leuccemia 
(Retinitis leucaemica) ; great pallor of the retinal vessels; hcemorrhages in 
retina (Retinitis apoplectica) ; deposits of pigment in the retina (Retinitis 
pigmentosa) ; contraction of field of vision, night-blindness and deposits of 
pigment in retina extending from periphery to centre of fundus. Direct and 
reflected rays of artificial light or of the sun, and overstraining the eyes un- 
der imperfect or unsteady light, also traumatic injuries. 

There are other affections of the optic nreve and of the retina which, too, 
may cause impairment of sight or even total blindness, without showing exter- 
nally any objective symptoms. Such affections were, before the ophthalmo- 
scope was known, classed under the terms Amblyopia (impaired sight) or 
Amaurosis (what renders obscure, dark). These terms have of late been 
stricken out of the books, because where there is impaired sight or loss of 
vision there can now, by the use of the ophthalmoscope, be found also a cor- 
responding change in the optic nerve or retina, a pathological cause of am- 
blyopia or amaurosis, from which the affection receives its proper name. 

THERAPEUTIC HINTS— Aeon., total blindness produced sud- 
denly by taking cold. 

Ammoniacum, after severe blows upon the head, sight impaired; 
smoke before the eyes, shaping different circles, most distinctly on white 
ground ; the margins of the circles are gray and become black upon sudden 
motions of the eye; better in clear, worse in cloudy weather; persons at a 
distance he cannot recognize ; by candle-light their faces appear dark. 

Apis, albuminuria, after scarlet fever. 

Arnica, after a violent blow, loss of sight. 



166 OPTIC NERVE AND RETINA. 

Arsen., after abuse of liquor and tobacco; urine scanty and albumi- 
nous. 

Aur. mur., after scarlet fever and during childbed (albuminuria); 
sudden loss of vision, with cold perspiration, small pulse, quick and irregular 
breathing. 

Bellad., optic disc swollen and outlines ill-defined, retinal vessels large 
and tortuous, blue and bluish-gray film seems to cover fundus. (Norton.) 
Haemorrhage of retina, with suppression of menses; cerebral congestion; 
sudden heat of head ; vertigo, burning and throbbing pain ; noises in ears 
anbl illusions of vision, while the rest of the body is cold and shivering ; pul- 
sation of carotids. After suppressed scarlet eruption. 

Bryon., eyes feel full and sore on motion or to touch. 

Cactus, with heart troubles. 

Cinchona, sudden blindness with violent pain in occiput, extending 
into the eyes ; irritability of entire spine ; spleen swollen and painful to press- 
ure; rumbling in the abdomen; sour vomiting; constipation. 

Crotal., haemorrhages in retina. (Norton.) 

Gelsem., thirst for light; after apoplexy, congestion to the head ; albu- 
minuria during pregnancy, after diphtheritis. 

Kali hydr., syphilitic form. 

Laches., haemorrhage of retina; albuminuria. 

Merc, corr., albuminuric form, especially during pregnancy. 

Merc, sol., sensitiveness of the eyes to the glare of a fire. 

Nux vom., abuse of stimulants and tobacco. 

Phosphor., photopsies and chromotopsies, as halo around the light; 
dryness of the nose ; after sexual excesses. 

Pulsat., " choked disc," great swelling of optic papillae and enlargement 
of vessels ; vision nearly lost, with severe headache, only relieved in the open 
air. (Norton.) Menstrual difficulties. 

Secale, photophobia; suppressed secretion of tears; stitching pain in 
the eyes; dilated pupils; blue and fiery dots flying before the eyes. 

Sulphur, suppressed itch. 

For impared sight (amblyopia) and blindness (amaurosis) the following 
remedies also have been found useful : Alum., Bar. carb., Bovista, Calc. 
carb., Chelid., Crotal., Cyclam., Elaps, Hepar, Ignat., Kali acet., Lycop., 
Natr. mur., Ruta, Santon., Sepia, Thuja, Zincum. 

Hemiopia, 

Or half vision, is a contraction of the visual field, either on the two right or 
on the two left sides of the eyes, in consequence of an affection of either the 
right or the left optic nerve tract before the crossing at chiasm ; blindness of 






HEMERALOPIA — HYPERESTHESIA RETINA. 167 

the opposite sides of each, retina, occurs when the optic nerve fibres are dis- 
turbed at the chiasma, that is at the point where the nerve fasciculi cross 
each other. Upper half blindness denotes an insensibility of the lower por- 
tion of the retinal nerve fibres, and is usually dependent upon a detachment 
of retina or embolism of a branch of the central retinal artery. Scotomata, 
or blind spots, are insensibility of certain corresponding parts of the retina. 

THERAPEUTIC HINTS.— Upper half blindness: Aurum, Digit., 
Phosphor.; right half blindness: Cyclam., Lith. carb., Lycop. ; half vision 
either side: Bovista, Calc. carb., Caustic, Chin, sulph., Lob. inn., Lycop., 
Mur. ac, Natr. mur., Sepia, Viol. od. 

Hemeralopia, Night-Blindness. 

The patient sees well enough, as long as there is enough stimulus of 
bright light, but he cannot discern objects any more, as soon as the amount of 
light required by him is withdrawn, be it daylight or candle-light. It is 
most common among seafaring men. The glare from the sea seems to be the 
exciting cause added to some constitutional weakness; but is also found 
occasionally with harvesters and soldiers, where fatigue and exposure to the 
glaring sunlight seem the elements in its production. 

THERAPEUTIC HINTS.— Cases have been cured by: Arg. nitr., 
Bellad., China, Hyosc, Lycop., Pulsat., Ban. bulb., Stramon., Sulphur, 
Veratr. 

Hyperesthesia Retinae. 

We understand by it an oversensitiveness of the optic nerve and retina; 
even a small amount of light cannot be borne, and sometimes its impression 
lasts too long. This may be caused by irritation of the optic nerve and 
retina, with or without ciliary irritation. Ciliary irritation is usually accom- 
panied by lachrymation and pain in the eyeball, and associated with many 
affections of the cornea and conjunctiva; this affection is usually spoken of 
as Photophobia. When the overexcitement of the optic nerve and retina 
does not depend on external conditions, we have, with or without intolerance 
to light, subjective appearances before the eyes, such as sparks, bright white, 
or colored patches, flames, colored rings, chromatic clouds, so-called phos- 
phenes, also known under the name of Photopsia and Chromotopsy ; and 
in some instances a too long duration of the impressions, especially from 
bright objects, which continue to affect the optic nerve even after the eyes 
have been turned to some other object, whereby confusion arises and the 
objects seem to dance. 



168 LENS. 

THERAPEUTIC HINTS.— For this affection a great number of reme- 
dies may present themselves for consideration. "We shall have to weigh care- 
fully all the symptoms of the case. Perhaps one or the other of the following 
may be indicated: Aeon., Bellad., Cinchona, Conium, Gelsem., Hepar, 
Hyosc, Ignat., Lact. ac, Merc, sol., Natr. mur., Nux vom., Phosphor., Pul- 
sat, Sulphur, Tart. emet. 



LENS. 

Cataract, 

Is loss of transparency of a part or of the whole, either of the crystalline 
lens (lenticular cataract), or of the capsule (capsular cataract), or of both 
(capsulo-lenticular cataract.) 

In the course of physiological development the lens commences to change 
after the age of about thirty-five years to greater density, more coloration 
and loss of convexity, and in the senile eye the pupil has lost its blackness, 
appears cloudy or of a light amber tint, or brownish-yellow, yet without loss 
of transparency. This ought to be borne in mind. The cataractous changes 
are different. Consisting in atrophy from loss of nutrition, the lens fibres 
are converted into different solid and fluid materials; the nucleus becomes 
hard and dry, while the cortex may be softening to the state of a semi-fluid 
pulp, which remains of opaque fibres, molecular substance and fatty tissue, 
especially in its hypermature state. This is the nature of the so-called Hard 
cataract. The Soft cataract consists of the conversion of the lens tissue 
into a paste-like material, or a degeneration of it into a soft substance of a 
thin milk-like color with granular flocculi, corpuscles and fatty material. 
The former is the cataract of adults, elderly and old people ; the latter is met 
with from birth to puberty. 

The cataractous changes of the capsule are probably the result of inflam- 
matory action; they are mostly attended by a secondary degeneration of the 
lens, or vice versa, accompany a fluid degeneration of the lens. In 
Traumatic cataract, which originates in consequence of a blow or other 
external injury to the eye, the capsule is nearly always opaque, and the 
cataract is of the soft kind; in the uncomplicated cataract of the aged, 
however, it is seldom altered. 

The Objective Symptoms of these different affections can clearly be 
elucidated only by the ophthalmoscope. They are important to the eye- 
surgeon, who will consult special works thereon, but even the naked eye is 
capable of detecting opacities of the lens. The following are the Subjective 
Symptoms: As soon as the opacity upon either the lens or the capsule is 
dense enough to interfere with the rays of light, the first symptom is indis- 






CATARACT. 169 

tinctness of sight or mistiness; at first distant objects are seen as if through 
a mist or fog, or a bit of glass that had been breathed on ; after awhile this 
mistiness envelopes near objects also. The adjusting power is lessened, 
because of the lens losing its elasticity. The patient now sees better in twi- 
light; then the pupil expands and more rays are allowed to pass through 
the lens. For this reason the patient shades his eyes in bright light and 
derives benefit from wearing goggles. In some cases there is even intolerance 
to bright light. In other cases the objects appear doubled or even farther 
multiplied, and are seen in fantastic forms. This arises when portions ,of the 
lens still remain transparent, but vary in the degree of their density, whereby 
an irregular astigmatism is produced. Muscae, of all shapes and sizes, and 
sometimes in showers, are of frequent occurrence ; but flashes, stars, fiery 
circles, bright metallic light, bright spectra like silver must be attributed to 
other diseases of the eye; they have nothing to do with the cataractous 
affection of the lens. 

Causes. — " Defective nutrition," merely expresses, in other words, what 
cataract consists of, but does not tell the cause, which in fact we know not. 
We* can merely state, that cataract has been observed to develop: after 
external injuries of the eye; in consequence of diabetes; after fever; in 
consequence of other diseases of the eyes, either active or of a low type ; in 
consequence of hereditary influences. After one eye has been attacked, the 
other is likely to follow. 

THERAPEUTIC HINTS.— Under certain circumstances the quickest 
relief may be afforded by an operation, but there is no doubt that homoeo- 
pathic treatment has succeeded not only in checking further development, 
but also in clearing up existing opacities of lens and capsule. Dr. J. C. Bur- 
nett bases the curability of cataract on the homologous nature of the lens 
with the mucous membrane of the common integument, and gives a number 
of cases cured by him and by others in his most interesting monograph on : 
Curability of Cataract with Medicines. Boericke & Tafel, 1880. 

The following are the most important remedies : 

Amm. carb. (right eye); Bar. carb. ; Bellad. (after acute inflam- 
mation of the eye); Calc. carb. (scrofulous individuals); Cannab., 
Caustic, (constant inclination to touch and rub the eye, which seems to 
relieve a pressure in it); Conium (old persons); Euphras. after Sul- 
phur (congenital cataract); Lycop. (after typhus; suppressed menses); 
Magn. carb. (from left to right; previous disposition to headache and 
furuncles); Natr. mur. (Burnett); Phosphor.; Saccharum Sacchari 
(in several cases of old age); Sepia, Silic. (after inflammation of the eye; 
preceding ringworms ; suppressed sweat of feet) ; Sulphur (from right to 
left; after cutaneous eruptions, especially suppressed itch. According to 



170 SIGHT. 

Jahr main remedy). According to Goullon, Jr., the main remedies are: 
Sulphur, high potency (30th and higher), or Spiritus sulph. ; Silic, or 
Aq. silic; Calc. fluor., or Lapis albus; Calc. carb., Phosphor., 
Caustic, Sepia, Bar. carb. Intercurring remedies: Bellad., Ferr. 
phosph., Euphras., Pulsat., Chelid., Cannab., Colchic, Sec. 
corn. — (Allgem. Horn. ZeiL, Vol. 107, page 125.) 

"Dislocation of the lens often results from injury and may be spon- 
taneous. It is most commonly dislocated backward into the vitreous, though 
it may lie in the anterior chamber or even under the conjunctiva. The lens 
may be seen in any case lying in its unnatural position. When in the 
vitreous, the tremulous condition of the iris will call attention to the 
trouble." — (Geo. S. Norton.) 

SIGHT. 

Refraction and Accommodation. 

A luminous body sends off rays of light in all directions, and in whatever 
direction they go they always move in straight lines, unless interfered with 
by a medium of different density. When entering a lens they are bent 
towards its thicker portion ; a biconvex lens converges them to a focus ; a 
biconvave lens scatters them for the same reason. Now when parallel or 
even slightly divergent rays of light from an object enter the pupil, and 
pass through the crystalline lens of the eye, they are bent by this body 
towards its thicker part and are thus focussed upon the retina. In this 
bending and gathering of the rays of light to a focus upon the retina con- 
sists what is technically called the Refraction of light. It is a purely 
mechanical process conditioned by the transparency and biconvexity of the 
lens, which like any other biconvex lens, focusses the parallel and divergent 
rays of light at a certain distance, according to the amount of its convexity, 
that is according to its refractive power. When an object is sufficiently near 
the eye to emit divergent rays, it is said to be at a finite distance; when, 
however, it is sufficiently far away to emit parallel rays of light to the eye, it is 
spoken of as being at an indefinite or indeterminate distance. In either case 
the rays are not entirely and equally parallel, and consequently the focus 
must vary in its distance behind the lens, either fall in front of, or behind 
the retina. 

Only if an object were brought in the exact position from which its rays 
could be focussed upon the retina, it could be seen distinctly. We know, 
however, from experience, that for a normal eye such exact position of 
objects as to distance, in order to see them, is not required. The healthy 
eye possesses a faculty by which it brings both parallel rays and rays in 



PRESBYOPIA, OR OLD SIGHT. 171 

various degrees of divergency, to an accurate focus upon the retina; it sees 
clearly and distinctly at different distances, adapting itself for the position 
of the object looked at; and this is called its power of Accommodation or 
Adaptation. The nearest distance to the eye at which a small object can 
be seen distinctly by the maximum of accommodation, or by its greatest 
effort to see, is termed "the near point of vision;" the farthest distance at 
which anything can be clearly discerned, is "the far point of vision." These 
points vary in different eyes ; the interval between the near and the far point 
is termed the range or territory of accommodation. 

Now the question arises, how is this accommodation of the eye to the 
various distances of objects effected? As the lens is only a passive agent 
of refraction, and as upon its form depends the distance where the transient 
rays are focussed, we must look for the means by which this change in the 
form of the lens is effected. And here all the latest researches agree in this, 
that the constant variations in the curvings of the lens, as accommodation 
for near and far objects requires, are brought about by the ciliary muscle of 
the eye. 

Associated with this ever-changing form of the lens by means of the cili- 
ary muscle are also pupillary movements — contraction for near objects to cut 
off the lateral rays of light, and dilatation for distant objects, the sphincter 
pupillse and the ciliary muscle being in a functional connection by nerve- 
fibres ; and to this may be added the action of the recti muscles, which in 
accommodating for near binocular vision, turn the eyeballs inwards, while for 
perceiving distant objects, they place them parallel. 

Presbyopia, or Old Sight. 

The constant change in the curvings of the lens, as accommodation 
requires, can readily be affected only so long as the lens is sufficiently soft 
and yielding. As, however, the lens in the course of years grows denser and 
therefore less*capable of being acted on by the ciliary muscle in the process 
of accommodation, and as also its shape becomes flatter and in consequence 
its refractive power reduced — the near point of vision gradually recedes, that 
is to say : If we were able all along to see an object distinctly at a distance 
of four or five inches, etc., because of the greater convexity to which the 
lens could be shaped by the ciliary muscle for such purpose, we now have to 
hold the same object further off, in order to receive a distinct visual impres- 
sion, showing that the lens is not capable any more of being shaped convex 
enough to gather the divergent rays of the near point to a focus upon the 
retina. The near point of vision has receded to eight, twelve or sixteen 
inches. With all this, distant objects are discerned as accurately as before. 
This is Presbyopia— a diminution of accommodation for near objects, with 
diminution of refraction, consequent on age. 



172 SIGHT. 

• 
This natural change in the crystalline lens commences in early life and 
gradually increases with advancing years. Generally about the age of forty, 
the near point is eight inches from the cornea, and at about forty-five years 
it recedes to twelve or sixteen inches. In some instances the change sets in 
suddenly, so that a month or even a week will make all the difference in the 
condition of the eye. In such cases we should bear in mind that a rapid 
increase of presbyopia is also a prominent symptom of glaucoma. Still later 
the far point for distinct vision, too, declines, and the focal range is thereby 
lessened. With the loss of range, there may be loss of the acuteness of 
vision, arising from retinal obtuseness. Presbyopia requires convex glasses, 
which ought to be changed as often as the progress in the change of the 
crystalline lens demands it. Lenses will not afford any help to distant vision, 
unless there be hypermetropia combined with it. 



Hypermetropia. 

This affection is caused by a congenital, often hereditary malformation of 
the eyeball, which is smaller than in the emmetropic eye; its antero-posterior 
diameter is shorter than that of a normal eye, consequently the parallel rays 
of light entering the pupil do not unite and form a focus on the retina, but 
fall behind it, and were the sclerotica removed posteriorly, they would con- 
verge to a point behind its boundary. Therefore, it is still farther impossible 
for divergent rays to be properly refracted for the function of sight. Only 
rays that have been artificially rendered convergent by a convex lens, are 
properly focussed upon the retina. 

Slight degrees of this affection are often masked by the great accommodat- 
ing power of the lens during youth ; an abnormally distant position of the 
near point, however, in young persons may be taken as a very conclusive 
evidence of the presence of hypermetropia; after manhood the marked 
removal of the near point, the loss of acuteness of vision, the very decided 
assistance afforded to far vision by a convex lens, and the strong glasses 
needed for seeing small type confirm its presence. 

"In hypermetropia, asthenopic symptoms, as : eyes tire easily, blurring of 
vision, aching in and over the eyes, etc., after using for near work, occur 
early and require immediate selection of the proper convex glass." (Norton.) 



Myopia, or Short-sightedness, 

Is the opposite condition to hypermetropia. The antero-posterior diameter 
of the eyeball is longer than in the emmetropic or normal eye, hence distant 
or parallel rays of light are brought to a focus before they reach the retina 
and the image which is formed on the retina is blurred and indistinct. Only 






ASTIGMATISM. 173 

divergent rays, that is, rays coming from Dear objects, are accurately focussed 
on the retina. While, therefore, the myopic eye can see near objects, it can- 
not see distant ones well without optical aid. The myopic far-point is always 
at a definite distance; in bad cases it may be within a few inches of the 
cornea; there is in such cases little difference between it and the near point. 
The two are in proportion to each other, the further the far-point, the further 
also the near-point and vice versa. 

" Myopia may be produced by a spasm of the ciliary muscle and must not 
be confounded with an elongation of the antero-posterior axis." (Norton.) 

The disposition to myopia is almost invariably congenital and heredi- 
tary; it is, therefore, a most uncommon occurrence for myopia to appear 
after the fifteenth year of age, and it is never acquired after the twentieth in 
eyes that are normal. 

Its development is favored by the tension of the eye, which is insepara- 
bly connected with looking at near objects, where, by the constant and strong 
action of the internal recti muscles to produce the necessary convergence of 
the optic axis for the requisite position of the corresponding portions of the 
retinse, the eyeball gradually is drawn into a more or less oval shape, which 
finally may amount to the formation of a posterior staphyloma by atrophy 
of the choroid and sclerotica. Myopia is, therefore, essentially an accom- 
paniment of civilization, where it prevails chiefly amongst those classes who, 
from childhood on, have had to use their eyes continuously in reading and 
writing or other close work. 

In old age, when the lens grows flatter (see Presbyopia) the near-point 
recedes and consequently the myopic can often read again without the aid 
of glasses. This gain in sight is not an actual improvement of the eye ; its 
myopic defect remains the same, but the flattening of the lens by age 
lengthens the focal distance which now reaches the retina. The myopic eye 
can be relieved by concave lenses, which ought to be used carefully and not 
too strong. 

Astigmatism. 

"The term astigmatism is used to express a 3tate of sight resulting from 
want of symmetry in the anterior portion of the eyeballs. The rays of light 
do not unite by convergence and form in a regular manner in one point or 
focus on the retina, but reach it partially or irregularly, some of them coming 
to a focus in front of it, or not forming any focus, whereby circles of dis- 
persion or diffuse images fall on the retina, and indistinctness of vision is 
produced." (Walton.) This irregularity in focalizing the rays of light is 
mainly due to assymmetry of the cornea, and in some cases also to that of 
the lens. The patient usually holds objects close to his eyes, as a myopic ; 



174 SIGHT. 

the lines of adjoining letters seem to cover each other; parallel lines in 
different directions, one set for instance being vertical and another horizontal, 
do not appear equally distinct but blurred ; things at a distance are some- 
times seen double, and a square figure will have the appearance of an oblong ; 
in high grades of astigmatism there is chromatic aberration, so that luminous 
objects sometimes appear surrounded by variously colored borders. Astig- 
matism may be combined with myopia or hypermetropia. It is often heredi- 
tary or may be caused by the removal of the pupil from its central position 
either from accident, disease or in consequence of an operation; by the 
slightly irregular manner in which the corneal flap may heal after an 
operation for the extraction of cataract ; by the irregularity in the corneal 
curves produced by inflammation of the cornea ; by the dislocation of the 
crystalline lens from accident or disease. 

Its remedies are carefully selected cylindrical glasses, and in case of 
inflammatory diseases of the cornea or traumatical causes, carefully selected 
medicines. Compare Corneitis, etc. 

Asthenopia. 

" This may be defined to be inability to maintain the adjustment of the 
eye for short distances, for a sufficient period without fatigue." (Walton.) 
The asthenopic eye gets tired when employed any length of time in reading, 
writing or other close work, especially by insufficient or artificial light; the 
ciliary muscle, which is the muscle of accommodation, cannot stand the 
strain required by the smallness of the objects and the close approximation 
of the eyes to them ; it relaxes and the crystalline lens flattens, whereby the 
focus from the objects is changed and the objects become indistinct and 
blurred. A little rest relieves it all; the ciliary muscle is ready again for 
shaping the lens to the necessary convexity— but soon gives out again. At 
last a pressure and fulness is felt in the eyes and a tension and pain in the 
forehead; sometimes the pupils become contracted and the conjunctiva red- 
dened. The cause of all this is want of sufficient refraction in the eyeball, 
which is principally found in a hypermetropic formation of the eye, and 
therefore there is a close relationship between the two affections; in pure 
forms of asthenopia, according to Walton, hypermetropia is never absent. 
This form is called Accommodative Asthenopia. Asthenopic symptoms 
will also occur when the ciliary muscle, in consequence of illness or exhaus- 
tive diseases, become paretic, or when the internal recti muscles, from relative 
or absolute deficiency of power, cannot maintain the proper convergence of 
the eyes for near sight ; then this is called Muscular Asthenopia. The 
accommodative form depends chiefly on the degree of the existing hyperme- 
tropia; it may develop itself at the early age of ten. The muscular form 



ASTHENOPIA. 175 

depends more on general conditions of the system, and as exciting causes 
may therefore be mentioned for the first : long-continued application of the 
eyes to close work, especially by insufficient light ; and for the second : gen- 
eral debility; mental troubles; dissipation, etc. 

THERAPEUTIC HINTS.— The accommodative form requires convex 
glasses for the relief of the existing hypermetropia ; the muscular form also 
needs correction of the usually existing anomaly of refraction by suitable 
glasses. A study of the general state of the debilitated system will be 
required for the selection of the corresponding remedy. 

Aeon., eyes hot and dry from overuse; relieved temporarily by cold 
water. 

Apis, stinging pain aud lachrymation. 

Arg. nitr., blepharitis; hypermetropia and weakness of the ciliary 
muscle. 

Calc. carb., fatigue and pain from usiug the eyes; on looking at near 
objects they become indistinct and blurred; general Calcarea symptoms. 

Chelid., "letters run together while reading; left eye agglutinated in 
morning ; lachrymation in the wind ; pain from reading in the eye ; worse 
from candle-light; lachrymation from reading." (E. Rushmore.) 

China, debility after exhausting sickness. 

Cina, spasmodic twitchings of the orbicular muscle; twitchings in the 
muscles of the face; from intestinal irritation by worms or otherwise; after 
masturbation. 

Cinnab., pain from inner canthus, extending above and around the eye. 

Conium, cannot bear bright light or heat. 

Euphras., blurring of vision relieved by winking. 

Gelsem., especially in the muscular form from weakness of the external 
rectus. 

Ignat., nervous, hysterical females; onanism. 

Jabor., asthenopic symptoms, especially dependent upon an irritable 
condition of the ciliary muscle. (Norton.) 

Lilium, pain in forehead; photophobia; blepharitis; astigmatism. 

Natr. mur., stiff and drawing sensation in the muscles upon moving 
the eyes; the eyes smart, itch aud burn; feel best on being kept shut and 
pressed upon; muscular form. 

Nux vom., after dissipations. 

Phosphor., dull pain deep in the eyes; black spots before the eyes, 
especially when looking at bright objects and by artificial light; better in 
twilight. 

Rhodod., weakness of internal recti; darting pains through head and 
eyes, worse before a storm. 



176 MUSCLES AND NERVES. 

Rhus tox., after great strain of the eyes; muscular form. 
Ruta, aching in and over the eyes after straining the eyes at fine work; 
heat in the eyes and lachrymation after close work ; accommodative form. 

MUSCLES AND NERVES. 

Mydriasis. 

This is a dilatation of the pupils. The iris is chiefly composed of non- 
striated muscular fibres, arranged in a circular and in a radiating direction. 
The circular fibres are supplied by the third nerve, and act as a sphincter 
pupillse, while the radiating fibres are supplied by the sympathetic nerve, 
and increase the aperture when stimulated to contract. Mydriasis may there- 
fore be caused either by a paralysis of the third nerve or by stimulation of 
the sympathetic. One of the differences between the two is, that with the 
paralysis of the third nerve there almost always is associated a paralysis of 
the ciliary muscle, which more or less destroys the power of accommodation. 
Its exciting Causes may be either peripheral, from exposure to cold winds, 
blows, etc., or cerebral, in consequence of effusion into the ventricles of the 
brain, concussion of the brain, basilar meningitis, diseases of the cerebellum, 
apoplectic effusions at the base of the brain, glaucoma and certain narcotics. 

Myosis 

"Is a persistent regular contraction of the pupil below its medium size, with 
immobility and without change of structure in the iris or in the eye." 
(Walton.) It is caused either by a paralysis of the sympathetic nerve or by 
an irritation of the third. In the first case there probably are diseases of the 
neck, or in the spinal cord, which involve the cervical sympathetic, at the 
bottom of the trouble ; in the latter case the cause lies in morbid conditions 
of the brain, which irritate the third nerve. 

Special THERAPEUTIC HINTS cannot be given. Mydriasis, as 
well as myosis, are mere symptoms of other more deeply seated disorders, 
which must be studied accordingly. Our repertories show a number of 
remedies for both of these symptoms. 

Ptosis, or Falling of the Upper Eyelid. 

This affection may be due: 1st, to a paralysis of the levator palpebrse 
muscle, which is under the control of the third cerebral nerve; 2d, to a less 
of muscular power in the levator, consequent on age ; 3d, to a falling of the 
eyebrow, in consequence of paralysis of the occipito-frontalis muscle; 4th, to 
a congenital deficiency of the levator palpebral ; 5th, to a hypertrophy of the 
palpebral integument; or, 6th, to chronic ophthalmia with granular eyelid. 






STRABISMUS, OR SQUINT. 177 

THERAPEUTIC HINTS.— The most frequently indicated remedies 
are: Caustic, Gelsem., Hyosc, Nux vom., Plumbum, Rhus tox., 
Sepia and Zincum. A congenital deficiency of the levator palpebra? 
cannot be reached by any medicine. For granular eyelid, compare the 
corresponding chapter. 

Strabismus, or Squint. 

" Strabismus is deviation of the visual axes. The axis of the one eye 
being directed to the object desired to be seen, while that of the other is turned 
too much inwards {internal squint), or outwards (external squint)." (Walton.) 

Internal squint is the most frequent of the two. It may arise from 
greater or less paralysis of the external rectus, generally of the one eye, excep- 
tionally of the two ; or from some functional change, some shortening, at first 
dynamically, afterwards at a varying period, organic shortening, with or 
without hypertrophy of the internal rectus ; from lesion of the brain or of the 
ocular nerves in cases of inflammation, softening, apoplexy, hydrocephalus, 
scrofulous tubercles, epilepsy; from intestinal irritation by worms; during 
teething ; from visual defects, in consequence of inflammation within the eye 
or of the cornea ; from diseases which damage the function of the external 
rectus, such as tumors, traumatic or specific inflammations, abscesses, neu- 
ralgia. Its most frequent cause is hypermetropia. 

The External or Divergent squint seldom appears before puberty, 
except in connection with a diseased brain. It mostly arises from some form 
of impairment of vision affecting either one or both eyes, or from a difference 
in the refraction of the two eyes, or some disparity between them in the 
function of sight, all of which is commonly associated with myopia. Its 
direct cause in most cases is paralysis of the motor oculi nerve. The ex- 
ternal rectus muscle is influenced in the same way by effusion in the orbit, 
tumors and all mechanical lesions of its muscles, and by cerebral disorders 
like the internal muscle in inward squint. 

THERAPEUTIC HINTS.— Cerebral irritation with corresponding 

symptoms require: Agar., Bellad., Cicuta, Gelsem., Hyosc, Nux 
vom., Stramon., Sulphur. 

Alum., recommended by Jahr if Bellad. and Hyosc. have failed. 

Cicuta, after convulsions. 

Calc. carb., after ophthalmia, or overstrain by close work; strumous 
subjects. 

Cyclam., after unsuccessful operation; after convulsions, or measles. 

Intestinal irritation from worms or other causes requires : 
12 



178 MUSCLES AND NERVES. 

Cina, picking of nose; restless sleep; grating of teeth; short hacking 
cough through the night. 

Cyclam., see above. 

Sepia, nocturnal enuresis during first sleep. 

Spigel., itching at the anus. 

Sulphur, nightly itching of the skin; cutaneous eruption; constipation. 

Suitable glasses may be of great help. 

Surgical operation is required where there is an organic shortening of 
the internal or external rectus ; paralytic squint is least benefited by it, and 
in mere nervous disturbance it is not called for at all. 



Nystagmus, Trembling of the Eyeballs. 

It is an involuntary, rhythmical motion of the eyeball, mostly from side 
to side, sometimes in an oblique direction, without impairment of the mus- 
cular movements. These oscillatory motions are nearly always permanent 
during the waking hours, but do not interfere with the simultaneous action 
of the two eyes; sometimes they are associated with internal squint. The 
disease nearly always arises in infancy, and is frequently seen in connection 
with congenital cataract, or other states of the eye which impair sight. It 
is common to the Albinos, when there is an absence of the pigmentum 
nigrum. Although ascribed to a morbid condition of innervation, its true 
nature is unknown. 



Luscitas, or Fixed State of the Eyeball, 

Is limited or lost power of movement of the eyeball, which remains in a 
fixed position either with or without deviation from the orbital axis, and 
cannot in any degree follow the movements of the other eye. Luscitas is a 
symptom either of paralysis of the third nerve, when the eyeball is turned 
outward by the abductor muscle, or of paralysis of the abductor, when the 
eyeball is turned inside — all consequences of brain-disease, chronic hydro- 
cephalus especially. But external causes, such as injuries to the muscles of 
the orbit or to their nerves, tumors, staphylomatous enlargements of the 
sclerotica, may also fix the eyeball in any direction. 



Morbid Winking 

Is a clonic spasm of the orbicularis palpebrarum muscle, and frequently 
found in connection with severe conjunctival irritation; sometimes it is of 
constitutional origin. 



NEURALGIA OF THE EYE. 179 

Twitching of the Eyelids, or Quivering, 

Nearly related to the above, may effect one lid or both. It sometimes is so 
slight that it cannot be seen, but may plainly be felt; although annoying, it 
seldom is attended with pain, and is usually the consequence of deranged 
digestion or feebleness from overwork. 



Blepharospasm. 

The eyelids are violently and persistently closed. It is nearly always 
associated with intolerance of light and discharge of tears. 

Its sources are various. They may arise in the eye itself, or in other 
organs, and transmit their influence to the brain at the origin of the portio 
dura, through the fifth nerve, the optic, the vagus, the sympathetic, or 
directly from cerebral disturbance. Thus we see it produced by trichiasis, 
strumous conjunctivitis, corneitis, retinitis; carious teeth, supraorbital neu- 
ralgia; a blow on the head or other injury; hysterical irritation. It may 
affect one or both eyes, it may last a long time uninterruptedly or in spells ; 
it may be associated with spasm of the facial muscles. 

THERAPEUTIC HINTS.— Nystagmus— Hyosc. ? 

Morbid winking has been relieved by Agar, and Ignat. 

Twitching by Cina, Physost. 

Blepharospasm by Bellad., Viola trie, Symphitum (after a blow), 
and other remedies, which must be selected according to the individual state 
of the patient. Compare the chapters which treat of its sources. 



Neuralgia of the Eye. 

It is usually an affection of the ophthalmic and superior maxillary division 
of the fifth cranial nerve, which supply the eyeball, the ocular appendages, 
and the circumorbital region. One or the other of the branches of these 
nerve-trunks may be affected. Most frequently we find it located in the 
upper eyelid, the middle of the eyebrow, the nasal extremity of the super- 
ciliary arch, the inner can thus, or the temple ; or it follows in the direction 
of the supra and infraorbital nerves; or it is entirely intraocular without 
any affection of the nerves radiating from the orbit. 

The first of these varieties is often intermittent or remittent and may 
become chronic; it may alternate with nervous pains in other parts of the 
body. The Causes are frequently obscure, often, however, traceable to 
malarial influences or exposure to cold. The second variety may arise out 
of the effects of the fangs of carious upper back teeth. When the pains are 



ISO ORBIT. 

deep-seated, its origin is intraorbital or even intracranial and may arise 
from thickening of the dura mater, orbital or cranial exostoses, aneurisms 
or tumors. 

THERAPEUTIC HINTS.— These different forms and causes show that 
not a few remedies may present themselves for our consideration. However, 
to avoid repetition, I refer to the chapter on neuralgia of the face. 

ORBIT. 

Orbital Cellulitis. 

" Inflammation of the orbit is usually severe and acute in character ; is 
marked by great swelling of the lids, extensive chemosis, protrusion of the 
eyeball and intense pain in and around the eye, aggravated on any movement 
of the eye. Movements of the eyeball are impaired. Pus soon forms, when 
we have an abscess in orbit, which may perforate through lids or conjunctiva. 
The inflammation may extend to the eyeball, producing a panophthalmitis, 
or to the brain, or may cause caries of orbit, etc. General febrile disturb- 
ances usually accompany the above local inflammation. Trauma is the most 
frequent cause. It may result from extension of inflammation in neighboring 
parts or from constitutional diseases. 

THERAPEUTIC HINTS.— Aeon., Apis, Hepar, Laches., Mercur. and 
Silic. may be indicated, but Rhus tox. is most frequently indicated." 

(George S. Norton.) 

Basedow's or Graves' Disease; Exophthalmic Goitre, 

Is characterized by palpitation with accelerated pulse, swelling of the thyroid 
gland, and exophthalmos or protrusion of the eyeballs. In its nature it has 
been considered by some as a morbid crasis, by others as a heart disease, and 
by still others as a neurosis of either the cervical sympathetic or the cervical 
medulla spinalis and medulla oblongata. I feel, therefore, at liberty to treat 
of it here as anywhere else. 

Autopsies have shown a considerable development of fat behind the eye- 
balls, which causes their protrusion ; also at times fatty degeneration of the 
eye-muscles, probably caused by disease and stretching; and atheromatous 
changes of the ophthalmic artery. Changes in the sympathetic and its 
ganglia have not at all been of a uniform nature, and in some cases have 
been wanting altogether. 

Symptoms. — Usually this disease develops itself very slowly, though some 



OR graves' disease. 181 

few cases of sudden origin have also been observed. Its first symptom in a 
majority of cases is palpitation conjoined with acceleration of the pulse, 
without any abnormal symptoms of the heart on physical examination; 
occasionally there are epigastric pulsation, increased force of the pulse in 
the carotids and their larger branches, especially in the thyroids, and a 
whirring aud blowing that may be heard by auscultation before the struma 
is developed ; pulsation of the retina and in rare cases pulsation of the liver. 
Some weeks or mouths later, slowly or rapidly, struma is developed, a soft, 
elastic swelling of the entire thyroid gland, which, however, does not attain 
to a very great size and is moreover subject to frequent changes. The surface 
of the tumor is often marked by veins, greatly dilated and crowded with 
blood, and auscultation reveals loud blowing sounds, often increased during 
systole. Struma seldom appears before palpitation and still more rarely is 
it wholly absent. Exophthalmus, the third prominent symptom, makes its 
appearance soon after the struma — in a few cases before it — and still more 
rarely as the initial symptom, preceding the struma and the palpitations. 
It always attacks both eyes, but sometimes appears on the one eye earlier, or 
remains at least more prominent than on the other. It seldom is wholly 
wanting, while in other cases it forms the only cardinal symptom, when it 
is associated with other kinds of general disturbances. In degree it varies 
greatly, from a slight prominence of the eyeballs to an excessive protrusion 
of the same, that no part of the globe is covered by the eyelids and even 
may amount to a luxation of the globe. The eyes protrude ; the eyeballs 
have an unusual lustre ; appear stiff and gradually lose their mobility in 
part or wholly. But this protrusion is not at all times the same, it increases 
and decreases proportionately to the force of the pulsations of the heart, and 
sometimes may be diminished by light pressure upon the eyeball. Yon 
Graefe has observed, that "the upper lid loses its power to move in harmony 
with the eyeball in the act of looking up or down," and he considers it a path- 
ognomonic sign of exophthalmus, which, however, others do not admit, as its 
occurrence, although frequent, is not constant. As a secondary group of 
symptoms in some cases may be mentioned : dryness of the conjunctival sac, 
distention of the conjunctival veins, and conjunctivitis; the lachrymal 
secretion is often increased. In bad cases : insensibility, diffuse desiccation 
or even perforation of the cornea. Ophthalmoscopic examination usually 
shows dilatation and increased tortuosity of the retinal veins, and in some 
cases spontaneous pulsation of the retina. The temperature of the body has 
been found increased to 101.8° F. in some cases, while in others it remained 
entirely normal. Also nervous disturbances have been observed, but they 
are so varied and so little characteristic, that they may be omitted wit hunt 
injury to the diagnosis of this malady. Its duration is protracted; months 
and years may pass with alternate improvement and relapse ; some cases get 



182 ORBIT. 

well, others hasten to a fatal issue by the consecutive changes of the heart, 
the permanent increased labor of which leads to dilatation of both ventricles 
and compensating hypertrophy. In other cases marasmus and other inter- 
curring diseases or complications may end the scene. 

Women are more subject to it than men ; in childhood it is rare, it occurs 
mostly during the time of puberty and climacteric years, seldom later. As 
predisposing Causes have been mentioned : chlorosis, anaemia, and neurotic 
tendencies ; as exciting causes have been found : injuries, traumatic or other- 
wise, and mental excitement, violent fright. 

THERAPEUTIC HINTS— As this affection is not poor in symptoms 
and mostly of long standing, by a careful examination we will be able to 
detect leading symptoms for one or another remedy, even not mentioned 
below. 

Amyl nitr., frequent flushes of face and head; oppression of chest; 
tumultuous palpitation. (Olfaction.) 

Badiaga. (Norton.) 

Bellad. has cured cases in allopathic hands, although the doses applied 
were certainly too massive, as they produced headache, nosebleed and angina. 

Calc. carb., in combination with a diet of nitrogenous substances, re- 
lieved greatly in a case of pronounced lymphatic constitution. 

Ferrum, in cases with disturbances in the sexual sphere, scanty or sup- 
pressed menses and great nervousness. 

Lycopus, has relieved the protrusion of the eyes and the cyanosis, but 
had no effect upon the glandular enlargement, which yielded to Iodine. 

Natr. mur., depressed vegetative vitality; despairing, hopeless feeling 
about the future ; dryness of the mouth ; sore tongue ; map tongue ; chronic 
constipation with hard stool ; chlorotic symptoms, with dirty, flaccid, torpid 
skin ; fluttering of the heart ; intermitting and irregular pulse. 

Secale has been successfully used by the old school. 

Spongia, easily frightened, especially at night, as if suffocating. 

It appears from this, that the most efficient remedies used thus far were 
such which are capable of acting especially upon the heart and the thyroid 
gland; under certain circumstances, therefore, Bar. carb., Bromium, 
Cact. grand., Phosphor., Silic. and Sulphur may likewise be 
indicated. 



EARS. 



Analogy between the Ear and the Eye. 

At first sight, these organs appear so entirely unlike each other, that it 
would seem scarcely possible to discover any analogy between them ; yet on 
closer inspection, the similarity between the two is quite striking. 

As I consider this similarity in the structure of the eye and ear of great 
importance in clearing up the rather occult affections of the ear (the treat- 
ment of which is often very difficult), I shall point out, with some detail, the 
following remarkable features of similarity between the organ of sight and 
the organ of hearing. 

The pinna corresponds to the upper and the tragus to the lower eyelid. 
In animals the auricle is even movable, to collect or reject sounds, as the 
eyelids are to take in or to keep out the light. 

The eyelashes are represented by the bristly hairs at the mouth of the meatus 
externus; to keep out dust and insects. 

The meatus externus is lined by a semi-mucous membrane, secreting ear- 
wax, corresponding to the conjunctiva of the eye, which secrets eye-butter ; 
both are subject to similar inflammations and mucous or purulent dis- 
charges. 

The membrana tympani, corresponds not only in function, but also most 
strikingly in structure, with the cornea. It collects sounds, while the cornea 
collects light ; and it is, at least, of a /ia(f-transparent texture. The diseases 
to which it is liable correspond with those of the cornea: inflammation, 
thickening, ulceration and perforation. 

Immediately back of this membrane, in the middle ear or tympanum, we 
find the ossicula auris, by which sound is broken and communicated to the 
auditory nerve, in the labyrinth, just as light, by means of the crystalline 
lens, is refracted upon the optic nerve. The middle ear or tympanum, with 
its ossicula, corresponds, therefore, precisely to the anterior and posterior 
chamber of the eye with the lens. 

(183) 



184 EARS. 

Still further back we come into the labyrinth of the ear, which is filled, in 
its membranous portion, with a limpid fluid, first well described by Scarpa, 
and which corresponds to the vitreous humor of the eye ; while the numerous 
filaments of the two branches of the auditory nerve, the vestibular and 
cochlear nerves,' spread out into a nervous membrane, closely resembling that 
of the retina, so that the labyrinth of the ear corresponds to the posterior part 
of the eye with its vitreous humor and its retina. The nerve-membrane of 
the ear terminates in fine fibrils or cilise (Corti's mechanism), and the retina 
in a layer of rods and cones. 

There is one appendix to the ear — the Eustachian tube — which starts at 
the tympanum, and opens into the lateral wall of the throat, and there is 
also one appendix to the eye — the lachrymal duct — which starts at the inner 
canthus of the eye and opens into the nose ; while lastly both organs are 
situated in close proximity to porous bones: the ear on the mastoid portion 
of the temporal bone, and the eyes below the frontal sinuses of the frontal 
bone. 

This striking similarity in the structures of the ear and eye at once brings 
the diseases of the ear (by comparing them with those of the eye) nearer to 
our comprehension, and may even influence the choice of a remedy in a 
given case. 

General Observations on the Ear. 

The auricles grow pale from fright, chills, spasms, loss of vital fluids, 
exhaustion and frost. A marked paleness of the left auricle denotes inflam- 
mation of the spleen. 

Redness of the auricles is found in congestive and inflammatory condi- 
tions of the head and ears. 

Flushes are caused by mental emotions ; or occur before bleeding of the 
nose, delirium, apoplexy. 

An habitual or frequently-occurring redness of the auricles denotes dis- 
turbed actions in the abdominal organs ; or else menstrual and hemorrhoidal 
affections. Hyperemia of the auricle, and sometimes of the middle ear, is 
often associated with the climacteric period. 

A striking redness of the auricles in new-born children is a sign of prema- 
ture birth. 

Small, inflammatory, purplish, suppurating spots on the auricles are a sign 
of chronic syphilis. 

A slight inflammatory, painful redness of the upper part of the auricle 
is often the forerunnner of an attack of gout. 

Swollen auricles, if inflammatory, are caused by erysipelas, injuries, erup- 
tions ; if habitual, not inflammatory, it is a sign of scrofulous conditions ; if 
edematous, a consequence of abscesses or Bright's disease. The auricles are : 



ECZEMA. 185 

Hot, in inflammatory and congestive conditions of the head and ears, also 
in consequence of great exertion of the voice, and in diseases of the larynx. 

Cold, in chills, spasms, and from exhaustion. Auricles habitually cold are 
found in weak and chlorotic individuals. In hysteric persons, cold auricles 
are the forerunners of a hysterical spasm ; while in delirium and mania they 
denote a cessation of the paroxysm. 

Discharges from the ears may originate either in the meatus auditorius 
externus, in the middle ears (the tympanum), or in the cavity of the skull. 
They are of various characters. 

, If, after a fall or external injury of the head, there be a discharge of 
blood, it denotes a fracture of the skull. The ears bleed also in scorbutic 
affections; from too great a pressure, or from insufficient pressure of the 
atmospheric air (cannon-shot; on high mountains;), from too great exertions 
in screaming, coughing, vomiting, straining, blowing musical instruments. 

Pus or ichorous matter is the product of a previous inflammation, either in 
the meatus auditorius or in the middle ear. In rare cases the pus comes 
from an abscess in the brain, which has broken through the petrous portion 
of the temporal bone. 

Thin eamvax is, in most cases, the consequence of a chronic inflammatory 
state of the meatus auditorius externus. 

THE AURICLE. 
Eczema. 

Various kinds of eruptions may befall the auricle, either spreading to it 
from adjacent parts or originating there. From among them eczema is the 
most common, differing in no way from its kind on other parts of the body. 
We meet it in its acute as well as in its chronic form, and very often asso- 
ciated with similar eruptions on the scalp, or face or other parts of the body. 
It may affect the entire lobe, or select only certain portions of it ; the sharp 
crevice behind the ear, where the auricle joins the mastoid process, is fre- 
quently its favorite seat. 

THERAPEUTIC HINTS.-Bar. carb., Calc. carb., Graphit., 
Hepar, Lycop., Merc, sol., Nitr. ac, Oleand., Petrol., Rhus tox., 
Sulphur, are the main remedies. For particulars compare Eczema of the 
Scalp. 

By their position the auricles are naturally exposed to various external 
injuries, from blows, cuts, heat or cold, and they also are not unfrequently 
the seat of depositions of urate of soda in arthritic patients. Their lower 
lobe is often disfigured by hypertrophy or little, round, hard tumors in con- 
sequence of previous piercing. 



186 THE AUDITORY CANAL AND DRUMHEAD. 

THE AUDITORY CANAL AND THE DRUMHEAD, OR 
MEMBRANA TYMPANI. 

Examination of these Parts. 

The canal is not straight but curved on its anterior and lower wall, and 
often obstructed by hair growing from its cartilaginous walls. The drum- 
head is placed obliquely across the canal at its furthest extremity, which it 
shuts off from the middle ear. In consequence of the crooked structure a 
simple look into the ear does not give us a full view of its walls nor of the 
drumhead. We have to straighten its curved course and push aside obstruct- 
ing hair or other impediments, as far as possible. This can best be done by 
an ear-speculum, which consists of a simple funnel-shaped tube, made of pol- 
ished metal. There are usually three of different diameters fitted together, 
for the purpose of giving choice to select that which best corresponds to the 
dimensions of the canal under examination. Its application is the following. 
Draw the auricle upwards and backwards, and insert the tube by gentle 
turning and twisting into the meatus as far as it can be done without using 
force or causing pain. Keep it then in its position and illuminate through 
it the parts to be examined. The best light is clear daylight or lamplight ; 
the direct rays of the sun may be too dazzling. In order to prevent the 
intervention of the head of the observer with the rays of light, an ordinary 
laryngoscopic mirror or reflector fixed upon the forehead of the observer, or 
one of shorter focus made for the purpose of aural requirements, or, for pre- 
liminary examination, even a common hand-looking-glass can so be held as 
to reflect the rays of light into the tube, that by a little management and 
turning of the ear-speculum we are enabled to inspect readily the drumhead 
and the walls of the external canal in all their parts. 

The membrana tympani, or drumhead, is a thin, semi-transparent, 
parchment-like membrane, spread obliquely across the external auditory 
canal at its farthest extremity. In its normal state its surface, as seen 
through the ear-speculum, appears concave. Its shape is that of an irregular 
oval disc, the long axis of which is directed from above downwards; it is 
attached to a well-marked bony groove upon an elevated ridge upon the 
bony caual — the AmmlllS tympanicus, being fixed to it by a cartilaginous 
ring — the AnnulttS cartilaginus, just as is the crystal of a watch to its 
bezel. 

It is composed of " three distinct structures, the external layer being a 
prolongation of the skin of the meatus externus, the internal being derived 
from the mucous membrane of the middle ear, while between these two 
comes the fibrous layer, and which is itself composed of two distinct layers, 
the one external, the fibres of which radiate; the other internal, the fibres of 
which take a circular course." 



EARWAX DIMINISHED OR INCREASED. 187 

" When we look at the healthy membrane, we may observe at its upper- 
most edge a whitish prominent part, the short process of the malleolus, and 
extending from this downwards and backwards nearly to the centre of the 
membrane ; we see a whitish or pale yellow stripe, and which is the malleus 
handle, widening out at its lower end into the form of a spatula. In front of 
and below the manubrium we see a triangular reflection, the cone of light, 
its apex being at the umbo, or deepest point of the convexity of the mem- 
brane, its base forwards and downwards towards and slightly short of the 
periphery; and then w# may, on looking closely, sometimes see shining 
through the membrane the promontory of the middle ear, and the long pro- 
cess of the incus." (Cooper.) 

The color of the membrane is a peculiar gray of different shades, con- 
ditioned by its transparent nature, by the bodies which lie behind it and the 
light which strikes upon it. If the mucous membrane which lines its inter- 
nal surface, or that of the entire middle ear is congested, we find the natural 
gray mixed with a faint or deep red ; or with a yellowish tint when the 
middle ear is filled with yellowish secretion. Indeed pathological changes 
have a marked influence upon the color of the membrane. So also is the 
natural soft gloss of the membrane greatly altered or even extinguished by 
pathological processes. The brightest reflection from the healthy membrane 
is the " cone of light," a triangular reflex of light in the anterior and inferior 
quarter of the membrane, which has its apex in the umbo and its base near 
along the periphery of the membrane; it is analogous to the reflex of light 
of the cornea. Its locality and brightness too changes from various patho- 
logical conditions. 

The External auditory canal is lined by a continuation of the external 
skin, which grows thinner as it approaches the drumhead, but is not changed 
to a mucous membrane. It is studded by numerous sebaceous and cerumin- 
ous glands from which the ear wax is derived. 

Earwax Diminished or Increased. 

The lining of the auditory canal being a continuation of the external 
skin, great dryness of the same is usually found in persons whose skin in 
general is of a dry nature. It seldom has anything to do with nervous 
hardness of hearing. It may, however, be in connection with torpid pro- 
cesses within the middle ear, especially the drying up and hardening process 
of its mucous membrane. 

An increase of earwax may be caused by frequent picking and boring 
with hard instruments in the ear, whereby a congested state of its lining 
membrane is induced; we find it in persons whose scalp produces much 
sebaceous secretion and who are inclined to sweat easily about the head ; it 



188 THE AUDITORY CANAL AND DRUMHEAD. 

is sometimes connected with a chronic eczema of the canal. Its accumula- 
tion usually goes on slowly and the forming of hard plugs of cerumen takes 
frequently a long time, the patient being not at all aware of their formation, 
until a gradually increasing deafness reminds him of something wrong in his 
ears. In other cases indurated earwax causes quite annoying symptoms. 
Besides hardness of hearing, amounting sometimes to deafness, there is great 
itchiness of the meatus, or a feeling of fulness and heaviness in the head, or 
there are spells of pain deep in the ear, and in some cases even serious 
attacks of vertigo. These attacks of vertigo in consequence of hardened 
earwax are caused by its pressure upon the drumhead, which is propagated 
by the chain of the ossicula to the fluid of the labyrinth. Vertigo, however, 
is a symptom also of other affections of the labyrinth. 

The hardened plugs of cerumen consist either of an amorphous, dark 
brown-red mass, principally made up from the secretion of the sebaceous 
and ceruminous glands, or they are strongly mixed with scales of the epider- 
mis and in old persons with hair ; some old plugs, which shine like mother- 
of-pearl, are mixed with cholesterin ; and in still others we find an admixture 
of cotton, seeds, dirt and other substances from the surrounding atmosphere. 
There are, however, cases where the hardened masses which obstruct the 
auditory canal have originated in the middle ear, and consist of dried pus 
mixed with blood, in consequence of catarrh of the middle ear and perfora- 
tion of the drumhead ; in still other cases the plugging up material consists 
of accumulated masses of fungi or the formation of polypi. All this must 
be borne in mind. Deafness from hardened plugs of cerumen will certainly 
be cured by the removal of this obstruction, while in complications with 
affections of the middle ear this is, by far, not so certain. Here the tuning 
fork will give us the best instruction. When deafness is caused by mere 
obstruction of the external meatus, the tuning fork vibrating on the vertex 
is heard better in the obstructed ear, contrary to the patient's expectation. 
When, however, we find that it sounds louder in the ear which is not 
affected, or is heard, at least, no better in the obstructed ear, we may assume 
that there is some complication in the inner ear, and need not expect a full 
return of hearing after the removal of the obstruction. 

THERAPEUTIC HINTS.— Plugs of hardened earwax must be removed 
and to do this there is nothing so expedient and harmless as injections of 
luke-warm water, by a suitable ear-syringe. It is not necessary to do it 
forcibly and if, as in some cases, the plug is very hard, and adheres very 
tightly to the walls of the canal, it is better to take for its accomplish- 
ment two or three sittings and in the meantime have the hardened substances 
softened by occasional application of warm water, than to try to force it in 
one sitting. " Carbonate of soda added to the warm water hastens the 



FURUNCLES OF THE EXTERNAL CANAL. 189 

removal of cerumen." (Houghton.) Often the hearing may be worse and 
a feeling of fulness come on after the first sitting, in consequence of the 
swelling of the hardened mass, and the entire closing up of the canal. The 
patient ought to be advised of this possible seeming aggravation. After the 
earwax is removed it will always be advisable to put some cotton or wool 
into the ear in order to protect the drumhead from shrill sounds and cold. 
But why does the earwax accumulate and harden in some persons, and not 
in others? There surely must be some constitutional reason for it, which we 
must try to mend, otherwise the same process will go on again. The follow- 
ing remedies must be considered : 

Carb. veg., "has served me well in malsecretion of cerumen with ex- 
foliation of dermoid layer of meatus." (Houghton.) Discharge of flesh- 
colored, offensive moisture from right ear; deficient or badly-smelling 
cerumen. 

Conium, accumulation of earwax, looking like decayed paper (scales 
of epidermis) mixed with pus or mucus, or blood-red; hardness of hearing 
ceasing when the wax is removed and returning with the wax. 

Graphit., in young persons with habitual herpetic eruptions in the 
meatus ; or meatus dry and scabby. 

Laches., want of wax; ears very dry. 

Mur. ac, accumulation of wax which is dry and hard, and of a brown- 
red color, with hardness of hearing. 

Petrol., large quantities of thick or thin wax; sensation of rushing of 
water in the ear ; old, aged persons. 

Furuncles of the External Canal. 

They correspond entirely to boils on any other part of the body. Start- 
ing at first as an inflammation of a hair-follicle or of a glandular follicle, by 
spreading, the surrounding subcutaneous connective tissue is drawn in the 
same process and a limited abscess is formed. In the auditory canal their 
size is naturally still more limited; they may, however, for a time completely 
close the canal, until they break and discharge the core. They are quite 
painful and sometimes we find several together or following each other. 
They correspond to styes on the eyelids. As a diagnostic sign from abscesses, 
Cooper states, that when they discharge, the pillow-case in the morning will 
be studded over with stains so closely resembling small sized buttons, as to 
deceive the most clear-sighted at a distance. 

THERAPEUTIC HINTS.— Hepar, Merc, sol., Pulsat., Sul- 
phur. 

11 Picric ac, is as near a specific for small furuncles in any part of the 



190 THE AUDITORY CANAL AND DRUMHEAD. 

body as any remedy can be. In the meatus externus it aborts the furuncle 
if seen early and mitigates, if advanced, as well as corrects the habit." 
(Houghton). " Furuncles in external auditory canal dependent upon mental 
overwork." (Geo. S. Norton.) 

Otitis Externa, or Diffuse Inflammation of the Auditory 

Canal. 

In its Acute form it commences frequently with itching, heat and a 
sensation of dryness in the ear, which gradually changes to a dull pain or a 
boring and tearing deep in the ear, and being generally worse in the night, 
deprives of sleep and causes feverish restlessness. In severe cases the pain 
may extend all around the ear and to the corresponding side of the head. 
A jar from sneezing or coughing, or the motion of chewing or gaping make 
it worse. The hearing grows duller in the degree in which the outer lining 
of the drumhead becomes involved. On inspection we find it congested and 
swollen and also the lining of the canal ; gradually exudation ensues, which 
at first is watery but finally becomes yellowish and purulent. With the 
establishment of otorrhoea the pain decreases, the epidermis loosens and the 
canal fills up with the products of desquamation. This state of things may 
gradually wear off and heal, or it may become chronic; the otorrhoea may 
continue for years. Usually Chronic otitis externa takes its origin in an 
acute attack as described above ; but there are cases where such acute and 
painful outbreaks are not remembered ; very often the commencement dates 
back to infant life. Sometimes the otorrhoea ceases for a time, especially 
during summer, but comes back again with damp and cold weather or from 
any other exciting cause. This form is often characterized by the presence 
of fungi. Chronic otitis may lead to ulceration, deep opacity and extensive 
thickening of the drumhead, to narrowing of the external canal by hyperos- 
tosis, to polypous growths within the canal, or to an extension of the inflam- 
matory process to the middle ear or the neighboring diploetic bony struc- 
tures, or even to the dura mater and brain. Deafness of various degrees is 
a usual concomitant. 

The Causes of external otitis are various. Acute and chronic exanthe- 
mata ; eczematous eruptions ; pemphigus ; irritating substances ; fungi of the 
aspergillus kind ; exposure to cold draughts. Most liable to its attacks are 
children. 

The Prognosis of an acute attack may be called favorable ; the chronic 
form is mostly difficult to manage. 

THERAPEUTIC HINTS —As soon as otorrhoea has commenced, 
great care should be taken to keep the ear clean. Occasional injections of 



EXAMINATION OF THE MIDDLE EAR. 191 

luke-wami water, administered carefully, are of great benefit. " Aurists are 
now beginning to advise dry applications, avoiding warm water except in 
acute troubles." (Houghton.) As regards the remedies, compare Otitis 
Media. 

THE MIDDLE EAR. 

The cavitas tympani is bounded exteriorly by the drumhead ; interiorly by 
the wall of the labyrinth; its roof divides it from the brain; under its floor, 
which is very irregular in shape and greatly varying in thickness and com- 
pactness in different persons, even sometimes in the two ears of one and the 
same person, lies the venajugularis interna; on its posterior wall we find the 
inlet to the antrum mastoideum, and on its anterior wall, nearer to the roof 
than the floor, just opposite to the antrum mastoideum, is the mouth of the 
Eustachian tube. 

The entire cavity is lined by a mucous membrane, which is smooth, 
whitish, very thin and tender. It does the service of the periosteum, as it 
contains the vessels which nourish the bony structure underneath. 

The antrum mastoideum and the numerous air-containing cells of the 
mastoid process are a kind of air-reservoir and resonator, a very important 
appendix to the middle ear, as by it the sonorous vibrations are more or less 
controlled. The Eustachian tube on the other hand is the draining canal for 
the secretions of the middle ear, and also its ventilation tube. For its outlet, 
which in grown persons resembles the mxmth-piece of a trumpet, opens into 
the naso-pharyngeal cavity, where it is constantly exposed to the stream of 
atmospheric air during respiration, by which communication the air in the 
middle ear is kept in the nearest possible equal tension with that of the 
atmosphere. 

Examination of the Middle Ear. 

1. By means of the Ear Speculum. — We can ascertain by its appli- 
cation the color and condition of the drumhead. When it is of a reddish 
tinge, there is inflammation of its inner lining, in consequence of catarrh of 
the middle ear; when it bulges there is an accumulation of mucus or pus 
behind it ; when it is perforated we may be able to view the condition of the 
ossicula behind it. 

By Meaus of Yasalva's Method. — This consists of a forced expiration 
by the patient himself, by keeping mouth and nose tightly shut. The effort 
of blowing without allowing the air to pass out either of the mouth or the 
nose forces it into the Eustachian tubes, through which it enters into the ears, 
where it causes a sense of fulness and a crackling in the drumheads, which 



192 THE MIDDLE EAR. 

from the internal pressure are made to bulge, provided the Eustachian tubes 
be pervious. If this sense is not produced, or only in one ear, we know that 
then and there the Eustachian tube or tubes are closed. This method re- 
quires intelligent patients. " In many cases the testimony of the patient is 
negative as regards the passage of air, when test with the watch shows that 
it did pass into the tympanum." (Houghton.) 

3. By means of Politzer!s Method. — This consists of blowing, by 
means of an india-rubber bag with a tube, a current of air into one or both 
nostrils of the patient in the moment when he is made to swallow a sip of 
water. The nostrils of course must be held shut so that the current of air 
cannot return through them, while the act of swallowing closes the upper 
portion of the pharynx, preventing the air from escaping through the mouth. 
Thus it has to pass through the Eustachian tubes into the ears of the patient, 
of which he Avill be cognizant by a certain fulness and pressure in the ear, or 
in case of perforation of the drumhead, by a whistling sound and a simulta- 
neous ejection of collected mucus into the external meatus. This method, 
too, requires intelligent patients, but it excels over Valsalva's method in this, 
that it acts more energetically. 

" Politzer's method of inflation can be made available without the use of 
water in most cases, by directing the patient to close the mouth and blow 
steadily as in the act of whistling, or blowing out a candle. In children the 
tympanum can usually be inflated without either expedient; a forcible emp- 
tying of the air-bag will dilate the Eustachian tube and fill the cavity." 
(Houghton.) 

4. By means of Catheterism. — It consists of blowing air into the middle 
ear by means of an Eustachian catheter. Here are Kramer's directions for 
the introduction of this instrument. "As a rule, the catheterism of the 
Eustachian tube should be accomplished with one of the catheters of size 1 to 
4, introduced through the corresponding nasal meatus of the ear, that is to 
be examined. For this purpose the patient is to be placed upon a chair with 
a common back, or with one somewhat higher than usual, in order that the 
head may be supported." "After the patient has blown his nose (partly for 
the purpose of clearing away a too abundant secretion, partly, in case the 
nose is too dry, to moisten it, and thus enable the instrument to slide along 
it with greater facility), we dip the catheter into pure olive oil, and blow 
through it to assure ourselves of its permeability. The head of the patient 
is then fixed with the left hand; the catheter is held with the thumb and 
finger of the right hand close to the funnel-shaped extremity, in such a 
manner that the ring attached is downward; the beak is placed in the nasal 
meatus, resting upon its floor, close to the septum, with the convexity 
upwards. From this point it is pushed backwards with a very light hand, 
sweeping as much as possible along the floor of the nostril, with continual 



EXAMINATION OF THE MIDDLE EAR. 193 

elevation of the handle, till the instrument becomes horizontal and its 
extremity rests against the posterior wall of the pharynx. The thicker the 
catheter, the more easily are these movements executed." 

" Irregularities in the form of the inferior turbinate bone and strong lateral 
displacement of the septum may render the first introduction of the catheter 
very difficult, and test severely the delicacy of the sense of touch in the 
hand of the operator. As the point of the beak arrives at the posterior wall 
of the pharynx, the funnel-shaped end of the catheter is to be raised a little 
above the horizontal line, and at the same time to be lightly withdrawn. 
The beak then sinks and rests upon the posterior wall of the soft palate, 
which at that instant contracts, performs a swallowing movement, raises 
itself, and when assisted by a quarter turn upon its axis from within out- 
wards, lifts the beak of the instrument into the tube." 

" If this rapid movement is not successful in the hands of an inexperienced 
person, the beak of the catheter must be conducted back to the upper part 
of the pharynx, in order that it may be slowly drawn forwards and turned 
at the same time laterally a quarter turn upon its axis towards the outside, 
by which means the ring of the funnel-shaped end is directed horizontally. 
It now slides over and into the swelling of the tube itself, where the beak 
of the catheter is directed, with its gravity against the anterior swelling of 
the tube, and here it hooks into it and can be clearly felt to be grasped by 
it upon quickly withdrawing it. The catheter lies here quite conveniently, 
being in no way a source of annoyance to the patient, even in speaking, in 
swallowing or in any of the movements of the head. For the sake of security 
we now elevate the beak of the catheter above the horizontal line, directing 
it upward and outward, the position of the beak being determined and 
rendered evident by the direction of the ring upon the funnel-shaped end." 

After a successful introduction of the instrument, the operator blows either 
with his mouth or by means of an india-rubber ball into the tube, through 
which the current of air is transmitted into the middle ear. On listening 
during this operation by either putting the ear to the ear of the patient, or 
by means of an otoscop, we hear the air rush in and beat on the drumhead, 
which produces a harsh sound when the drumhead is very dry, and a soft or 
moist sound when the drumhead is moist. A thin, interrupted, or whistling 
sound indicates an obstruction of the Eustachian tube; a rattling noise, as 
from some distance, indicates that the Eustachian tube is lined with mucus; 
a rattling sound, which appears to originate nearer, indicates a collection of 
mucus or pus in the middle ear; a fine, sharp whistling, with ejection of pus 
into the external meatus, indicates perforation of the drumhead ; a distant, 
faint and indistinct noise proves that the air does not reach the middle 
ear at all, either because the catheter is not correctly inserted into the outlet 
13 



194 THE MIDDLE EAR. 

of the Eustachian tube, or because there exists an obstruction in the tube 
which the air-douche cannot overcome. 

5. By means of the Watch.— If we want to ascertain the distance at 
which a patient is able to hear, we must use an instrument which gives a 
sound always of the same nature and strength, and which can easily be held 
at different distances from the ear, to be examined. Such an instrument is 
the watch. We commence by holding it at a distance and bring it gradually 
nearer to the ear until its tick is perceived ; the reversed order might give 
rise to mistakes. As soon as the patient can indicate the tempo of the tick, 
we are sure that he hears it, and we know the distance in which he hears by 
exact measurement. 

6. By means of the Tuning-fork. — It is a known fact, that the sound 
of a watch or a vibrating tuning-fork, when placed on the bony structure of 
the head or on the teeth, is heard at once louder as soon as we shut the ears, 
by lightly inserting one finger into each ear. If we close only one ear, we 
hear the sound louder on this side than on the other. This physiological fact 
has been made use of in the diagnosis of ear diseases, where, in some cases, it 
gives valuable hints. 

The same effect, namely, which is produced by closing the ear with a 
finger, must be brought about by any morbid obstruction within the ear 
which interferes with the normal conduction of sound. And what prevents 
the sound from entering into the ear, must necessarily prevent the sound- 
waves also from passing out of the ear, when produced by and conducted to 
the inner ear by vibrations of the skull bones ; consequently they must be 
reflected back to the labyrinth and thus be perceived doubly as loud. 

The causes, which may act similar to an artificial closure of the external 
meatus, are various. It may be a collection of cerumen, a foreign body, or 
a furuncle in the external canal, or obstruction of the Eustachian tube, or 
myringitis, or thickening of the drumhead ; it may be a collection of secretion 
about the ossicula, or a want of flexibility, or even a partial destruction of 
the same, or a softening or thickening of the membranes of the fenestras to 
the labyrinth. In any of these conditions the patient will surely hear the 
tuning-fork, which, by the way, gives the best and truest results, when placed 
on the median line of the top of the head, loudest in that ear which is thus 
affected. 

If the patient, on the contrary, should hear the tuning-fork better in the 
sound or comparatively well ear, and less distinctly in the affected one, we 
may assume with tolerable probability that the affection of the bad ear con- 
sists of a loss of sensibility of the Acusticus in the labyrinth. 

However, even here we must not be too rash in our conclusions, and 
remember that there is a great difference in the capacities which patients, and 
even persons in health, manifest with regard to their power of distinguishing 



OTITIS MEDIA. 195 

the vibrations of a tuning-fork placed upon the head. Aged persons as a 
rule have much less capacity of perceiving the vibrations of a tuning-fork, 
than persons below fifty years of age. It will be well in all cases to place 
the tuning-fork as a controlling experiment, also upon the front teeth of the 
lower jaw. A peculiar observation of Von Trcelsch is, that the tuning-fork, 
when placed on the head, very quickly ceased to vibrate in cases of a very 
unfavorable nature. 

Otitis Media. 

Under this name I intend to treat what Von Troelsch has separately and 
elaborately described as simple catarrh and purulent catarrh of the middle 
ear. Both forms represent an inflammatory state of the mucous lining of 
the cavity of the middle ear, the mastoid cells and the Eustachian tube, either 
in part or in toto. The first is the lighter form, producing a mucous secre- 
tion which, however, at times may be mixed with pus and blood ; the second 
is the more serious form, characterized by its purulent secretion, and mostly 
ending in perforation of the drumhead. It may be the result of sinrple 
catarrh, and I do not find any characteristic signs by which the two could 
positively be distinguished from each other at the commencement. 

The catarrh of the middle ear is either acute or chronic. Its Acute form 
is mostly very painful ; only exceptionally it runs its course without pain, 
especially in tuberculous individuals. The pain is felt deep in the ear, is 
sometimes excruciating and extends over the whole of the affected side of the 
head ; it is usually not increased by pulling at the auricle or by pressure 
upon the parts before the ear, but gets decidedly worse from swallowing, or 
any quick movement of the head, or any concussion from a hard step, and 
at nights. If the mastoid process becomes involved, there is pain in that 
region and sensitiveness to pressure, and according to Cooper, even at an 
early stage "we can find a little gland situated midway over the mastoid 
process and on a line with the anterior opening of the auditory canal, im- 
mediately behind the auricle, become tender and swollen, while its immediate 
surroundings are insensitive to pressure." This inflammatory process is 
further attended by high fever and sleeplessness, when it may indeed simulate 
an acute meningitis; by deafness of various degrees, developing either sud- 
denly or gradually, and caused by the exudation which covers the ossicles 
and destroys their natural mobility; by "catarrh in the head." In fact it 
may have spread from a catarrhal inflammation of the naso-pharyngeal 
mucous membrane, through the Eustachian tube into the middle ear. 

There is no age exempt from it, but in childhood it is especially preva- 
lent, though it is often not recognized. 

I might for its diagnosis in little children draw the attention to the fol- 



196 THE MIDDLE EAR. 

lowing Symptoms: high fever; great restlessness; crying and screaming 
without apparent cause, sometimes in spells or incessantly for days. The 
child gets worse from any motion, especially of the head, from being rocked, 
from swallowing and especially when sucking. In fact it cannot be made to 
suck, it lets the nipple go at each attempt of drawing. Often the little ones 
bring their hands automatically to the affected side of the head. In some 
cases the pressure of the exudation within the ear causes vomiting, somnolence 
alternating with great restlessness, delirium, partial or entire loss of conscious- 
ness, convulsions of the limbs or of the facial muscles. If all this is com- 
plicated with an exanthematic fever, or typhoid fever, pneumonia or bronchitis, 
its diagnosis is indeed difficult. A nasal catarrh or an angina might better lead 
to its discovery. At all events it will be well to try the application of warm 
water to the ears in suspicious cases, which gives more or less relief if the ears 
are affected. An examination of the auditory canal in otitis media by the ear 
speculum reveals a slight redness of the canal near the drumhead ; the drum- 
head itself appears slightly reddened from its congested mucous layer inside, 
or sometimes shining and red, like a polished copper-plate; afterwards or 
sometimes from the first its mild lustre grow T s dimmer or is lost entirely and 
with it also the cone of light. When the secretion in the middle ear in- 
creases, the drumhead is marked by single radiating blood-vessels and par- 
tial bulging, especially of its upper and posterior portion. Sometimes the 
collected pus shines through the drumhead and gives it a yellowish appear- 
ance. Externally w r e find swellings of the glands around the ear and redness 
and swelling of the naso-pharyngeal mucous membrane. Otitis media termi- 
nates often in perforation of the drumhead. 

Its Causes are exposure to cold, which especially in persons prone to 
catarrhal affections, will often excite this complaint. We find it frequently 
associated w 7 ith tuberculosis, syphilis, exanthematic fevers, typhoid fever, 
diphtheritis and croup; we must not lose sight of it during the process 01 
dentition. 

It yields in most cases kindly to homoeopathic treatment. 

THERAPEUTIC HINTS.— Aeon., excruciating pain often in the 
whole affected side of the head with high fever, dry skin, anguish, crossness 
and restlessness ; great sensitiveness to noise ; auricles hot and red ; meatus 
externus dry and red; drumhead red, almost copper-colored, with visibly 
engorged and throbbing vessels ; after exposure to wind and cold. 

Arg. nitr., ulceration of the drumhead; muco-purulent discharge from 
the ear; naso-pharyngeal inflammation. 

Arnica, deep pain and heat extending to the mastoid process; feeling 
of being bruised about the ear ; stitches in and about the ear ; hardness or 
hearing. Traumatic origin ; from getting chilled after being heated ; typhoid 
fever; pysemic symptoms. 



OTITIS MEDIA. 197 

Arsen., typhoid symptoms with suppression of discharge; lymphatics 
inflamed; high temperature; collapse; profuse, cold perspiration; pyaemia; 
pain relieved by warm applications. Burning, itching and crawling in 
external meatus; red, burning pustules in the canal and upon the auricles. 

Bellad., sticking in and behind the ear; digging, boring and tearing; 
coming and going suddenly, extending to the throat; inflammation of the 
throat ; ringing, buzzing and roaring in the ear ; face flushed ; eyes brilliant 
and staring ; congestion to head ; delirium ; deafness or sensitiveness to light 
and noise; auricle red and sensitive to touch ; erysipelas of scalp. Drum- 
head congested, enlarged vessels covering its entire surface. After exposure 
to cold draughts ; cold foot-baths ; having the hair cut ; dentition. 

" The frequent instillation of warm water (as warm as it can be borne), 
either alone or with the addition of a few drops of Bellad., will usually 
relieve the terrible pains while the remedy is administered internally." 
(Norton.) 

Borax, stitch-pains with involuntary starting; lancinating headache; 
itching in the ear; mucous discharge; hot ear; external meatus swollen. 
Children fret and cry and fear downward motion. 

Calc. carb., beating pain, with knocking, buzzing and roaring; pain 
from ear to neck and under jaw T ; Avorse from evening till midnight; better 
from perspiration ; thick discharge ; swelling of lymphatic glands about ear 
and neck ; perspiration about the head ; scrofulous subjects ; sensitiveness to 
cold and damp air; period of dentition; teeth carious and bluish-black at 
the roots. 

Capsic, itching deep in ear; shooting, pressing pain in and about the 
ear ; deep-seated pain under the ear, opposite the angle of the inferior max- 
illary, not extending down the jaw; mastoid process swollen; middle ear 
and mastoid cells filled with pus; external meatus closed; drumhead per- 
forated. 

" Capsic. is specially valuable in acute necrosis of mastoid process, or in 
acute symptoms arising in chronic diseases of the mastoid. The full pulse, 
fever and haggard look of the patient are marked features of the picture of 
the drug. In abscess of the mastoid in very young children it has not 
proved as effective." (Houghton.) 

Chamom., catarrhal inflammation; pain in paroxysms; excruciating; 
patient beside himself from pain; irritable and cross; screaming. Auricle 
red and hot ; face changing color, now red and hot and then again pale ; or 
only one cheek red and the other pale; hot sweat about the head; green, 
colicky discharges from the bowels ; dentition. 

Ferr. phosph., catarrhal affection of the Eustachian tube and ear, 
often combined with catarrh in chest, or bowels, or both. 

Gelsem., catarrhal inflammation at the beginning; cold in head and 



198 THE MIDDLE EAR. 

closure of Eustachian tube ; tense, dull, bound, giddy sensation in head with 
chilliness; stupor, drowsiness. 

Hydrast., after frequent gatherings and earache, deafness. The 
right membrane is bulged outward, looks purplish, and the malleus handle 
is of a pinkish suffusion; left membrane of the same character, though not 
bulged. (R. T. Cooper.) 

Kali carb., stitch-like pain and drawing, especially behind the right 
ear ; head and right ear hot ; face pale, sometimes flushed ; strong fever with 
dizziness; chilliness, shuddering; anxiety in chest; weary in all the limbs. 

Kali hydr., otitis in rickety children with great tenderness of the 
head. 

Merc, sol., deep-seated, tearing and shooting pain, extending to the 
malar or inferior maxillary bone; worse from evening till midnight, by 
w r armth in bed ; enlarged, sensitive cervical glands ; stomatitis or ulcerated 
sore throat; tongue large, flabby, indented; fauces inflamed; perspiration 
from least exertion ; otitis accompanied by facial paralysis. 

Merc, dulc, especially when the Eustachian tube and mucous mem- 
brane of the pharynx are affected. 

Natr. sulph., sharp, lightning-like stitches in the ear; catarrhal affec- 
tion from damp and rainy weather, cold bathing, playing on wet ground ; 
hydrogenoid constitution. 

Nux vom., great pain in ear; hardness of hearing with roaring, 
singing and other noises ; auditory canal dry and sensitive ; cold in head ; 
itching in Eustachian tube; headache; vertigo; periodical nausea and vomit- 
ing ; constipation ; creeping chilliness. Better in warm, worse in cold and 
damp weather. 

Phosphor., painful gathering, first in left and then in right ear, and 
shooting pains through ear worse at night; stopped up feeling in ear; itching 
in ears ; rather deaf in left ear ; deafness to human voice ; reechoing of his 
own words. When the ear gets better, styes appear on eyelids, or eruption 
at the septum of the nose ; constipation. 

Plant, maj., pain in the ear with pain in the teeth and face. The 
pains are sharp, twinging, running. (Houghton.) 

Pulsat., sharp pain, increasing gradually to great intensity, then ceas- 
ing suddenly, but soon increasing again; shooting pain; hardness of hearing; 
headache and toothache; carious teeth; auricle sensitive; external meatus 
red and swollen; profuse discharge; phlyctenular inflammation on drum- 
head, or ulceration and perforation; dryness of auditory canal; catarrh of 
Eustachian tubes ; swelling of cervical glands ; mild disposition ; thirstless- 
ness; constant change of position; shifting pains on different parts of the 
body; catamenial irregularities. Worse in the evening; from heat or close 
room; better in open air. 



THE CHRONIC FORMS OF OTITIS MEDIA. 199 

Rhus tox., pain worse at night and at rest; from cold, damp and rainy 
weather ; deafness to human voice. 

Sulphur, drawing, shooting pain ; heavy pressure and heat at vertex, 
extending to both ears, with soreness of the brain ; hot flushes of the face, 
followed by cold sweat ; hardness of hearing, especially for the human voice. 
In children who suddenly cry out with pain, while they appear listless and 
unobservant, and where it seems doubtful whether the irritation be in the 
brain or in the intestinal canal. Styes; swollen nose; eruptions on different 
parts of the body. In complication with meningitis, eruptive fevers. 

Tellur., pain day and night, of a dull, throbbing character; itching 
and swelling (left ear), with painful throbbing in the external meatus ; dis- 
charge of a watery fluid, smelling like fish-pickle, which causes a vesicular 
eruption upon the external ear and neck, wherever it touches the skin; the 
ear bluish-red, as if infiltrated with water; hearing impaired; rough, angu- 
lar disposition ; after scarlet fever. 

Tereb., dental caries and otitis; dental irritation, with symptoms either 
of cerebral or abdominal irritation ; burning soreness and interstitial disten- 
tion of the gums ; suppression of urine and convulsions ; wakeful at night, 
screaming as if frightened ; staring look ; clenching of fingers ; twitching of 
different parts of the body ; picking of nose ; dry, short cough ; aching of 
limbs and head; feverishness ; changeable temper; cross and irritable. 
Eczema in front of left ear. (Cooper.) 

Ver. vir., acute otitis. 

"Paracentesis of the membrana tympani is advisable, if the pains are 
not readily relieved by remedies, and if there is an accumulation in the 
middle ear, causing the drumhead to bulge ; for a spontaneous rupture may 
leave a permanent perforation, while a simple puncture leaves no bad results, 
besides at once giving the patient relief from the agonizing pain." (Norton.) 

Digest after chronic forms of Otitis media. 

The Chronic Forms of Otitis Media. 

Chronic catarrh of the middle ear and its appendices is often developed 
in consequence of acute attacks, sometimes, however, without these. It con- 
sists either of an interstitial solidification or sclerosis of the middle ear tissue 
(dry catarrh), or of a swelling, tumefaction and thickening of the lining 
membrane, either of the middle ear or the Eustachian tube alone, or of both 
together, or of an ulcerative destruction of the mucous membrane and con- 
sequent perforation of the drumhead (chronic suppurative catarrh). 

The Sclerosis of the middle ear tissue yields no discharge, therefore it 
is called "dry catarrh." Its nature is quite obscure, and only from post- 
mortem examinations we know that this pathological process gradually pro- 



200 THE MIDDLE EAR. 

duces a stiffness and unyieldiness of the lining membrane of the middle ear, 
that greatly interferes with the normal vibrating capacities of the drumhead, 
the ossicula and the membranes of the fenestra rotunda et ovalis. Many 
cases of deafness produced in this way have, no doubt, formerly been classed 
under "nervous deafness." 

The Moist catarrh is characterized by hypersecretion and tumefaction 
of the mucous membrane. This originally thin transparent and smooth mem- 
brane gradually becomes whitish or bluish-gray, its substance thickened, and 
its vascularity increased ; patches of granulations form upon its surface, and 
fatty, cheesy or calcareous deposits in its periosteal layer. The whole lining 
of the middle ear may thus be chauged, and the pathological process may 
extend into the Eustachian tube, making it impervious for ventilation. 

The Suppurative form manifests itself by its purulent otorrhcea ; the 
mucous membrane appears, in some cases, greatly swollen and red, in others 
only moderately so and pinkish-yellow, and in still others, whitish-gray and 
cicatrized; it is covered with pus. At times we find this morbid process 
attended w T ith caries of the bony structure and almost always with perforation 
and greater or less destruction of the drumhead. 

The patient with chronic catarrh does not often know when his trouble 
began ; only by a gradually increasing hardness of hearing his attention is 
drawn to it. The grade of deafness depends not so much on the extension 
of the catarrhal affection as on its location, by which it is apt to interfere 
more or less with the conduction of sound-waves to the labyrinth. A slight 
degree of catarrh, if it destroys the mobility of the fenestral membranes, 
causes greater deafness than a much more extensive catarrh, if it affects the 
walls of the middle ear or even the drumhead. 

Impaired hearing, when it is better in clear and dry and worse in damp 
and rainy weather; when it is momentarily relieved by Valsalva's or Po- 
litzer's method, or after an act of swallowing from which the patient perceives 
a kind of crack in the ear; when the own voice gives a more resonant sound, 
or the tuning-fork on the vertex is perceived louder in the affected ear — it 
usually denotes an affection of the Eustachian tube. When, on the contrary, 
under all these conditions, the degree of hearing is not altered, we may infer 
that the trouble is located in the articulations of the ossicula or in the fenes- 
tral membranes. A perforation of the drumhead is not necessarily attended 
with great impairment of hearing, even an entire destruction of the same 
does not cause eutire loss of hearing; of greater importance in regard to 
hearing are the changes from aural catarrh already referred to, which affect 
the articulations of the ossicula or the fenestral membranes on the labyrinth 
wall. The drumhead, if perforated, as a rule, heals kindly, but if it is kept 
open from continued inflammation and discharge, or even destroyed, the 
middle ear loses its protection against external influences and is thus con- 
tinually subjected t» new irritations. 



THE CHRONIC FORMS OF OTITIS MEDIA. 201 

Chronic otitis media suppurativa often leads to the formation of polypi 
and caries. Caries of the temporal bones may lead to abscesses in the brain 
or meningitis purulenta, to paralysis of the face, to haeinorhages, emboli, septic 
infection and phlebitis. 

Its Prognosis must be made according to these different characters and 
states. 

THERAPEUTIC HINTS —Valsalva's or Politzer's method, or cath- 
eterism will prove beneficial in cases of imperviousness of the Eustachian 
tube, where it is important to procure a better ventilation of the middle ear, 
or in cases of perforated drumhead and copious collection of slime and pus 
in the middle ear, to cleanse it of these secretions. The main work even here 
will have to be done by carefully selected remedies. Besides those mentioned 
under the acute form of aural catarrh, compare: 

Arsen., profuse, ichorous, cadaverously-smelling discharge; sinking 
and prostration. 

Asaf., purulent discharge; after abuse of mercury. 

Aurum, fetid discharge; caries of mastoid process with pain like a 
bruise, worse at night, by uncovering and at rest; better by motion in the 
open air. Meatus externus lined by fetid pus, like decay of necrosed bone ; 
drum perforated; ossicula destroyed ; middle ear denuded; fistulous openings 
through mastoid processes; offensive nasal discharge. Syphilis and abuse 
of mercury. 

Bar. carb., in cases involving the external meatus, Eustachian tube 
and structures of the pharynx, especially tonsils. 

Bar. mur. "has served me better than Bar. carb. after long trials with 
the latter. Baryt. corresponds to an extra patency of Eustachian tubes caused 
by pharyngeal weakness or paresis. Clacking sound on swallowing, sneezing, 
or eructation, and by the two latter actions air is forced into the tympanum. 
Large tonsils reduced under its action." (Houghton.) 

Calc. carb., profuse discharge; chronic deafness; sensitive to shrill 
sounds ; crackling sounds when chewing ; singing in the ears with snapping 
as from electric sparks ; roaring in the ears. Drumhead perforated ; edges 
covered with granulations, extending to external meatus ; polypous growths. 
Sore eyes; sore, ulcerated nostrils; smell of rotten eggs as gunpowder in the 
nose; nasal discharge; catarrh of Eustachian tube. 

Carb. veg., offensive discharge; aural meatus and drumhead inflamed; 
pain from ear down to neck : after itch-like eruptions. 

Caustic, offensive discharge; paralysis of face; hardness of hearing; 
own voice reechoes ; roaring and whizzing in ear ; throat reddened, with in- 
creased mucus ; meatus dry with little brown wax. 

Cinchona, haemorrhage from ear after prolonged suppuration. 



202 THE MIDDLE EAR. 

Conium, hardness of hearing; ears stopped up by dark brown wax and 
pus ; pain in head ; ringing in ears ; enlarged liver with pain on pressure ; 
jaundice; urine scanty, brown and bilious; constipation, alternating with 
bilious diarrhoea; cervical glands hard and tender. 

Elaps, deafness; offensive, yellow-greenish discharge; buzzing in ears; 
frontal and occipital headache, worse from motion and stooping. Dull pain 
from nares to ears ; when swallowing, pain goes to the ears ; posterior wall 
of pharynx dry, mucous membrane fissured and covered with crusts ; offensive 
discharge from nose ; subject to epistaxis and eruption about nose and face ; 
snuffles and pain from root of nose to forehead. Skin dry and hot, but always 
complains of feeling cold. 

Ferr. met., discharge from left ear; chlorotic complexion ; impaired 
hearing; murmur in left jugular vein; palpitation of the heart. 

Fluor, ac, hardness of hearing, with rheumatism; ringing in the ears 
and numb feeling in the bones of face, near the right ear. Hearing is better 
on bending the head backwards ; scalp sensitive ; hair matting. 

Gelsem., deafness after massive doses of morphine or quinine. 

Graphit., deafness; hears better when riding in a carriage; catarrh of 
right tube ; roaring in right ear ; feeling as if a skin were covering the ear 
inside ; sensation as of a valve opening and closing in the ear ; detonation 
and cracking in the ear when swallowing or sneezing; own voice resounds; 
roof of mouth and fauces red. Eruption behind the ears, with sticky secre- 
tion; eczematous eruption of the face; mucous membrane of meatus red and 
excoriated; or dry and scabby; or oozing of water and pus, or blood; or 
thin, watery offensive discharge from both ears after scarlet fever with 
deafness. 

Hepar, detonation in the ear when blowing the nose; drawing, tearing, 
stitching pain worse in night and cold air; soreness of surface in spots when 
touched; skin ulcerates from slight injury; scabs behind the ears; on ulcer- 
ated surface white shreds, which are removed with difficulty ; wants to be 
wrapped up warmly even if hot. Abuse of mercury. 

Jodium, deafness, with tonsillitis and catarrh of Eustachian tube; in- 
dolent ulceration of the drumhead; glandular enlargement in front of the 
tragus; pinched, dried-up look of the face. 

Kali bichr., thick yellow discharge, mixed with stringy mucus; sharp 
pain coming and going quickly and changing location ; stitches from ear up 
into the head and down into the neck ; better from heat. Naso-pharyngeal 
catarrh ; ropy mucus ; " clinkers" in nose. 

Kreosot., deafness with hereditary syphilis. 

Laches., dryness of left ear; roaring and drumming in the ears; sense 
of coldness in the affected ear and side of head; dry, scurfy condition of 
nostrils ; discharge of blood and pus from the nose. 



THE CHRONIC FORMS OF OTITIS MEDIA. 203 

Lycop., external meatus excoriated by an offensive discharge; drum- 
head destroyed. Patient cannot bear to be covered. After scarlet fever 
with affections of the parotid glands, eruptions and abdominal troubles. 

Mercur., deafness; offensive discharge; polypi; external meatus and 
drumhead inflamed; itching in the ears; vesicular eruption in the face and 
itching pimples on legs. Syphilis. 

Merc, bijod., follicular catarrh in pharynx; enlarged tonsils. 

Merc, dulc, "is more effective than the other forms of Mercur. in 
overcoming closure of Eustachian tube, and probably it is in this way that it 
relieves the deafness of advancing years." (Houghton.) 

Merc, praec. rub., purulent discharge; leaden heaviness in occiput; 
falling out of hair. 

Mezer., deafness after the suppression of an eruption of the scalp 
characterized by the formation of crusts, beneath which, when pressed, oozes 
a purulent or semi-purulent fluid. 

Natr. carb., hardness of hearing and roaring in left ear with caries of 
the left molar teeth; pain in left side of face; stiffness of neck and left 
shoulder; pain in small of back and left leg, worse from motion, better in 
rest ; menses irregular, scanty ; all worse before the monthly. 

Nitr. ac, difficult hearing; obstruction of tube with swollen tonsils 
after scarlet fever ; caries of the ossicula or mastoid process, from syphilis or 
abuse of mercury. Shooting pains ; pain in bones, worse from every change 
of temperature, at night, on washing, on rising from a seat and from touch ; 
better while riding in a carriage. 

Phosphor. , deafness to the human voice ; resounding of own voice ; sen- 
sation as if a foreign body were lodged in the ear ; great itching in the ears. 

Picric ac, noises in the head and sinking in the pit of the chest, being 
worse when tired and fatigued; deafness. (R. T. Cooper.) 

Psorin., offensive discharge; offensive exhalation from whole body; 
itching in the ears; tinea capitis; scabs over fetid ulcers on and behind the 
ear. Similar to Sulphur but not reached by it. 

Pulsat., catarrh of Eustachian tube with hardness of hearing. 

Sepia, sensitive to musical sounds; herpes on the lobe, behind the ear 
or on the nape of the neck. 

Silic, hardness of hearing, worse from washing and changing linen; 
otorrhcea and bad cough after scarlet fever; constant watery, curdy and 
ichorous discharge, without pain, except after a fresh cold. Ulceration, caries 
and necrosis; pain drawing and shooting, worse at night and from change 
of weather or movement ; also after being long seated. Wants to have the 
head wrapped up. External meatus dry at outer portion, ulcerated further 
in and at drumhead. Child bores into its ear with its fingers when asleep, 
causing a discharge of blood and pus; it enjoys having the ear cleansed. 



204 



THE MIDDLE EAR. 



Feeling of sudden stoppage in the ear relieved by gaping or swallowing. 
"Silic. is especially curative in cases in which the ulceration covers with a 
firm scab, under which pus abounds. One subjective symptom I have found 
a guiding one: hissing sounds in the ear which is perforated." (Houghton.) 

Sulphur, deafness, especially for the human voice; purulent, offensive 
discharge, worse in damp weather, after meningitis. Drawing, shooting pains 
in the ears; pressure in the ears when swallowing or sneezing; ulcers in the 
middle ear; rusty ulcers on the drumhead. Frequent styes; swollen nose; 
eruptions on different parts of the body ; worms and itching of anus ; hot and 
sleepless in the night; hot feet and burning of soles in bed with inclination 
to uncover the feet ; disinclination to being washed. 

Thuja, discharge which smells like putrid meat; granulations in the 
middle ear similar to condylomata ; polypi. 






Digest to Acute and Chronic Otitis Media. 



PAIN AND SENSATIONS. 

Beating, with knocking, buzzing and 
roaring: Cede. carb. 

Bruised feeling about ear: Arnica. 

Burning : Arsen. 

Cold sensation in ear and side of head : 
Laches. 

Digging, boring and tearing: BeUad. 

Drawing, shooting: Sulphur. 

■ , , worse at night and from change 

of weather, or movement: Silic. 

, stitching, worse in night and cold air : 

Hepar. 

Dull, throbbing, day and night : Tellur. 

Foreign body, as if lodged in ear: 
Phosphor. 

Itching: Borax, Capsic, Mercur., Phos- 
phor., Psorin. 

Pain in ear: Nux vom., Plant, maj. 

, when swallowing: Elaps. 

Pressure, when swallowing or sneezing: 
Sulphur. 

Paroxysms, excruciating, patient beside 
himself from pain : Aeon., Chamom. 

Sharp, twinging, running: Plantago. 

, increasing gradually to great inten- 
sity, then suddenly ceasing, but soon 
commencing again: Pulsat. 

, coming and going quickly: Bellad.; 

and changing location : Kali bichr. 



Shooting : Nitr. ae., Pulsat. 

, worse at night : Phosphor. 

, pressing in and about ear : Capsic. 

Sticking in and behind ear: Bellad. 
Stitches in and about ear: Arnica. 

, with involuntary startings: Borax. 

, sharp, lightning-like : Natr. sulph. 

Stitch-like and drawing, especially be- 
hind ear : Kali carb. 
Stopped-up feeling in ear: Phosphor. 

EXTENT AND DIRECTION. 
Deep pain and heat extending to mastoid 

process: Arnica. 
, tearing and shooting, extending to 

malar or inferior maxillary bone: Mere. 

sol. 
Pain from ear to neck : Carb. veg. 

, and under jaw : Cole. carb. ' 

, to throat, coming and going suddenly : 

Bellad. 
Stitches up into the head and down to 

neck : Kali bichr. 
Deep-seated pain under the ear, opposite 

the angle of the inferior maxillary, not 

extending down the jaw : Calc. carb. 
Painful gathering first in left and then in 

right ear: Phosphor. 
Excruciating pain often in the whole 

affected side of the head : Aeon. 



DIGEST TO ACUTE AND CHRONIC OTITIS MEDIA. 



205 



Dull pain from nares to ears: Elaps. 
Heavy pressure and heat at the vertex, 

extending to both ears, with soreness of 

the brain : Sulphur. 

AURICLE. 

Sensitive: Pulsat, 

Hot: Borax, Sulphur. 

, right ear and head : Kali carb. 

and red: Aeon., Chamom. 

Bluish-red, as if infiltrated : Tellur. 

Itching and swelling (1. ear.) with painful 
throbbing in external meatus : Tellur. 

Red, burning pustules, outside and inside: 
Arsen. 

Vesicular eruption outside from dis- 
charge: Tellur. 

Herpes on lobe, behind the ear, or on 
nape of neck: Sspia. 

Ulceration covers with a firm scab under 
which pus abounds: Silic 

Scabs over fetid ulcers: Psorin. 

Behind ears, scabs: Hepar. 

over fetid ulcers : Psorin. 

eruption with sticky secretion: 

Graphit. 

In front of tragus : Glandular enlarge- 
ment: Iodum. 

of left ear : Tereb. 

EXTERNAL MEATUS. 

Burning, itching and crawling : Arsen. 
Diy: Pulsat, Silic. 

left ear : Laches. 

and scabby: Sulphur. 

with little brown wax: Caustic. 

and red : Aeon. 

and sensitive : Nux vom. 

Inflamed: Bar. carb., Carb. veg., Mercur. 
Red and swollen: Borax, Pulsat. 
Closed: Capsic. 
Red and excoriated: Graphit. 
Ulcerated, white shreds, which are re* 

moved with difficulty : Hepar. 
Lined by fetid pus: Aurum. 
Polypi : Calc. carb., Mercur , Thuja. 

DRUMHEAD. 

Inflamed: Carb. veg., Mercur. 



Bulging and purplish : Hydrast 

Copper-colored, engorged, throbbing 
vessels: Aeon. 

Enlarged vessels all over: Bellad. 

Phlyctenules upon it : Pulsat. 

Ulceration : Arg. nitr., Pulsat, Silic. 

, indolent: Iodum. 

Rusty ulcers: Sulphur. 

Perforation : Aeon., Capsic., Bycop., Pulsat. 

, edges covered with granulations, ex- 
tending to external meatus: Calc. carb. 

MIDDLE EAR. 

Feeling as if a skin were covering the 

ear inside: Graphit. 
Denuded: Aurum. 
Ulceration : Silic., Sulphur. 
Caries, necrosis : Aurum., Nitr. ac., Silic. 
Granulations like condylomata: Thuja. 

MASTOID PROCESS. 

Swollen: Capsic. 
Caries: Aurum. 
Fistulous opening : Aurum. 
Necrosis : Capsic , Silic. 
Abscess: Capsic. 

- — - in children not proved successful: 
Capsic 

EUSTACHIAN TUBES. 

Itching : Nux vom. 

Catarrh: Bar. carb., Calc. carb., Ferr. 
phosph., Pulsat. 

, right side : Graphit. 

■ with hardness of hearing: Pulsat. 

with catarrh of pharynx : Merc dulc. 

Obstruction with swollen tonsils: Nitr. ac. 
Closure : Gelsem., Merc. dulc. 

DISCHARGE. 

Discharge from left ear: Ferrum. 

like decay of necrosed bone : Aurum. 

mucous: Borax. 

muco-purulent: Arg. nitr. 

offensive, fetid : Arsen., Aurum, Carb. 

veg., Caustic, Elaps., Graphit., Mercur., 

Psorin., Sulphur. 

, excoriating parts: Lycop., Tellur. 

, smelling like putrid meat: Thuja. 



206 



THE MIDDLE EAR. 



Discharge, smells like fish pickle : Tellur. 

, yellow-greenish : Elaps. 

Haemorrhage after prolonged suppura- 
tion: Cinchona. 

Otorrhcea: Silk. 

Profuse : Arsen., Calc carb., PulsaL 

Purulent : Asaf., Mere, prcec. rub., Sulphur. 

Pus and blood, after boring with fingers in 
ears during sleep : Silic 

Thick : Calc. carb. 

"Watery, ichorous: Arsen., GraphiL, Silic, 
Tellur. 

, yellow, mixed with stringy mucus: 

Kali bichr. 

Water, pus or blood : GraphiL 

Suppressed discharge with typhoid 
symptoms: Arsen. 

HEARING. 

Buzzing : Calc. carb., Elaps. 

Clacking on swallowing,' sneezing or 
eructation: Bar. mur. 

Crackling when eating: Calc. carb., 
GraphiL 

Deafness, impaired hearing, hardness of 
hearing : Arnica, Bellad., Caustic, Conium, 
Elaps., Ferrum, GraphiL, Mercur., Nitr. 
ac, Pier, ac, PulsaL, Silic, TeUur. 

, chronic: Calc. carb., Pier. ac. 

, in left ear: Phosphor. 

, for human voice: Phosphor., Rhus 

tox., Sulphur. 

, with hereditary syphilis : Kreos. 

, with tonsillitis : Iodum. 

, with roaring in left ear : Natr. carb. 

, with rheumatism: Fluor, ac. 

, after suppression of crusts on scalp, 

with purulent secretion underneath: 
Mezer. 

, of advancing years : Merc dulc. 

Detonation, when swallowing or sneez- 
ing: GraphiL 

, when blowing the nose : Hepar. 

Hearing better on bending head back- 
wards : Fluor, ac 

, when riding in a carriage: GraphiL 

Hissing in perforated ear: Silic 

Resounding of own voice: Caustic, 
GraphiL, Phosphor. 



Ringing: Conium. 

, buzzing and roaring : Bellad. 

and numbness in bones of face near 

right ear: Fluor, ac. 
Roaring : Bellad., Calc carb., Pier, ac 

and drumming : Laches. 

and whizzing: Caustic. 

in right ear: GraphiL 

Sensitiveness to musical sounds : Sepia. 

to shrill sounds : Calc carb. 

to noise and light: Bellad. 

Singing with snapping as from electric 

sparks: Calc. carb. 
Stoppage by dark brown wax and pus : 

Conium. 
relieved by gaping or swallowing: 

Silic. 
As of a valve opening and closing in 

the ear: GraphiL 

SYSTEMIC SYMPTOMS. 

Stupor: Gelsem. 

Listless and unobservant : Sulphur. 

Delirium: Bellad. 

Suddenly cry out with pain, otherwise 

listless: Sulphur. 
Fret and cry : Borax. 
Screaming: Chamom. 
Disinclined to being washed : Sulphur. 
Enjoys having the ear cleaned: Silic. 
Fear downward motion : Borax. 
Anxiety in chest : Kali carb. 
Anguish: Aeon. 
Mild disposition: PulsaL 
Changeable temper: Tereb. 
Rough, angular disposition : Tellur. 
Cross: A con. 
and irritable : Chamom., Tereb. 



Headache : Bellad., Conium, Nux vom. 
, frontal and occipital, worse from 

motion and stooping : Elaps. 
— — , lancinating: Borax. 
, tense, dull, bound, giddy sensation 

with chilliness: Gelsem. 

, and toothache : PulsaL 

, and aching of limbs : Tereb, 

Noises in head and sinking at pit of chest : 

Pier, ac. 



DIGEST TO ACUTE AND CHRONIC OTITIS MEDIA. 



207 



Leaden heaviness in occiput: Mercprcee. 

rub. 
Vertigo : Gelsem., Nux vom., Pier. ae. 
Congestion: Bellad. 
Meningitis: Sulphur. 
Perspiration about head : Cole, carb., Silic. 

, hot : Chamom. 

Scalp sensitive: Fluor, ae., Kali hydr. 

Erysipelas: Bellad. 

Tinea: Mezer., Psorin. 

Falling out of hair : Merc, prozc. rub. 

Matting of hair : Fluor, ae. 

Brilliant and staring : Bellad. 
Staring look: Tereb. 
Frequent styes: Pier, ae., Sulphur. 
Styes appear when the ear gets better : 

Phosphor. 
Sore eyes : Calc. carb. 



Calc. 



Smell of rotten eggs or gunpowder 

carb. 
Cold in head: Gelsem., Nux vom. 
Discharge : Calc. carb. 

, offensive : Aurum. 

of blood and pus : Laches. 

Snuffles and pain from root of nose to 

forehead: Elaps. 
Ropy mucus, "clinkers:" Kali bichr. 
Dry, scurfy nostrils: Laches. 
Ulcerated nostrils: Calc. carb. 
Eruption at septum : Phosphor. 
about nose and face and subject to 

nosebleed: Flaps. 
Swollen nose: Sulphur. 
Picking of nose : Tereb. 



Pinched, dried-up look: Iodum. 
Haggard look : Capsic. 



Pain in face and teeth : Plantago. 

in left side : Natr. carb. 

Paralysis: Caustic, Merc. sol. 
Flushed: Bellad. 

Hot flushes followed by cold sweat : Sulphur. 
One cheek red, the other pale: Chamom. 
Changing, now red, then pale : Chamom., 

Kali carb. 
Chlorotic complexion: Ferrum. 
Jaundice : Conium. 
Eruption, vesicular: Merc. sol. 
, eczematous: Graphit. 



Stomatitis : Merc. sol. 
Tongue large, flabby, indented : Merc. sol. 
Roof of mouth and fauces red : Graphit. 
Gums sore, burn, and swollen : Tereb. 
Teeth and face painful: Plantago. 

, carious: Pulsat., Tereb. 

, left molar : Natr. carb. 

, and bluish-black at roots : Calc. carb. 

Dentition, period of: Bellad., Calc. carb , 

Chamom. 
with cerebral or abdominal irritation : 

Tereb. 
Naso-pharyngeal inflammation: Arg. 

nitr., Kali bichr. 
Fauces inflamed: Bar. carb., Bellad, Merc. 

sol. 

, with increased mucus : Caustic. 

, follicular: Merc. bij. 

, mucous membrane fissured and 

covered with crusts: Flaps. 
Tonsils enlarged: Bar. carb., Merc. bij. 

reduced under its action: Bar. mur. 

Thirstlessness: Pulsat. 

Cervical glands swollen : Merc, sol., Pulsat. 

, hard and tender : Conium. 

Lymphatic glands about ear and neck 

swollen: Calc. carb. 
Neck and left shoulder stiff: Natr. carb. 
In left jugular vein murmur: Ferrum. 



Periodical nausea and vomiting: Nux 

vom. 
Green, colicky discharge : Chamom. 
Constipation : Nux vom., Phosphor. 
, alternating with bilious diarrhoea: 

Conium. 
catarrh in bowels or chest, or both : 

Ferr. phosph. 
Abdominal troubles: Lycop. 
Enlarged liver: Conium. 
Worms and itching of anus : Sulphur. 
Urine, scanty, brown, bilious: Conium. 

suppressed, with convulsions: Tereb. 

Menses, irregular and scanty : Natr. carb., 

Pulsat. 



208 



THE MIDDLE EAR. 



Cough, bad: Silic. 

, dry, short : Tereb. 

Palpitation: Ferrum. 
Full pulse : Capsic. 



Dry skin : Aeon. 

, but always complains of feeling cold : 

Elaps. 
Eruptions: Lycop. 

, on different parts: Sulphur. 

Pimples, itching, on legs: Mercur. 
Soreness of skin in spots when touched : 

Hepar. 
Ulcerates from slight injury : Hepar. 



Chilliness : Nux vom. 

, shuddering: Kali curb. 

Feverish: Tereb. 

Fever: Aeon., Arsen., Capsic. 

, with hot soles and inclination to un- 
cover feet : Sulphur. 

, with dizziness : Kali carb. 

, typhoid: Arnica. 

, eruptive: Sulphur. 

Perspiration from least exertion: Merc, 
sol. 

, profuse, cold: Arsen. 

Exhalation offensive from whole body: 
Psorin. 



Drowsy: Gelsem. 

Sleepless: Sulphur. 

"Wakes up screaming as if frightened: 

Tereb. 
Restless: Arsen. 

Changes position constantly : Pulsat. 
Pains shifting in different parts : Pulsat. 
Weary in all limbs : Kali carb. 
Twitching of different parts : Tereb. 
Clenching of fingers: Tereb. 
Sinking, prostration, collapse: Arsen. 
Anaemia: Arsen. 

Hydrogenoid constitution: Natr. sulph. 
Lymphatics inflamed : Arsen. 
Pysemic symptoms: Arnica. 
Rickets : Kali hydr. 
Scrofulous children: Cak. carb. 
Syphilis : Kreos , Merc. sol. 



CIRCUMSTANCES THAT 
CAUSE IT. 
Cold bathing : Natr. sulph. 

foot-baths : JBellad. 

Chilled after being heated: Arnica. 
Exposure to cold draughts: Bellad. 

wind : Aeon. 

Having hair cut: Bellad. 

Itch-like eruptions: Carb. veg. 

Meningitis: Sulphur. 

Mercury, abuse: Asa/., Aurum,. Hepar, 

Nitr. ac. 
Morphine and quinine : Gelsem. 
Playing on wet ground : Natr. sulph. 
Scarlet fever: Nitr. ac., Tellur. 

with deafness : Graphit. 

with swollen parotid glands : Lycop. 

Sulphur, after if not sufficient : Psorin. 
Syphilis: Aurum, Nitr. ac. 
Traumatic : Arnica. 
Vaccination: Silic, Thuja. 
Weather damp, cold and rainy: Natr. 

su'ph., Rhus tox. 

WORSE. 

In evening : Pulsat. 

till midnight : Cak. carb., Merc. sol. 

At night and at rest: Rhus tox. 

Damp weather : Calc carb., Nitr. ac, Nux 

vom., Sulphur. 
Washing and changing linen: Silic 
Heat or close room : Pulsat. 
Warmth in bed : Merc sol. 

, cannot bear covering: Lycop. 

Before monthly : Natr. carb. 
After being long seated : Silic. 
On rising from a seat : Nitr. ac 
Being tired and fatigued: Pier, ac 

BETTER. 

Cleansing the ear is enjoyable: Silic. 
Motion in open air: Aurum. 
Riding in a carriage : Nitr. ac, Graphit. 
Warmth : Nux vom. 

, wants head wrapped up : Silic. 

Perspiration : Calc carb. 

, wants to be wrapped warmly : Hepar. 

Heat: Kali bichr. 

Warm applications: Arsen. 

Open air : Pulsat. 



POLYPI — NERVOUS DEAFNESS. 209 

Polypi. 

These morbid growths are more frequently found in combination with 
chronic suppurative catarrh of the middle ear. It is probable that in most 
cases they are the product of this morbid process, although it is possible, also, 
that, having originated primarily, they may by constant irritation cause in- 
flammation, ulceration and perforation of the drumhead. Their substance is 
very vascular, soft, red and easily bleeding when being touched ; sometimes 
they are of greater consistence, have a smooth and shining surface, and grow 
grape-like on pedicles. Their size differs greatly. From mere tiny excres- 
cences they may increase to masses which fill the entire external meatus and 
even overlap it. They have been found to grow from the surface of the ex- 
ternal meatus, from the drumhead and from different parts of the surface of 
the middle ear. According to Von Troelsch their most frequent origin is the 
middle ear ; Toynbee and Wilde, on the contrary, observed them most fre- 
quently to originate on the posterior pail of the external meatus. In regard 
to their histological nature, they are either a hyperplasia of the mucous lining 
of the middle ear- — MUCOUS polypi — or a proliferation of connective tissue — 
Fibrous polypi — or a growth .of a jelly-like substance— Gelatinous 
polypi. The first are the most frequent, the last the rarest form. 

THERAPEUTIC HINTS— Alumen usta, 3d cent, "will reduce 
granulation on the drumhead or inner extremity of meatus." (Houghton.) 

Calc. carb., large polypi, filling the whole external meatus and over- 
lapping it ; bleed occasionally ; chronic nasal discharge. 

Calc. jod., offensive, thick, yellow discharge from the ear; deafness; 
pain in region of the heart, worse on going up stairs ; frequent urging to 
urinate, as if the bladder were full, worse in afternoon and evening. 

Merc, sol., offensive discharge; polypi in external meatus, which is 
inflamed. 

Sanguin., Teucrium. 

Thuja, large polypi with otorrhoea; bleed easily. Shooting pain in 
ear. Granulations in middle ear. 

Nervous Deafness. 

Under this name a number of ear affections have heretofore been classed, 
which now are diagnosed as one or the other form of chronic middle ear 
catarrh. Other affections still remain, which must be favored with this 
title, until by further experimentation and improved means of diagnostic 
researches, we shall have gained a more precise knowledge of their nature. 
" Nervous deafness " comprises all those defects of hearing which take their 
14 



210 THE MIDDLE EAE. 

origin in affections of the labyrinth, of the acoustic nerve and its origin, or 
of the brain. Various as these affections are and may be, we seldom have 
the means of accurately defining their nature during the life of the patient. 
We meet nervous defects of hearing after the abuse of quinine ; in hysteria 
and chlorosis; in consequence of injuries to the head; various affections of 
the brain. 



Meniere's Disease. 

The following are Meniere's observations: "1. Attack of noises of 
various kinds, intermitting or continuous, and impairment of hearing coming 
on suddenly in heretofore well organs of hearing. 2. These functional dis- 
turbances have their seat in the inner ear and are capable of producing 
apparent brain-symptoms, such as vertigo, stupefaction, uncertain gait, turn- 
ing motions of the body and sudden falling down, attended with nausea or 
vomiting and fainting. 3. These attacks recur from time to time and are 
always followed by a higher or lower grade of deafness, even sudden entire 
loss of hearing. 4. It is most probable that the material change which lies 
at the bottom of these sudden disturbances, has its seat in the semi-circular 
canals." In one case post-mortem revealed an apoplectic effusion in these 
parts. This affection is also known under the name of Labyrinthine or 
Auditory vertigo, and according to Hinton is at times attended with 
unconscious divergence of the eyes and " seeing double " when inattentive. 
It seems, however, that not in all cases the primary affection lies in the laby- 
rinth. The same symptoms have been observed when in consequence of 
obstruction of the external meatus, or of catarrhal affections of the middle 
ear, with profuse exudation, or with sudden stoppage of the Eustachian 
tube — an undue pressure is exercised upon the labyrinth. It is clear that in 
this case the prognosis is much more favorable than when the labyrinth is 
-originally affected. We can distinguish a primary affection of the labyrinth 
from one secondarily caused by external pressure, by the suddenness with 
which it attacks without any premonitory symptoms, and by the absence of 
all obstructions, either in the external meatus or in the Eustachian tubes. 

THERAPEUTIC HINTS— A case of suppurative inflammation of 
the labyrinth after cerebro-spinal meningitis is recorded by Dr. Searle. 
Total deafness; straddling, gathering gait. No conduction of sound of a 
heavy tuning-fork through forehead and head. Silic. 30 improved. Kali 
brom.j 1 ^ cured. 

There are recommended by R. T. Cooper: Salicylate of Soda, Chin, 
sulph., Conium, Cicuta, Amyl nitr., all of which produce more or less 
deafness and vertigo, the leading symptoms of Meniere's disease. 



TINNITUS AURIUM. 211 

" Salicylate of Soda seems to correspond most closely to the usual 
symptoms and has served me better than any other remedy." (Norton.) 

Arnica, vertigo worse when rising and walking, but also when lying. 
Great thirst ; belching and vomiting of sour masses ; feeling of coldness in 
occiput. (J. Leeser.) 

The secondary form must be treated according to its causes, which 
compare. 

Tinnitus Aurium. 

Variable as sounds and noises, so also is the character of tinnitus 
aurium. We might, however, discern two distinct groups of tinnitus 
aurium: 1, noises in consequence of an irritability of the auditory nerve, 
and 2, noises in consequence of irritation in or on the blood-vessels or 
adjacent parts of the hearing apparatus which the normal auditory nerve 
perceives. 

The first class — so-called subjective sounds or noises — are the conse- 
quence of cerebral disorders, as hyperemia of the brain, intoxication by 
quinine or alcohol, faulty composition of blood in chlorosis, and exaltation 
or depression of the nervous system in general. But even here we may 
already have trespassed the proper boundary line between the two groups ; 
irritation of the nervous and vascular system cannot be kept asunder, as 
the one is dependent upon the other. 

The second class — objective sounds or noises — are much more frequent 
and manifold in their causes. All kinds of irritations of the drumhead, or 
middle ear, or Eustachian tube, or labyrinth, either from circulation, inflam- 
mation, exudation, alteration of tissue, or foreign bodies, may give rise to it. 
Pulsating noises are probably mostly of a vascular origin; ringing noises 
may be caused by clonic or tonic spasms of the muscles in the middle ear or 
of the Eustachian tubes; the crackling noise in the ear during an act of 
swallowing originates by the contraction of the abductor tubes; many other 
and various noises may be caused by vibrations of pus or dried scales of 
mucus, or by foreign bodies on the drumhead, or by the bursting of small 
bubbles of slime in the ear, when shaking the head, etc. 

Tinnitus aurium is often aggravated by worriment, mental and bodily 
depressions; by sudden changes of weather, especially damp weather; in 
illy- ventilated rooms; after sumptuous meals, the use of spirituous drinks 
and tobacco, and from bodily exertions if long continued. The patient 
usually feels better in the open air and in the company of friends, when a 
lively conversation withdraws his attention from the constantly annoying 
noise, provided he hears well enough to participate in the conversation and 
the room be not overheated or badly ventilated. 



212 THE MIDDLE EAR. 

Pressure with the finger upon the mastoid process or upon the first cer- 
vical vertebra changes and often ameliorates the noise in ears, while in many- 
cases by reflex action an irritation of the trigeminus causes an irritation of 
the acusticus, so that many patients complain of an increase of the noise as 
soon as they touch single parts of the face, or are being shaved. To this 
reflex action from the skin we must count also those aggravations which fre- 
quently take place in consequence of. changing the linen, of standing with 
bare feet upon a cold floor, and so on. 

Tinnitus aurium is, as may be seen from its various causes, often asso- 
ciated with various degrees of deafness. In chronic catarrh of the middle 
ear a continuous noise is an unfavorable sign. Sometimes tinnitus and deaf- 
ness increase and decrease in like proportions ; other times tinnitus increases 
as the deafness decreases. 

THERAPEUTIC HINTS.— It is obvious that special hints cannot 
be given. We must necessarily in each case consider its cause, for which 
necessary hints will be found in the foregoing chapters. Tinnitus, however, 
may in some cases by its peculiarity hint to a remedy by which the entire 
aural affection may be removed. Here I must refer to our repertories and 
Materia Medica. 

Otalgia Nervosa 

Is a hyperesthesia of the sensible nerves of the ear, and must not be con- 
founded with the pain caused by inflammatory processes in the ear, as met 
with in otitis media. It is of much rarer occurrence than otalgia accompa- 
nying otitis. It characterizes itself frequently by its typical course. Often 
it is associated or caused by caries of a molar tooth on the same side, or by 
ulceration of the epiglottis, as a reflex action of the vagus. 

THERAPEUTIC HINTS.— Compare facial neuralgia, toothache, etc. 

Plant, maj., "is our sheet-anchor for otalgia independent of organic 
lesions." (Houghton.) 

Sodium seleniate 30 , has just relieved a pure otalgia of years stand- 
ing. (Norton.) 






NOSE. 



General Observations. 

1. Concerning the indications from its form and shape. 

A thick, swollen nose is either a sign of inflammation (if accompanied by 
pain, heat and redness) or of rachitic and scrofulous diseases. Lovers of 
intoxicating drinks are generally blessed with a suspicious looking nose of 
such a shape. 

The nose becomes pointed, pinched, during spasms; during a chill, and 
in collapse. 

When in children the nose becomes suddenly pointed, it is a sign of im- 
pending spasms; an habitually pointed nose denotes derangement in the 
mesenteric glands, and general atrophy. 

If the nose becomes pointed suddenly during the act of parturition, it is 
a sign of internal haemorrhage, or complete exhaustion, or threatening con- 
vulsions. 

The pointed nose of a nursing mother indicates her complete unfitness for 
being wet-nurse. When it sets in suddenly in severe illness, it is always a bad 
symptom ; being a sign of extreme exhaustion and collapse. A heavy motion 
of the nasal wings during respiration is a sign of impeded respiration, either 
from asthma, pneumonia, croup, dropsy in the chest, or incipient paralysis 
of the respiratory muscles, and utter prostration. 

2. In regard to color. 

A red nose may result from a variety of causes : extreme cold air, con- 
gestions, crying, being overheated, cold in the head, worms, scrofula, intem- 
perate use of ardent spirits. In young girls it denotes the setting in of 
menstruation. 

Circumscribed redness of the point of the nose, of the cheeks, and of the 
forehead, with paleness and coldness of the other parts of the face, denote, in 
pneumonia, that suppuration has taken place. 

A coppery shining redness of the root of the nose is a sign of existing 
syphilitic ulcers within the nose. 

(213) 



214 NOSE. 

The copper nose of wine and liquor drinkers is well known. 

A pale nose is found in various morbid affections; during a chill, during 
syncope, in spasms, from nausea, after great exertions, from sexual excesses, 
profuse haemorrhages, and so on. In women it is a sign of approaching 
menses or disturbed menstruation; profuse leucorrhoea; chlorosis. During 
pregnancy it is a sign that the foetus is dead. In eruptive fevers it denotes a 
disturbance in the exanthematic process and probably metastasis to internal 
organs. 

A grayish, lead-colored nose is found in dropsy of the chest and peri- 
cardium, in induration of the lungs and some malignant typhoid fevers. 

Single lead-colored stripes have been observed in the obstinate obstruction 
of the portal vein. 

A bluish color of the nose is found in some cases of apoplexy ; in croup, 
in catarrhus suffocativus, in diseases of the lungs, heart and larger blood- 
vessels ; in short, in all morbid conditions which cause a stagnation of blood, 
cyanosis. 

Brownish, yellowish spots on and over the nose, like a saddle, indicate 
mostly a diseased liver or chronic leucorrhoea. 

A blackish fur at the nostrils is found in typhus, epidemic dysentery, 
cholera, altogether in conditions of great prostration. 

3. In regard to temperature. 

A hot nose we find in violent coryza, inflammation, before bleeding, 
during delirium, sopor, apoplexy. 

Coldness of the nose we find during a chill, spasms, nausea ; from loss of 
blood, exhaustion, and in consequence of inflammation of the bowels. 

An habitually cold nose is found in disordered states of the abdominal 
viscera, in dropsical complaints and in chlorosis. 

To all this I have to add one more pathognomonic sign: 

The constant picking and boring at the nose, which is found frequently in 
consequence of irritation in the intestinal canal from worms, or in typhoid 
fevers and cerebral affections. In these latter cases there is always a want 
of natural secretion in the nose ; it is as dry as a powder-horn ; its getting 
moist again is one of the most favorable signs in such cases. 

Examination of the Cavity of the Nose. 

In order to get a full view of the Anterior nasal cavity, it is necessary 
to dilate the nostrils. This is best done by means of Fraenkel's or Von 
Troeltsch's speculum narium, instruments which after being introduced into 
the nose can be made to expand so as to push off the side walls of the nose 
from the septum. If we now place the patient in a position where the direct 
rays of the sun fall into the dilated nostrils, or in the absence of sunlight, 



EXAMINATION OF THE CAVITY OF THE NOSE. 215 

concentrate by a reflector the rays of candle-light or diffused daylight into 
the nasal cavity, we will be able to see the entire anterior part of it, from the 
superior turbinated bone to the floor; the anterior portion of the middle 
turbinated bone; the anterior and inferior surface of the inferior turbinated 
bone ; the surface of the septum, and in many cases the posterior wall of the 




pharynx through the inferior meatus. The turbinated bones appear in a 
normal state as pale, red protuberances, covered with mucus. Any alteration 
from the normal color, any swelling or hypertrophy, or change in configura- 
tion, the amount of secretion, the presence of ulceration, etc., will thus be 
admitted to our view. 

In order to get a view of the Naso-pharyngeal cavity and the Posterior 
portion of the nasal cavity, we must inspect these parts through the 
pharynx. For this purpose we need a tongue spatula, a reflector and a 
pharyngeal mirror which, in some cases, may be substituted by an ordinary 
laryngoscopic mirror. The tongue may be held down with the spatula by 
the patient himself, if he be intelligent enough, after the physician has de- 
pressed it in a manner that it cannot obstruct our view and still remain 
behind the lower incisor teeth. Free passage being thus provided the phy- 
sician "introduces the mirror into the pharynx by passing it as closely as 
possible over the lower teeth and along the back of the tongue in the median 
line, until it is in the free space between the base of the tongue, the laryngeal 
opening, the posterior wall of the pharynx, and the velum palatinum. It 
should not stand directly in the median line, on account of the uvula, which 
would lie in front of it and obstruct the view, but rather on the right or the 
left side, under one or the other of the arches of the soft palate, with its upper 
edge brought close to the posterior wall of the pharynx. The problem to be 
solved in introducing and placing the mirror is, not to touch the patient." — 
(Fraenkel.) This requires practice, and it is not an easy matter to handle the 
instrument in such a manner as to receive clear pictures from the parts above 
and behind the velum palati. The illumination is best achieved by a reflector 
fixed upon the forehead of the examiner, as mentioned under the examination 
of the ear. If successful in our operations, we will see posteriorly in the rhino- 
scopic picture the fornix pharyngis or vault of the pharynx, which is attached to 



216 NOSE. 

the base of the skull ; its surface is covered with ridges, running irregularly, 
and its structure consists of a dense adenoid tissue, on which account this 
region is called tonsilla pharyngea. Laterally we will see the recessus 
pharyngei, or the fossa of Rosenmuller, from which anteriorly rise on either 
side the pharyngeal openings of the Eustachian htbes. In front and above we 
see the posterior nares, the septum, the posterior portion of the middle tur- 
binated bone, and part of the middle meatus of the nose. With the exception 
of the septum, the mucous membrane, covering the walls of this region, has 
a fresh red color; the turbinated bones, usually covered with more or less 
mucus, appear as steel-gray or yellowish-red protuberances. The erectile 
bodies found on the posterior portion of the turbinated bones frequently lead 
to sudden swellings. Further down we see the posterior surface of the 
velum, on the sides of which run downward and inward two folds of mucous 
membrane. 

Catarrh, Coryza, Cold in the Head. 

Catarrhal inflammation of the mucous membrane, lining the nasal cavity, 
is characterized by redness and swelling of this membrane, and a discharge 
from it, which at first is watery and lastly becomes muco-purulent, therefore 
the name Catarrh, meaning a floiving down, namely of impurities from the 
head, according to the Ancients' idea of this trouble. It is usually preceded 
by a feeling of lassitude and chilliness, and a sensation of weight and pressure 
in the head, which latter symptom gives rise to the name of Gravedo or 
Coryza, while Cold in the head expresses its principal cause. The hyper- 
semic state of the mucous membrane is at first attended with prickling and 
dryness of the nose and a frequent disposition to sneeze ; then follows the 
discharge, at first, as mentioned above, watery and by-and-by muco-purulent. 
If mild, the morbid process may end with this. But often it spreads from 
the mucous membrane to the epidermis, inflaming the nose wings and upper 
lip, or may even provoke erysipelatous inflammation of the face ; or it spreads 
upwards into the frontal sinuses; or through the lachrymal duct to the 
lachrymal sac and the conjunctiva ; or sideways into the Highmorian cavities ; 
or backwards into the retro-nasal cavity, where it not unfrequently affects 
the Eustachian tubes ; causing ringing in the ears, difficulty of hearing, etc. ; 
or it extends downwards into the larynx, trachea and bronchial tubes pro- 
ducing cough, or diarrhoea when it affects the mucous lining of the intestines. 
Nasal catarrh is often attended with neuralgia of the fifth pair of nerves. 

Coryza occurs sporadically and in the form of an epidemic. There is no 
doubt that some persons show a decided predisposition to it. Taking cold 
by means of sudden changes in the temperature, or exposure to sudden cool- 
ing of the surface after being heated, is one of the principal causes of this 



COLD IN THE HEAD. 217 

affection, but also irritants of various description, vapors of iodine or acrid 
gases, or the pollen of plants, compare "hay fever," are fruitful sources of 
this complaint ; we find it also associated with the initial stage of measles, 
while typhoid fever and scarlatina exclude it. The epidemic form seems to 
have its cause in peculiar (unknown) states of the atmosphere— deficiency 
or superabundance of ozone ? 

"The question of the contagiousness of coryza must, in spite of the nega- 
tive result of inoculation, be considered as one and the same with the 
question of the contagiousness of catarrhal or purulent secretions in general, 
and in the light of clinical observations must, for the present, be answered in 
the affirmative, especially as regards purulent secretions." (Fraenkel.) 

The duration of a simple catarrh is usually from two to three days. 
Complicated cases last much longer. An acute attack if neglected, or if 
dependent on some dyscrasia, may run into the chronic form. 

The Purulent nasal catarrh, or Nasal blennorrhcea, characterized by 
its purulent secretion, we find often in newborn children, as the consequence 
of infection by the leucorrhceal discharge of the mother; it may be caused 
also by the action of gonorrheal matter; it develops itself during the course 
of scarlet fever or variola, in diphtheria and in consequence of cauterizations 
of the mucous membrane. It is a much graver form than simple catarrh and 
may also lead to chronic catarrh. 

THERAPEUTIC HINTS.— Aeon., in the commencement, dry state; 
from cold winds. Headache, sneezing ; running of the nose ; watering of the 
eyes ; roaring in the ears , flushed face ; thirst ; scanty, hot urine ; dry, short 
cough with crying ; accelerated pulse and breathing ; hot, dry skin ; sleep- 
lessness or dozing with starting. 

Amm. carb., stoppage, especially at night; acrid, watery, burning dis- 
charge ; congestion of blood to tip of nose when stooping. 

Amm. mur., coryza with stoppage; great soreness and tenderness of 
nose ; loss of smell. 

Anac, fluent; frequent sneezing; sense of smell acute, or illusory like 
pigeon dung or burning tinder. 

Aral, rac, coryza with frequent sneezing, soon followed by asthma; 
excessively sensitive to slightest depression of temperature. 

Arsen., burning, excoriating, watery discharge, with a feeling of being 
stopped up ; or stoppage alternating with running of nose and burning. Cold 
worse in morning with throbbing headache ; frequent sneezing ; hoarseness ; 
rawness and burning in throat; tickling in throat-pit and dry cough at night. 
Nosebleed; pale face; great thirst; sleepless and restless; lassitude. Great 
inclination to catarrhal affections. 

Arum triph., discharge of burning, ichorous fluid, excoriating nostrils, 



218 NOSE. 

upper lip and corners of mouth. Stoppage. Constant boring and picking 
at nose and lips. 

Asar., fluent coryza with deafness and sensation as if the ears were 
plugged with something. 

Bellad., watery and acrid discharge with burning in nose; or dryness 
of nose with acute or dull smell; frequent sneezing which painfully shakes 
the head ; erysipelatous redness and swelling of the nose with chilliness and 
heat in the face ; intense redness of face ; severe throbbing headache ; dull pain 
in frontal sinuses; hallucinations or delirium with injection of conjunctiva, 
photophobia and lachrymation. Great dryness in fauces ; difficulty of swal- 
lowing; soft palate inflamed and glistening; tonsils swollen. Children either 
cry continually and nothing seems to please them, or they are drowsy, apathetic 
and desire nothing ; grown persons are either very sensitive to slightest noise, 
excited or stupefied. Worse afternoon and evening. 

Byron., extending into frontal sinuses or cluest; stitch-pain. 

Calc. carb., sudden colds with dropping of clear water from the nose 
in spells; mouth dry, fauces rough; heat and dulness of head; frequent and 
profuse urination ; great liability to catarrhs in scrofulous children ; stoppage 
of nose. 

Camphora, fluent coryza with chilliness at commencement; thin, sal- 
low, nervous, sensitive people with cold hands and feet. 

Cepa, profuse watery discharge with sneezing, excoriating nose and 
lip ; itching, burning and stinging in eyes ; flow of tears ; headache. Worse 
in evening and warm room ; better in open air. Laryngeal cough with pain 
as if the larynx would be torn. North-easterly storms. 

Chamom., chilly, feverish; thirsty; one cheek red, the other pale; 
rattling cough. 

Cyclam., sneezing and profuse discharge; loss of smell and taste; pain 
in head and ears. 

Eupat. perf., hoarseness; cough worse in the evening; aching in all 
the bones. 

Euphras., profuse discharge of mild mucus; upper lip stiff as if of 
wood; eyes inflamed and full of acrid tears; cough only throughout the 
day. 

Gelsem., summer colds with violent sneezing in the morning; edges of 
nostrils red and sore; pharyngeal inflammation with pain on swallowing, 
shooting up into the ear; deafness. Hands and feet cold in p.m.; then 
drowsy; fever until morning; half waking and talking in sleep during night. 
Disposition to catch cold at any change in the weather. 

Hepar, nose swollen and red, sensitive to touch; blowing the nose 
causes whizzing and snapping in the ear, and a raw feeling inside of nose ; 
feverish and sensitive to cold air ; wants to be covered, even when hot. When 



CATARRH, CORYZA, COLD IN THE HEAD. 219 

fluent coryza suddenly stops and is followed by horseness and croupy cough. 
Disposition to taking cold after the abuse of mercury. 

Hydrast., posterior nares clogged with mucus; obstruction of nasal 
passages ; frontal headache. 

Iodium, glassy mucus; watery discharge at night, with sneezing; stop- 
page worse in evening; loss of smell. Eustachian tubes affected with dul- 
ness of hearing and noises in the ears. 

Kali bichr., a sense of tight pressure at the root of the nose, and dull, 
heavy headache in forehead, better from pressing tightly the bridge of the 
nose ; discharge is acrid, excoriating nose and lip. Worse in warm, better in 
cool temperature. 

Kali hydr., inflammation of Schneiderian membrane, extending to 
frontal sinuses, Highmorian cavities, lachrymal ducts and fauces. Nose red 
and swollen ; discharge watery, acrid, continually, with violent and painful 
sneezing. Eyelids swollen, conjunctiva injected; lachrymation. Sticking 
pain in ears. Red face, with anxiety and restlessness ; hammering pain in 
forehead with a sensation as if the head were compressed from both sides, or 
enlarged three times its size. Frantic excitation; fever with great thirst, 
hot, dry skin, alternating with drenching sweat; heat preponderates with 
intermitting shuddering, and dark, hot urine. 

Laches., profuse discharge of a thin, watery slime; soreness of nostrils 
and lip ; preceded often for a few days by a feeling of soreness, rawness and 
scraping in the throat. Violent headache in forehead, when the discharge 
suddenly dries up. 

Lycop., inflammation of frontal sinuses with tearing headache, WT>rse 
evenings ; nightly stoppage, with breathing through the mouth. 

Merc, sol., sneezing and dropping of watery fluid from the nose, 
which is swollen, red and sore. Inflammation of eyes, frontal and Highmo- 
rian cavities, of larynx, trachea and bronchi, of tonsils and fauces. Profuse 
sweat at night, not relieving. Rheumatic pains, worse in the night; in 
warmth and in cold. Epidemic form or common colds. 

Nux vom., ordinary colds at the commencement; when dry or fluent 
only through the day and stopped up at night ; tingling in nose, scraping in 
throat ; heat in head and pain in forehead ; hot and feverish and chilly on 
moving. Smell as of old cheese, sulphur or tinder; constipation. Colds of 
newborn children. 

Phosphor., frequent alternation of fluent and dry coryza; obstruc- 
tion often in the morning; or discharge from one and stoppage of the other 
nostril; sneezing causes pain in throat or head and constriction of chest. 
Fauces feel raw and burning and appear dry and glistening. Hoarseness 
and bronchial catarrh. Smell and taste gone. 



220 NOSE. 

Phytol., flow of mucus from one nostril; while the other is stopped; 
total obstruction of nose when riding. 

Pulsat., at the commencement, when dry and fluent alternately, or 
stopped up in the evening, with loss of smell and taste and appetite ; thirst- 
lessness; chilliness; or later with profuse, thick, yellow or greenish discharge, 
nosebleed. Conjunctiva inflamed; pressure at root of nose; tearing in High- 
morian cavity extending to ear. Dry cough at night when lying down, 
better on sitting up ; stomach ache ; slimy, painful diarrhoea. All symptoms 
are worse in the evening and in a warm room ; better in open air. 

Rhus tox., thick, yellowish discharge; eczema on both sides below 
nose ; nose swollen and now and then bleeding. Aching in all the bones, 
worse in rest. 

Sanguin., pain over root of nose; eyes sore to touch; sore throat; 
cough, and finally diarrhoea. 

Sepia, profuse and mild discharge, coming on suddenly, combined with 
rheumatic pains in the limbs and intense occipital headache. 

Spigel., copious discharge, badly tasting and smelling; flows during 
night from posterior nares down into the throat, and causes choking. 

The snuffles of infants require : 

Amm. carb., when the child in the act of going to sleep starts up 
again on account of not getting any breath. 

Chamom., Nux vom., Pulsat. 

If of a syphilitic nature, compare Chronic Catarrh. 

Chronic Catarrh, Ozaena. 

An acute attack may in consequence of bad management or neglect 
become chronic, especially in its purulent form, or when there is a scrofulous 
or syphilitic dyscrasia in the person. At first "the mucous membrane 
becomes thickened and livid," later it seems to shrink, " becomes thin and 
pale, apparently consisting of connective tissue and blood-vessels alone, and 
hardly worthy the name of mucous." "The epithelial cells are partly 
destroyed or they become turbid, and the mucous membrane, losing its natu- 
ral lustre, appears opaque and uneven." 

The secretion is generally of a purulent character, profuse or scanty. 
Often it forms crusts, which adhere firmly to the membrane underneath ; 
their color is frequently of a greenish cast, or they are mixed with blood. 
And when the secretion undergoes a specific decomposition, a peculiar, pene- 
trating stench is produced, which is communicated to the expired air. From 
this symptom the complaint has been called Ozsena, or Stinknose. Mostly 
ozsena grows on a dyscratic soil, although cases occasionally occur without 
either syphilis or scrofula being present. 



CHRONIC CATARRH, OZ^NA. 221 

Chronic catarrh is prone to frequent acute exacerbations. It may 
assume a suppurative character, destroy the periosteum and cause caries ; or 
it may lead to polypoid excrescences. It may spread to the frontal and 
Highmorian cavities, or to the skin surrounding the nostrils, causing excori- 
ations of upper lip and infiltration of the cervical glands. It usually is 
attended with loss of smell, either partial or total, and its annoying and 
intractable character is well known to both patient and physician. 

THERAPEUTIC HINTS.— Agar., profuse fetid discharge; accumu- 
lation of mucus in nose, with sensation as if the nose were entirely filled 
with it ; bad smell from mouth. 

Alum., soreness and scabs in the nose; thick, yellow mucus. 

Ant. crud., on inhaling cold air, it feels as if it went over a raw, very 
sensitive surface. Nostrils crusty, and corners of mouth cracked and sore. 

Arg. nitr., discharge of pus with clots of blood. Chilliuess, lachry- 
mation and stupefying headache. Violent itching of nose. 

Asaf., greenish, offensive discharge. Mercurial complication. 

Aurum, nose inflamed; nasal bones sore to touch; caries of nasal 
bones; fetid discharge; nostrils ulcerated and agglutinated; whole nose pain- 
ful, worse at night. Mercurial and syphilitic complication. 

Aur. mur., small, painful sores inside of nose; blowing out of blood; 
mucus from head to throat ; headache ; constipation ; haemorrhoids. 

Bar. carb., scabs form in posterior nares and behind the uvula. 

Berber., extending to antrum Highmorianum, especially left side. 

Calc. carb., purulent discharge fetid, thick, yellow-reddish, making 
lip sore; slimy discharge through the day, with sensation of stoppage; stop- 
page aud dryness at night; stoppage worse in morning on getting awake. 
Nose swollen, especially at root; soreness on edges and septum, also ul- 
ceration ; upper lip swollen. Smell dull, or like rotten eggs, dung, or gun- 
powder. Hoarseness in morning ; rough voice which improves from hawk- 
ing. Scrofula. 

Coral., discharge resembling molten tallow. Profuse secretion of 
mucus through the posterior nares, obliging to hawk frequently. 

Cuprum, affection of frontal sinuses, with pain in forehead, worse over 
left eye and root of nose, worse from motion, better when lying. Nose feels 
stuffed and yet sometimes discharges yellow and again watery matter. Smell 
gone; taste imperfect. 

Curare, fetid lumps of pus; scanty menses; pain in os uteri; slight, 
watery, starchy leucorrhoea. 

Elaps, partial stoppage and stuffiness high up in the nostrils, with 
dull aching to forehead; worse in wet weather, occasionally bad smell from 
the nose ; offensive discharge ; posterior wall of throat covered with a dry, 



222 nose. 

greenish-yellow scab, wrinkled and fissured, extending up to nose ; occasional 
nosebleed ; pain from root of nose to ears on swallowing ; sneezing at night ; 
sense of smell gone; profuse and dark catamenia. 

Graphit., stoppage with secretion of tough, fetid slime; stoppage with 
periodical attacks of fluent coryza of short duration ; hard masses of slime, 
or crusts in nose; purulent, fetid discharge worse during the menses; bloody 
discharge ; smell as from an old cold in nose, or as of burnt hair ; ulcerative 
nostrils; moist eruption behind the ears; eruptions around anus aud genitals. 
Great inclination to take cold. 

Hepar, nose extremely sensitive to touch ; swollen and red ; the nos- 
trils feel raw after the discharge of mucus ; the interior of the nose is sensitive 
to air. 

Iodum, fetid discharge; nose swollen and painful. Scrofula. 

Kali bichr., constant snuffing in warm, damp weather; discharge of 
crusts slightly tinged with blood ; perforating ulcers on septum ; ulceration 
of mucous membrane; ulceration of frontal sinuses with violent pain in 
that region, if discharge stops. Fetid smell from nose; loss of the sense of 
smell. 

Kali carb., obstruction worse in the room, better in open air; yellow- 
green or bloody discharge; or purulent and fetid from one nostril; crusts 
closing the nostrils ; collection of mucus in throat and feeling of a lump in 
the throat ; convulsive and tickling cough at night with choking and gag- 
ging, especially in the morning ; rheumatic and gouty symptoms. 

Kali hydr., syphilitic origin after abuse of mercury with pain in shin 
bones, especially at night. 

Kali phosph. — Schiissler. 

Lycop., stoppage at night, breathing with open mouth; "discharge of 
elastic plugs ; " catarrhal headache and despondency. 

Merc, prot., "dark redness of the fauces; elongation of the palate, 
with collection of the mucus behind ; enlargement of the tonsils, which are 
sometimes covered with yellowish or whitish patches, small in size ; collection 
of tough, yellow mucus in the posterior naves which partially drops into the 
throat, causing constant inclination to hawk and spit in order to clear the 
throat and nose." (Fisher.) 

Natr. carb., profuse discharge of thin, white mucus; or thick, yellow- 
greenish, musty smelling mucus, ceasing after a meal, or at night ; stoppage 
of nose at night. Worse from exposure to slightest draught, or when remov- 
ing an article of clothing. Loss of smell and taste. 

Natr. mur., stoppage high up in nose, with sudden dribbling at times of 
clear water from nose ; posterior nares feel dry in the morning, with scraping 
in larynx and rough voice. Continual lachrymation from obstruction of the 



CHRONIC CATARRH, OZ^NA. 223 

nasal duct ; roaring and buzzing in the ears and head with inability to work, 
read, or think. Loss of smell and taste. 

Nitr. ac, often mucous discharge only from posterior nares; red, 
scurvy tip and nostrils, feels like splinter on touching it ; fetor. Mercurial 
poisoning. 

Petrol., obstruction of posterior nares; copious collection of slime in 
the fauces with a feeling of dryness. Eustachian tubes obstructed, with 
whizzing, roaring and cracking in the ears; hardness of hearing. Bad 
smell from mouth. 

Phosphor., discharge yellow, or yellow-green, or bloody; nose swollen 
and sore to touch; nostrils ulcerated. In scarlatina, with swelling of neck 
and staring eyes, icy-cold and bluish hands; discharge flows down into the 
throat on lying. 

Psorin., great fetor; bad smell of all secretions and excretions. In- 
tractable cases where other remedies have failed. 

Pulsat., thick, yellow or green and fetid discharge; nose swollen and 
itching in the evening; wings ulcerated; oozing of watery fluid from nose; 
loss of smell and taste. Young girls with menses too late, scanty and pale, 
followed by leucorrhoea; chilliness, intermingled with heat. Timid, whining 
mood ; disposed to internal vexation and grievance ; mild, yielding disposi- 
tion ; slow, phlegmatic temperament. 

Rhodod., one nostril stopped, the other free; unpleasant tingling up in 
the nose to forehead ; follicular catarrh in forehead ; constant hemming and 
hawking. 

Sepia, greenish crusts with bloody borders; eczema behind the ears; 
symptoms of portal congestion. 

Silic, secretion tough, slimy, purulent; stoppage in the morning fol- 
lowed by hawking of thick, green-yellow, fetid masses after getting up. Acrid 
water from nose making it sore and bloody ; septum sore, and smarting crusts 
high up in nostrils ; frontal sinuses inflamed with pounding and throbbing 
pain in forehead ; fauces dry and painful; uvula swollen; Eustachian tubes 
itching ; chronic inflammation of tonsils and swelling of submaxillary glands. 

Sulphur, slimy, acrid discharge with burning in eyes and upper lip ; or 
dryness of nose like parchment and a feeling of stiffness of the nose followed 
by discharge of thick, bloody slime and then again dryness with sneezing. 
Inclination to draw the phlegm down through posterior nares. On blowing 
the nose the ears feel obstructed, or it feels as if air were entering the ears. 
Soreness inside of nose and of septum. The interior of nose is sensitive to the 
inhalation of air in a warm room ; not in open air. 

Besides compare therapeutic hints under acute catarrh. 



224 



NOSE. 



Digest to Acute and Chronic Catarrh in Head. 



Common cold at commencement: Nux 

vom. 

of newborn children : Nux vom. 

, epidemic: Merc. sol. 

Dry at first: Aeon. 

with acute or dull smell : Bellad. 

or fluent only through day, stopped 

up at night : Nux vom. 
, with stiff feeling of nose, followed by 

discharge of thick, bloody slime, and 

then dryness with sneezing : Sulphur. 
Fluent: Aeon., Anac. 

, alternating with dry : Phosphor. 

only through day, stopped at night : 

Nux vom. 

in spells : Cede. carb. 

in one and stopped up in other nostril : 

Phosphor., Phytol., Rhodod. 

with chilliness at commencement: 

Camphor. 

with deafness and plugged up feeling 

in ears: Asar. 

with sneezing : Cyclam. 

with frequent sneezing, followed by 

asthma: Aral. rac. 

, if suddenly stopped, is followed by 

hoarseness and croupy cough : Hepar. 

Discharge acrid, watery and burning: 
Amm. carb. 

, with burning in nose: Bellad. 

in eyes and upper lip : Cepa. 

, with excoriating nose and lip: Cepa, 

Kali bichr. 

and of corners of the mouth : Arum 

triph. 

, with making nose sore and bloody: 

Silic. 
, with swollen, red and sore nose: 

Merc. sol. 
, with sneezing: Cepa, Iodum, Kali 

hydr. 

, with stopped up feeling : Arsen. 

Bloody: Graphit., Kali carb., Phosphor., 

PulsaL, Sulphur. 
Burning: Amm. carb., Arsen., Arum 

triph. 
Fetid : Agar., Asaf., Aurum, Elaps, Iodum, 

PulsaL, Spigel. 



Fetid lumps of pus: Curare. 

and purulent from one nostril : Kali 

carb. 

, worse during menses : Graphit. 

, thick, yellow-reddish, making lip 

sore: Calc. carb. 

Purulent, tough, slimy : Silic. 

, with clots of blood : Arg. nitr. 

Greenish, offensive: Asaf. 

or yellow, thick : Pulsat. 

and nosebleed : Pulsat. 

Yellowish, thick: Rhus tox. 

Yellow-green or bloody: Kali carb., 
Phosphor. 

During day with stoppage : Calc. carb. 

Mucus, slime, glassy: Iodum. 

, like molten tallow: Coral. 

, profuse, mild : Euphras., Sepia. 

, thin and watery : Laches., Natr. carb. 

, thick, bloody : Sulphur. 

, yellow: Alum. 

, thick, yellow-greenish, musty smell- 
ing, ceasing after a meal, or at night: 
Natr. carb. 

, thin, watery: Laches. 

, white: Natr. carb. 

Oozing of watery fluid: Pulsat. 

Blowing out of blood : Aur. mur. 

Nosebleed occasionally: Elaps, Arsen. 

Crusts, tinged with blood : Kali bichr. 

, greenish with bloody borders : Sepia. 

Crusts, or masses of hard slime: Graphit. 

Elastic plugs: Lycop. 

POSTERIOR NARES. 
Mucus clogs posterior nares: Hydrast. 

from head to throat : Aur. mur. 

discharges only from posterior nares : 

Nitr. ac. 
discharges into throat on lying: 

Phosphor. 

at night, causing choking : Spigel. 

, obliging to hawk: Coral. 

, yellow : Merc. prot. 

, inclination to draw phlegm down 

through posterior nares : Sulphur. 
Dryness, in the morning with scraping 

in larynx and rough voice : Natr. mur. 



DIGEST TO ACUTE AND CHRONIC CATARRH IN HEAD. 



225 






Scabs in posterior nares behind the 

uvula: Bar. carb. 
, dry, greenish ; wrinkled and fissured 

on posterior wall of throat, extending up 

to nose : Elaps. 
Stoppage, obstruction: Arum triph., Calc. 

carb., Hydrast. 

, evening: Iodum. 

, morning on getting awake : Calc. carb., 

Phosphor. 
, followed by hawking of thick mucus : 

Silic. 
, night: Amm. carb., Natr. carb., Nux 

vom., Silic. 

and dryness: Calc. carb. 

, must breath through mouth: Lycop. 

when falling asleep, starts up to get 

breath : Amm. carb. 

, when riding: Phytol. 

, in warm room, better in open air: 

Kali carb. 
, alternating with fluent coryza: Amm. 

mur., Arsen., Cuprum, Graphit., Nux vom., 

Pulsat. 

, with tough, fetid slime : Graphit. 

, as if nose were entirely filled with 

mucus: Agar. 

of posterior nares : Petrol. 

, with dull aching in forehead : Flaps. 

, with sudden dribbling of clear water 

from nose: Xatr. mur. 

of one side and the other free : Bhodod. 

Constant snuffing in warm, damp 

weather: Kali bichr. 

INTERIOR NOSE. 

Sensitive to air: Hepar. 

to cold air, as if it went over a raw 

surface: Ant. crud. 
to air in a warm room, not in open 

air: Sulphur. 
Soreness and scabs: Alum. 

, and of septum : Silic, Sulphur. 

Sores, small and painful: Aur. mur. 
Tingling : Nvx vom. 
Ulceration: Kali bichr. 

, perforating septum : Kali bichr. 

Crusts on nostrils: Ant. crud. 

closing nostrils: Kali carb. 

15 



Rawness of nostrils from discharge: 

Hepar. 
Soreness of nostrils and septum: Calc. 

carb. 

and lip : Laches. 

and redness : Gelsem. 

Ulcerated nostrils: Aurum, Calc. carb., 

Graphit, Phosphor., Pulsat. 
Inflammation extending into frontal 

sinuses or chest: Br yon. 
, Highmorian cavities, left side: Ber- 
ber. 

lachrymal ducts and fauces : Kali hydr. 

, with tearing headache, worse even- 
ing: Lycop. 
, with pain in forehead, worse over left 

eye and root of nose, worse from motion, 

better when lying : Cuprum. 
, with pounding and throbbing pain 

in forehead : Silic. 
Dull pain in frontal sinuses : Bellad. 
Pain in frontal sinuses, after suppressed 

coryza: Laches. 
Ulceration in frontal sinuses with violent 

pain there, when discharge stops : Kali 

bichr. 
Pain over root of nose : Sanguin. 

and ears on swallowing : JElaps. 

Pressure at root of nose: Pulsat. \ 

, and dull, heavy headache, better 

from pressing tightly the bridge of nose 

Kali bichr. 
Caries of nasal bones: Aurum. 

EXTERNAL NOSE. 

Red and swollen: Aurum, Bellad., Hepar. 

Kali hydr. 

and sensitive to touch : Hepar. 

and scurvy tip and nostrils, feels like 

splinter on touching it : NUr. ac. 
Erysipelatous redness and swelling Avith 

chilliness and heat in the face: Bellad. 
Swollen and itching in evening: Pulsat. 

and painful : Iodum. 

and especially at rest : Calc. carb. 

and sore to touch : Phosphor. 

and now and then bleeding: Rhus tox. 

Congestion to tip when stooping: Amm. 

carb. 



226 



NOSE. 



Soreness and tenderness: Amm. mur. 

to touch : Hepar. 

, worse at night : Aurum. 

of nasal bones to touch : Aurum. 

Wings ulcerated : Pulsat. 
Violent itching of nose: Arg. nitr. 
Boring and picking at nose and lips: 
Arum triph. 

SMELL. 
Loss of smell: Amm. mur., Cuprum, Elaps, 

Iodum, Kali bichr. 
and taste : Cyclam., Natr. carb., Natr. 

mur., Phosphor., Pulsat. 
Illusory, like pigeon dung or burning 

tinder: Anac. 
, like dung, rotten eggs or gunpowder: 

Cale. carb. 
, like from an old cold, or burnt hair: 

Graphit. 
, like old cheese, sulphur or tinder: 

Nux vom. 
Fetor from nose: Kali bichr., Nitr. ac. 

, worse in wet weather: Elaps. 

, and of all secretions and excretions : 

Psorin. 

SNEEZING. 

Frequent : Aeon., Anac., Aral, rac., Arsen. 

, night: Elaps. 

, morning in summer colds: Gelsem. 

, with profuse discharge: Oyclam. 

, which painfully shakes head : Bellad. 

, causing pain in head or throat, and 

constriction of chest : Phosphor. 

Blowing the nose causes ears to feel ob- 
structed, or as if air were entering the 
ears: Sulphur. 

, whizzing and snapping in ear, and a 

raw feeling inside of nose : Hepar. 

SYSTEMIC SYMPTOMS. 

Stupefied: Bellad. 

Inability to work, read, or think: Natr. 

mur. 
Excited: Kali hy dr. 
Delirium or hallucinations with injected 
conjunctiva: Bellad. 



Anxiety and restlessness: Kali hydr. 
Children cry continually and nothing 

pleases them : Bellad. 
Timid, whining mood, internally vexed 

and grieved ; mild disposition : Pulsat. 
Drowsy, apathic, desire nothing: Bellad. 
Desponding with headache: Lycop. 



Headache : Aeon., Aur. mur., Cepa. 

and despondency: Lycop. 

and earache: Cyclam. 

in forehead: Hydrast., Kali hydr., 

Laches., Nux vom. 

when discharge suddenly dries up: 

Laches. 

as if compressed from both sides, or 

enlarged ten times its size : Kali hydr. 

in frontal sinuses: Bellad., Laches., 

Lycop. 

in occiput with rheumatic pain in 

limbs: Sepia. 

, stupefying: Arg. nitr. 

, throbbing: Bellad. 

Heat and dulness : Calc. carb. 

and pain in forehead : Nux vom. 



Conjunctiva inflamed : Kali hydr., Pulsat. 
Eyes inflamed with acrid tears: Euphras. 
Eyelids swollen : Kali hydr. 
Inflammation of eyes, frontal and High- 

morian cavities, larynx, trachea, bronchi, 

tonsils and fauces : Merc. sol. 
Itching, burning and stinging in eyes: 

Cepa. 
Lachrymation : Aeon., Arg. nitr., Cepa. 
from obstruction of nasal duct : Natr. 

mur. 

and photophobia : Bellad. 

Soreness to touch: Sanguin. 



Eustachian tubes itch : Silic. 

obstructed, with noises in ears : Iodum, 

Petrol. 
Dulness of hearing: Gelsem., Iodum, 

Petrol. 
Sensitive to slightest noise: Bellad. 
Eczema behind ears : Sepia. 
Eruption, moist, behind ears: Graphit. 



DIGEST TO ACUTE AND CHRONIC CATARRH IN HEAD. 



227 



Roaring in ears: Aeon. 

and buzzing, with inability to read or 

think: Natir. mur. 
Sticking pain in ears: Kali hydr. 
Tearing from Highmorian cavity to ear : 

Pulsat. 



Redness of face: Aeon., Bellad., Kali 

hydr. 
of one, paleness of other cheek: 

Chamom. 
Paleness: Arsen. 
Eczema below nose: Rhus tox. 
Corners of mouth cracked and sore : Ant. 

crud. 
Upper lip stiff as if of wood: Euphras. 
swollen: Calc. carb. 



Mouth dry: Calc. carb. 
Thirst: Aeon., Arsen., Chamom. 
Thirstless: Pulsat. 
Taste imperfect: Cuprum, Pulsat. 
Bad smell from mouth : Agar., Petrol. 
Fauces dry : Bellad. 

, glistening, raw and burning: Phos- 
phor. 

and painful : Silic. 

, with collection of slime in fauces : 

Petrol. 
inflamed, with pain on swallowing, 

shooting up into ear : Gelsem. 

dark red : Merc. prot. 

Throat, feeling of lump and collection of 

mucus in : Kali carb. 

, raw and burning : Arsen. 

, scraping in : Nux vom. 

— ■ — , sore : Sanguin. 

, and scraping, raw before coryza: 

Laches. 
Swallowing difficult : Bellad. 
Palate elongated, with mucus behind : 

Merc. prot. 

- inflamed and glistening : Bellad. 

swollen : Silic. 

Tonsils inflamed and submaxillary glands 

swollen : Silic. 
, swollen : Bellad. 



Tonsils sometimes covered with yellowish 
or whitish patches : Merc. prot. 



Stomach ache : Pulsat. 

Portal congestion : Sepia. 

Slimy, painful diarrhoea : Pulsat. 

Ending with diarrhoea : Sanguin. 

Constipation : Aur. mur., Nux vom. 

Haemorrhoids : Aur. mur. 

Eruptions around anus and genitals : 

Graphit. 
Scanty, hot urine : Aeon. 
Frequent and profuse urination: Calc. 

carb. 
Pain in os uteri : Curare. 
Scanty menses: Curare. 
, too late and pale in young girls: 

Pulsat. 
Profuse and dark menses : Elaps. 
Leucorrhoea follows menses: Pulsat. 
, slight, watery, starchy: Curare. 



Hoarseness: Arsen., Eupat. perf. 

in morning: Calc. carb. 

with bronchial catarrh : Phosphor. 

Rough voice which improves from hawk- 
ing: Calc. carb. 

Cough only through day: Euphras. 

, worse in evening : Eupat. perf. 

at night : Arsen., Kali carb., Pulsat. 

, convulsive with choking and gagging 

in the morning : Kali carb. 

, dry: Aeon., Arsen., Pulsat. 

when lying down, better on sitting 

up: Pulsat. 

from tickling in throat-pit : Arsen. 

, with crying: Aeon. 

, with pain in larynx as if it would be 

torn: Cepa. 

, followed by diarrhoea : Sanguin. 

, rattling: Chamom. 

Inclination to catarrhal affection : Arsen. 

Stitch pain in chest: Bryon. 

Accelerated pulse and breathing: Aeon. 



Chilly : Arg. nitr., Chamom., Pukat. 

, intermingled with heat: Pulsat. 

Cold hands and feet in p.m. : Gelsem. 



228 



NOSE. 



Nux 



Feverish: Chamom. 

in morning: Gelsem. 

- and hot, and chilly on moving : 

vom. 

, intercurrent shuddering: Kali hydr. 

Hot, dry skin: Aeon. 

, alternating with drenching sweat, 

and hot, dark urine : Kali hydr. 
Profuse sweat at night, not relieving: 

Merc. sol. 
Scarlet fever with swelling of neck, 

staring eyes, icy-cold and bluish hands : 

Phosphor. 



Rheumatic and gouty symptoms: Kali 

carb. 
— — pains, worse in night : Merc. sol. 
Aching in all the bones : Eupat. perf. 

, worse in rest : Rhus tox. 

Pain in shin bones, worse at night : Kali 

hydr. 
Lassitude: Arsen. 



Drowsy: Gelsem. 

Sleepless or dozing with starting: Aeon., 

Bellad. 
Half waking and talking in sleep during 

night: Gelsem. 



Phlegmatic: Gelsem. 



Scrofulous: Iodum. 

with liability to catarrhs : Calc. carb. 

Nervous, thin, sallow, sensitive with cold 
hands and feet : Camphor. 

Disposition to take cold: Ghwphit., 
Hepar. 

at any change in weather: Gelsem. 

from slightest depression of tempera- 
ture : Aral. rac. 

BETTER AND WORSE. 

> in- open air : Cepa, Pulsat. 

>■ in cool temperature : Kali bichr. 

> when covered even when hot : Hepar. 

< in warm room: Cepa, Kali carb., 
Pulsat. 

< from exposure to slightest draught, or 
when removing an article of clothing : 
Natr. carb. 

<^ in cold and warm : Merc. sol. 

< in afternoon and evening : Bellad. 
<^ in evening : Cepa, Pulsat. 

<^ in morning with throbbing headache : 
Arsen. 

CAUSED BY: 

Mercurial poisoning: Asaf., Aurum, 

Hepar, Kali hydr., Nitr. ac. 
North-easterly storms : Cepa. 
Intractable : Psorin. 



Influenza, Grippe. 

It is an epidemic disease characterized by a series of catarrhal manifesta- 
tions, attacking the respiratory, and generally also the digestive organs, and 
is attended by great and rapidly developed weakness, pains in the limbs, 
severe headache, serious nervous symptoms and more or less fever. It attacks 
all persons without distinction of age, sex or occupation ; atmospheric con- 
ditions and local circumstances, such as elevation, condition of soil, etc., are 
not known of exercising any particular influence upon its spread; in short, 
exciting causes are not known. The assumption of its contagiousness has 
been abandoned just as often as it has been established. It spreads rapidly 
in its local diffusion, advances comparatively slowly on a grand scale over 
countries and seas without being essentially influenced by human intercourse 
or the direction of the wind ; in other cases it remains limited to narrow cir- 
cuits, while at still other times it appears simultaneously at different points 



INFLUENZA, GRIPPE. 229 

of the earth's surface or attacks districts far removed from one another with 
inexplicable leaps. 

Its Diagnostic difference from a common epidemic catarrh lies in its 
marked march of progression and its independence of weather and season, 
while from a commencing typhoid fever it differs by its persistent elevation 
"of temperature and the absence of enlargement of the spleen and rose spots, 
the moderately frequent pulse, etc. It is not a very fatal disease ; but as it 
modifies and complicates all other existing diseases, it is especially hard on 
the weak and also on the aged ; a tuberculous disposition is often ripened by 
it into full bloom, and chronic bronchial catarrhs are not unfrequent sequelae 
of its visitation. 

THERAPEUTIC HINTS.— An epidemic is usually manageable by 
one or a few remedies, but different epidemics require different remedies, as 
the genius of their combination is an ever-changing one. To detect the spe- 
cifics for a prevalent grippe, a comparison of the hints given above under 
catarrh may be of help ; the following are additional hints. 

Aeon., dry cough and stitches in chest. 

Arsen., cough and all symptoms worse after midnight; great thirst, 
great restlessness and great debility. 

Bellad., cerebral symptoms; drowsiness; starting in sleep; delirium 
when shutting the eyes ; wants to sleep and cannot sleep. Severe headache ; 
dryness in mouth and throat ; spasmodic cough. 

Bryon., pain in all the limbs, worse from motion; cough, with pain in 
pit of stomach, around the short ribs and in chest; affection of liver. 

Eupat. perf., severe backache, or bone-pains, with bilious symptoms. 

Gelsem., feels "played out," feverishness, catarrhal running from nose, 
collection of mucus in throat; pain in throat up to ear when swallowing; 
cough. 

Laches., feels worse after sleep; fever worse in the afternoon; sweat 
without relief. 

Mercur., rheumatic pains not relieved by sweat; flabby tongue, with 
imprints of teeth; diarrhoea; boiling heat from pit of stomach over the 
entire body. 

Nux vom., fever-heat with chilliness by slightest motion; dull, heavy 
headache ; vertigo ; hard cough ; sour taste ; nausea and vomiting ; belching ; 
pain in chest ; constipation. 

Phosphor., bronchial affection with dry cough, tightness of chest, worse 
before midnight ; great debility. 

Pulsat., evening aggravation; loss of appetite ; bitter taste; diarrhoea; 
chilliness. 



230 NOSE. 

Rhus tox., great aching in all the limbs, worse in rest; great restless- 
ness ; red tip of tongue ; typhoid symptoms. 

Sabad., lachrymation in open air, when looking at a bright light, when 
coughing or yawning. Sleepy in daytime; chilliness, with heat of face; 
cough on lying down. 

Sanguin., smell in nose like roasted onion; wheezing-whistling cough 
and finally diarrhoea, which relieves the cough. 

Tart, emet., shaking, loose cough, with oppressed breathing, which is 
relieved by expectorating ; gastric symptoms. 

Yearly Cold, Rose Cold, Hay Fever, Hay Asthma. 

It is a slight febrile catarrh, which affects the conjunctiva, the mucous 
membrane of the nose and upper air-passages, and frequently, but not always, 
is attended by asthmatic difficulties, which sometimes are of great intensity. 
It attacks only people peculiarly disposed to it, and regularly recurs every 
year when the roses bloom (rose cold), or when hay is made (hay fever, hay 
asthma), during the months of May till September (summer catarrh). In 
regard to its Exciting Causes we glean from Blackley's careful experi- 
ments the following: A thorough observation of atmospheric conditions 
showed that the attacks do not run at all parallel with extremes of light and 
heat. Ozone, benzoic acid, and cumarin produced only a very unimportant 
influence upon the respiratory organs and none which resembled the symp- 
toms of hay fever. Dust, which, besides, is differently constituted in different 
regions, may occasion cough and catarrhal symptoms at various seasons ; but 
these have little similarity to hay fever, and are not at all confined to the 
summer season. The fragrance of flowers of various kinds has little effect, 
although the smell of chamomilla matricaria produces disagreeable symptoms, 
headache, etc. The effect of spores of penicillium glaucum was hoarseness, 
increasing to aphonia, bronchial catarrh, etc., which lasted for some days. 
On the other hand there has been complete success in developing the features 
of hay fever by the operation of pollen upon the organs of respiration, and 
it is therefore a certainty that the exciting cause of hay fever must be ascribed 
to the pollen, fresh or dried, of different plants, especially grasses, floating in 
the air. For this reason the attacks are milder in-doors than in the open 
air, and may be prevented altogether by removing to regions which are free 
from this exciting cause. 

THERAPEUTIC HINTS.— Hay fever being the result of irritation 
of the Schneiderian membrane by the pollen of different plants, especially of 
grasses, it can be mitigated by a sojourn at the seaside, especially an island 
or a narrow peninsula, where the air is least pregnated by such pollen. A 



EPISTAXIS, NOSEBLEED. 231 

sea-voyage prevents it altogether. High mountain air is also nearly free of 
these exciting causes, as are the centres of large cities, where the patient feels 
best on keeping in-doors. A number of remedies have been tried and some 
found beneficial. They are: Ailanth., Arsen., Arum triph., Camphor, 
Cyclam., Euphorb., Euphras., Gelsem., Glanderin, Grindelia, 
Hydr. ac, Ipec, Iodum, Kali bichr., Kali hydr., Laches., Lobel., 
Merc, corr., Merc, sol., Moschus, Natr. carb., Natr. mur., Phos- 
phor., Pulsat., Sabad., Silic, Sticta pulm., Tart, emet., Tax. 
bacc, Zincum. Their special applicability must be studied from the 
hints under nasal catarrh and asthma. 

Naja trip., hay fever after sneezing stage and asthmatic trouble re- 
maining. In asthma when all other medicines had failed to touch, and had 
been well nigh abandoned. (M. Preston.) 

Arum mac. 30 , in water "until the throat troubles are better." 
Euphorb. off. 30 , "when the eyes get lachrymose." (Th. Meurer.) 

Epistaxis, Nosebleed. 

This affection is a mere symptom of the most different conditions of the 
organism. We observe it in consequence of congestive as well as in con- 
sequence of anaemic and chlorotic conditions. It may sometimes bring relief 
to headache and congestive states ; and it may be an unfavorable sign in 
adynamic and contagious diseases, as small-pox and measles, when they assume 
a typhoid character. In diseases of the heart, lungs and spleen, it is never 
a good sign. In old age it is a sign of threatening apoplexy. 

Its most frequent Exciting Causes are, mechanical injuries; a fall or 
blow upon the nose ; straining when coughing ; and suppression or irregularity 
in menstrual discharges, or a suppression of an habitual hemorrhoidal flow. 

The blood itself varies greatly in character. It may be bright red or 
dark — almost black; it may easily coagulate, and it may be quite thin and 
never coagulate. 

Generally, one nostril only bleeds; seldom both. The blood discharges 
either through the nostrils in front, or backwards, through the posterior nares, 
into the fauces, thence into the stomach or the larynx. This last phenomenon 
requires a little attention, so as not to confound it with vomiting of blood, or 
bloody expectoration from the lungs. 

THERAPEUTIC HINTS.— In general, bright blood, Aeon., Arnica, 
Bellad., Bryon., Dulcam., Hyosc, Millef., Rhus tox., Sabad. 

Dark blood, Crocus, Nux vom. 

Clotted blood, Chamom., Mercur., Rhus tox., Platina. 

Aeon., in arterial congestive bleeding; palpitation of the heart; 
children. 



232 nose. 

Agar., in old people with relaxed state of the circulatory system. 

Amm. carb., in the morning, when washing. 

Argent., with tickling and crawling sensation of the nose. 

Arnica, after external injury; always worse from washing the face or 
blowing the nose. 

Arsen., after a fit of passion or vomiting; great heat and restlessness. 

Bellad., congestion to the head; answers questions as if frightened; 
pupils dilated; vertigo on stooping. "Worse from motion, noises and bright 
light ; sparks before the eyes ; noise in the ears ; fainting ; chronic cases. 

Bryon., in the morning after rising; after being overheated; vicarious 
menstruation. 

Carb. veg., profuse and long-continuing; paleness of face; small, 
intermitting pulse; in convalescents from fever; excited by emotion, jarring; 
short and hot breath; numbness; tenderness in region of liver; jaundice. 
Also daily at 9 o'clock a.m. 

China, anaemic state; singing, ringing in the ears; great paleness of 
face and fainting. 

Conium, suppressed menstruation by taking cold; frequent ebullitions 
of blood; jerking sensation about the heart. 

Crocus, black, viscid blood, with cold sweat on forehead; yellowish 
face; fainting. 

Eriger., congestion of the head; febrile action; red face. 

Ferrum, in ansemic children with frequent changing of color in 
the face. Haemorrhophilia. 

Ham am., in combination with haemoptysis. 

Indigo, with dry cough. 

Kali carb., when washing the face, every morning at 9 o'clock. 

Melilot. is said to stop nosebleed immediately. 

Merc, sol., blood coagulates in the nose, and hangs down like icicles. 

Moschus, with all the signs of depletion; spasmodic jerking of the 
muscles. 

Nux vom., congestion to the head; pain in forehead; constipation; 
suppressed hemorrhoidal flow. 

Pulsat., vicarious menstruation; catarrhal affections; anaemic chil- 
dren. 

Rhus tox., at night; during stool; from bending forward, and any 
bodily exertion. 

Secale, anaemic state, either from exhaustive diseases or artificial deple- 
tion ; the blood is thin and does not coagulate. Aged persons. 

Thlaspi bursa pastoris is recommended by Bonninghausen as one of 
the most efficient remedies, but without special indications. 

Trill, pend., passive haemorrhage. 



POLYPI AND INFLAMMATION OF THE NOSE. 233 

Ver. alb., deadly paleness of face, getting red when rising; coldness of 
body; slow, intermitting pulse. 

Sometimes nosebleed may be immediately stopped by compressing the 
facial artery, on the side of bleeding, against the superior maxilla near the 
angle of the nose. 

Polypi in the Nose 

Are mostly of the mucous variety. They have been cured by Calc. carb., 
Calc. jod., Kali nitr., 3d trit., Phosphor., Pulsat., Sanguin. and 
Teucrium. Cepa. (Riickert.) 

Inflammation of the Nose. 

It attacks the deeper layers of the mucous membrane and the perios- 
teum, and is usually circumscribed. The mucous membrane is highly 
inflamed, and the external skin oedematously swollen. The nose is very 
painful and at times when the inflammation extends higher up, brain symp- 
toms appear with more or less fever. It may be caused by external injuries, 
may be associated with catarrh or blennorrhoea, or appear without any 
demonstrable cause. 

THERAPEUTIC HINTS— It is usually quickly relieved by Bellad.; 
Hepar or Silic. may in some cases be required. 



FACE. 



The face of a patient tells a long story, and it will be well for the 
student to closely observe its features, expression, color and temperature. 
The experienced physician reads out of it not only the degree of severity of 
an attack, but often also its whole general nature. But that must be learned 
by practice. There are shades so fine that they could not be well described, 
but which nevertheless stamp upon the whole a peculiar character. 

1. The aspect of the face. 

a. A delicate appearance, with long-fringed eyelashes and brilliant eyes, 
often serves to point out the tubercular diathesis. 

b. The thickened alse of the nose and upper lip of scrofula are most 
marked in childhood. 

c. The pallor of anaemia is very important; it is waxy in chlorosis and 
pasty in diseases of the kidneys. 

d. A puffy appearance about the eyelids along with anaemia is very gen- 
erally an indication of albuminuria. 

e. A bloated, blotchy face generally indicates irregular habits of living. 
/. The features undergo remarkable changes in erysipelas, parotitis, 

facial paralysis, etc. 

g. A sunken face indicates exhaustion, either from too great exertion, 
or loss of sleep, want of nourishment, or profuse diarrhoea, or disturbed 
digestion. If it sets in suddenly during pregnancy, it is a premonitory sign 
of abortus. If you find it in the incipiency of a disease, without previous 
weakening causes, it denotes a severe illness. If it sets in suddenly, during 
a disease, without chill or spasm, by which it might be caused, it is a sign of 
extreme exhaustion, collapse, or metastasis, mortification, or apoplexia ner- 



h. The hippocratic face is characterized in the following way: 
The skin upon the forehead is tense, dry or covered with cold perspira- 
tion ; the temporal regions are sunken in ; the eyelids are pale, and hang 
down; eyes are dull, without lustre, turned upwards, and sunken; the alse 

(234) 



FACE. 235 

nasi are pinched together, and the nose is very pointed; the malar bones 
stick out, and the cheeks are sunken in and wrinkled ; the ears appear to be 
drawn in, and are cold; the lips are pale, livid; the lower jaw sinks down, 
and the mouth is open. It is always a sign of extreme prostration of 
vital power, and is found in cholera, in mortification, and during death 
struggle. 

i. A wrinkled face is natural to old age, but in children it is a sign of 
imperfect nutrition, and is found in consequence of exhausting diarrhcea and 
atrophy. In boys and half-grown lads a wrinkled face, without loss of appe- 
tite or sleep, is a sign of onanism, or other bad habits. Such a young, old 
and wrinkled face is a pitiful sight. 

The linea ophthalmia zygomatica is a line or fold, commencing at the inner 
canthus of the eye, running towards the zygoma: where it ends. It shows mo- 
mentarily, when children cry, but becomes more permanent in children with 
affections of the brain. Its appearance in simple catarrh is said to indicate 
the setting in of whooping-cough. 

The linea nasalis is a line or fold, w T hich commences at the upper part of 
the aloz of the nose, and runs towards the orbicularis oris (the sphincter of the 
mouth), forming a more or less perfect half-circle. This line, if found in 
children, denotes abdominal diseases, especially inflammation of the bowels, 
also rachitis, scrofula and atrophy. In grown persons it is said to have been 
observed as a concomitant symptom of albuminuria, ulcer and cancer of the 
stomach, and degeneration of the liver. 

The linea labialis is a line or fold, which commences at the corner of the 
mouth, and runs down towards the side of the chin, where it ends, and whereby 
the chin appears to be elongated. This line is said to be a characteristic 
sign in children of inflammatory diseases of the larynx and lungs. Very 
marked it has been found in grown persons who suffered with ulceration of 
the larynx and bronchial affections, attended with difficulty in breathing 
and much mucous discharge. 

h. The risus sardonicus, a spasmodic distortion of the face, which 
resembles a kind of laughing, is found in irritation and inflammation of the 
brain, in inflammation of the pericardum and diaphragm, in irritation of the 
intestinal canal, in abnormal conditions of the menses, even after mental 
excitement, fright and depression of spirits. 

1. Marshall Hall says that iu general it may be observed that the brow 
is contracted by pain within the head ; the nostrils are drawn acutely up- 
wards by pain in the chest ; and the upper lip is raised and stretched over 
the teeth or gums by painful affections of the abdomen. 

2. The expression of the face is, in health, the reflex of the mind ; 
and in disease it has a distinct reference to the nervous system. 

In general, I may say: 



236 FACE. 

a. A rigid, staring, stupid, troubled, but sometimes also a smiling counte- 
nance, is found in affections of the brain, and in typhoid conditions. 

b. An anxious, sad, and restless expression is found in lung and heart 






c. A morose, long-faced, apathetic expression is found in abdominal dis- 
orders. 

3. The color of the face. 

a. Redness, if habitual, denotes a tendency to gout and haemorrhoids ; 
and is a sign of indulgence in good-living and alcoholic drinks. 

Flying, often changing redness is seen in children during dentition, in 
women before menstruation, or after conception, and is also found in inflam- 
mation of the lungs. 

Bright, vivid redness is found in nervous diseases, hysteria and tendency 
to haemorrhages. 

Dark, purplish redness is found in congestive, apoplectic and suffocative 
conditions. 

Redness, coming and going in spots, I have often found in brain diseases 
of little children, and also in pneumonia. 

One-sided redness, with paleness and coldness of the other side, in en- 
cephalitis, is, according to Schonlein, a sign of the formation of pus in that half 
of the brain which corresponds to the red side of the face. It is found also 
in diseases of the lungs, heart and abdomen, and in children during dentition. 

The circumscribed hectic flush is characteristic of phthisis. 

Redness of the cheeks, with a white ring around the alee of the nose and the 
mouth, are frequently met with in different fevers, especially scarlatina, and 
is a sign of pretty severe illness. 

b. Paleness. 

Sudden paleness, especially around the mouth, is found in children with 
colicky spasms in the abdomen. 

Great paleness, alternating with flushes of redness, is found in inflamma- 
tion of the lungs and brain ; also during dentition. 

A pale, peculiar white and wrinkled face is found in children with chronic 
hydrocephalus. 

A sudden paleness, after an inconsiderable limping, in children, combined 
with great lassitude, is a sign of a lingering hip-disease. 

In women, paleness is a sign of profuse or suppressed menstruation or 
chlorosis. 

Sudden paleness during pregnancy prognosticates threatening metror- 
rhagia, or abortion, or the dying of the foetus. 

Sudden paleness about the nose is in scarlet fever a bad sign ; it denotes 
a metastasis to the brain ; during the peeling-off period it is a forerunner to 
dropsy. 



FACE. 237 

Sudden paleness after a fall indicates concussion of the brain. 
Pale lips are characteristic of chlorosis. 

c. Blue color of the face 

Is found in organic diseases of the heart, especially in dilatation of the 
ventricles and disorganizations of the valves, whereby the oxygenation of the 
blood is interfered with. In the highest degree it exists in cyanosis, a state 
in which, consequent upon structural faults in the heart, the venous and ar- 
terialblood becomes mixed. In newborn children, the refore, if it is lasting, 
it is a sign of such malformation ; if it, however, soon passes off, it may have 
been caused by hard labor-pains, face-presentation, or by the navel string 
being wound around the neck of the child. 

We meet it likewise in consequence of strangulation or suffocation. 

d. Livid, grayish, lead-colored face denotes deep-seated organic diseases, 
scirrhus, gangrene. 

e. Yellowish color of the face is found mostly in diseases of the liver. 

The yellowness of jaundice varies from a pale orange to a deep green- 
yellow. The yellowish color of infants does not always denote jaundice; it 
is very often merely a discoloration by hsematin, which remains in the skin 
until absorbed, and is analogous to the effects of a bruise ; there is no yellow- 
ishness of the white of the eyes attending it. 

There is a certain yellowness of a malignant aspect, which is distin- 
guished from jaundice by the pearly lustre of the eyes. It is associated with 
a cancerous diathesis. 

/. Brown spots in women are mostly signs of pregnancy, or irregularity 
in menstruation ; they are also said to be found in liver complaints. 

Irregular brownish spots a little raised above the skin and covered with 
small pustules, which sometimes discharge a bloody fluid, are in children a 
sign of congenital syphilis. 

Fat, short, and broad persons, with dark brown or black hair, dark eyes, 
yellow-brownish, dark color of the skin, are mostly affected on the right side 
with liver complaints and so on. 

g. Telangiectasias on the face, especially on the upper parts of the cheeks 
and on the lower eyelids, are almost always connected with some obstruction 
or stasis; often in the chest, but more frequently in the abdomen, and a 
diminution of chlorides in the urine. 

Telangiectasias, if ever so small, on the right side of the face, denote an 
obstruction in one of the organs on the right side; and if on the left, a stasis 
in one of the organs on the left side. 

Bright red telangiectasias denote an arterial, whilst purplUh- looking 
indicate a venous obstruction, either in the chest or abdomen of the corre- 
sponding side. 



238 FACE. 

Small varices on the left side of the nose, or lips, or glans penis, indicate 
a venous obstruction in the heart or kidney. 

So also are ringworms almost always indicative of some kidney affections. 
4. The temperature of the face. 

a. Heat of the face is found in congestion of the head, in fevers, in 
inflammatory conditions, in coryza, and in other complaints. 

b. Coldness of the face we find in chills, in spasms, exhaustion, in sick- 
ness of the stomach, in syncope. 

A deadly coldness in cholera ; also in violent hysterical paroxysms. 
In inflammation of the lungs, coldness of the face denotes the commence- 
ment of suppuration. 

Sudden coldness of the face in scarlet fever portends death. 

Erysipelas of the Face. 

Compare Erysipelas of the Scalp. All which is said there is equally 
applicable here. 

Crusta Lactea, Milk Crust. 

This is a disease of nursing infants. The eruption usually commences as 
a patch of slightly raised pimples. The patch itches, increases in size, and 
becomes more inflamed in consequence of being constantly rubbed ; the cuticle 
is raised in more or less defined vesicles, which are usually broken by friction ; 
the surface becomes excoriated, somewhat swollen, pouring out an ichorous 
secretion. 

With the increase of irritation the patch spreads. In case the eruption 
commences in several patches, they are liable to run into one. Thus the 
disease increases ; the secretion, from being a transparent and colorless ichor, 
becomes opaque, milky, then yellowish, and at last purulent, while small 
pustules are developed on the red and tumefied skin around the patch. For this 
reason it has been called impetigo. The forming crusts now grow thicker, and 
have the appearance of dried honey. Not unfrequently, as a consequence of 
pressure or friction, blood is mingled with the discharges, and the crusts 
become colored of various hues, from a lightish-brown to positive black. 

Although commencing on and being confined most frequently to the 
forehead and cheeks of the child, this obstinate disease may attack the whole 
body, being a source of great suffering to the child and annoyance to the 
mother. 

Should the eruption continue even after the milk teeth are all cut, no 
new light of prophecy need beam upon the little patient, according to Wilson : 
" When puberty arrives, then certainly the disease will go." For, although 



239 

there are cases of pretty tolerable stubbornness, yet I have not seen a case 
which did not yield to a judicious homoeopathic treatment in a reasonable 
space of time. 

THERAPEUTIC HINTS.— Arse n., pimples and vesicles; acrid 
discharge ; itching ; burning ; worse at night in cold air ; better from external 
warmth. 

Bellad., teething, jerking in sleep; want to sleep yet inability to go 
to sleep. 

Calc. carb., children fair and plump ; teething; scrofulous habit ; worse 
about new moon ; burning after washing ; perspiration after eating or drinking. 

Cicuta, thick, yellowish scurf on the chin and upper lip, with oozing; 
scurf on nose. 

Crot. tigl., itching followed by burning; vesicles run together, ooze 
and form thick, gray-brown crusts. 

Lycop., thick crusts, underneath cracked surface; skin dry; excoriated 
places ; worse at night and in warmth. 

Merc, sol., tendency to inflammation of the lymphatic glands; saliva- 
tion ; scorbutic gums. 

Rhus tox., acrid, inflamed look; swollen glands on neck and throat; 
stiffness of the neck. 

Sulphur, excoriations, pimples, vesicles; violent itching, worse at night; 
bleeding from scratching ; diarrhoea in the morning. 

Compare Eczema Capitis. 

Comedo, Acne Punctata and Rosacea. 

"Comedo is a distended, sebaceous follicle, whose contents, projecting 
above the surface of the skin, becomes black from dirt, and when pressed out 
assumes the shape of a worm. When an irritative process is set up around 
a hair follicle by the retention of the secretion, and assumes a true inflamma- 
tory character, we have Acne punctata." 

"Acne rosacea is a chronic inflammation of the face, made up of acne 
spots, periglandular inflammation, erythema, and new growth of connective 
tissue, growing independently of the glands." (Lilienthal, p. 126 and 127.) 

THERAPEUTIC HINTS— Comedo and Acne punctata I have seen 
disappear after Bellad. or Pulsat. Compare also Arsen., Carb. veg., 
Hepar, Kali brom., Kali hydr., Lachnanth., Silic, Sulphur. If in con- 
nection with sexual excesses : Calc. carb., Phosph. ac, or Sulphur. 

Acne rosacea is much more difficult to manage. 

Alum., when the redness is livid and the veins varicose. 



240 FACE. 

Arsen., when there is great burning. 

Calc. carb., when there are menstrual disorders and congestion to the 
head. 

Calc. sulf. is very important. 

Carb. veg., varicose veins on nose. 

Laches., bluish redness. 

Petrol., more at the commencement, when the vessels are not yet 
injected. 

Sulphur, great itchiness and bluish color of the face. 

Besides, compare: Ant. crud., Capsic, Carb. an., Canthar., Caustic, 
Conium, Dulcam., Ledum, Mezer., Natr. mur., Nitr. ac, Nux vom., Rhus 
tox., Ruta, Sepia. 

Lupus. 

Fox, Volkman and Virchow consider lupus as a neoplasma, consisting 
of cell-proliferation, This large accumulation of proliferating cells, pressing 
away and destroying the layers of the cutis, and often also the deeper-lying 
tissues, is characteristic of lupus. We meet it in different stages: 1, there 
are only brownish-red spots — Lupus maculosus; 2, there are papules or 
nodules elevated above the skin, also of brownish-red color and in size from 
that of a pea to a hazel-nut — Lupus tuberculosus ; 3, there is infiltration ; 
the skin appears of a similar color and is covered with lamellae of the epi- 
dermis — Lupus exfoliaticus; 4, there are atonic ulcers, which result from 
the softening of the infiltrations — Lupus exulcerans; 5, there are new 
formations rising above the skin which frequently involve large portions — 
Lupus hypertrophicus; and 6, there are large ulcers extending peripheri- 
cally — Lupus serpigillOSUS. The first four stages are also known under 
the name of Lupus nonexedeus, and the latter two Lupus exedens. The 
favorite seat of lupus are the nose and cheeks; from lupus exedens great 
disfiguration of the face may result. 

All authors agree that lupus has nothing to do with syphilis, either 
acquired or congenital. (Lilienthal, Skin Diseases.) 

THERAPEUTIC HINTS— Aur. mur., when starting from the mu- 
cous membrane of nose and spreading to the cartilages, bones and skin. 

Graphit., lupus of nose, with deep ulceration. 

Lycop., superficial ulceration in pale, sallow patients. 

Besides, compare: Arsen., Bar. carb., Carb. an. and veg., Caus- 
tic, Cicuta, Hydrocotyle Asiatica, Kalibichr., Phosphor., Silic, 
Staphis., Sulphur, Thuja. 



ULCUS RODENS AND EPITHELIOMA. 241 

Ulcus Rodens and Epithelioma. 

The Rodent ulcer has hard sinuous edges, is of several or perhaps of 
many years duration, almost painless, and occurs in middle-aged or elderly 
persons of fair health and without enlarged glands. It attacks by preference 
the eyelids and the adjacent portions of the cheek, the nose, or the cheeks. 
It is as rare on the lower as epithelioma is on the upper lip. 

Epithelioma is the common form of so-called cancer of the lip or 
tongue (also of vulva, clitoris, penis and rectum). It is essentially an infil- 
trating disease, beginning as a rule, as a little wart or tubercle, and then 
gradually spreading, it may crack, fissure and ulcerate, and when at this 
stage, we easily recognize its malignant character by the infiltration with the 
cancerous material, and the integument then presents the well-known indu- 
rated and everted edges. The base of the ulcer is dirty or grayish, more or 
less papillated; it may be reddish and discharge a thin fluid or be disposed 
to scab over. (Lilienthal's Skin Diseases.) 

THERAPEUTIC HINTS— For Rodent ulcer compare: Arsen., 
Bellad., Cicuta, Hepar, Hydrocotyle, Hydrast., Mercur , Mtr. ac, Silic, 
Staphis., Sulphur, Uran. 

For Epithelioma of lip compare : Acet. ac, Arg. nitr., Arsen., Ars. 
jod., Aurum, Bellad., Carb. an., Chelid., Clemat., Conium, Hydrast., Kreos., 
Laches., Pulsat., Silic, Sulphur, Thuja. 



16 



MOUTH. 



1. Its external parts. 

The lips we have had to notice on several occasions, as parts of the face. 

Their paleness denotes poverty of blood ; a transient paleness, however, 
is found in chills, spasms, fainting fits and frights. 

Their redness is a healthy condition ; but an increased deeper, or brighter 
redness is found in feverish conditions. A higher redness of the lower lip, 
without apparent fever, indicates Sulphur. 

Bluish lips are seen in all such conditions, where a free circulation of 
blood is interfered with. 

Dry lips are found in all acute, feverish or inflammatory conditions. 

Brownish or even blackish crusts form in typhoid states. 

Fever-blisters, hydroa, are found on the lips very often in intermittent 
fevers and pneumonia, scarcely ever, however, in typhus; and lastly, the 
cancer of the lip, a malignant growth, appears mostly at the prolabium, rarely 
at the adjoining integument of the lip. 

The mouth is kept open in stoppage of the nose, difficulty of breathing, 
great interior heat, hardness of hearing. In fevers it is a sign of great ex- 
haustion — the lower jaw falling down, especially during slumber. This 
symptom very frequently indicates Lycop. 

The mouth is spasmodically closed in lock-jaw and other spasmodic 
affections. 

2. The interior cavity of the mouth. — We shall examine it under 
the following heads: Gums, teeth, tongue, salivary glands and their ducts, 
tonsils, uvula, soft palate, fauces and mucous membrane of the mouth and 
fauces. 

The Gums 

Present different aspects. They are pale in anaemia, from the abuse of iron 
and mercury, and in spasmodic conditions; blue in cyanosis and scurvy; 
brown and blackish, coated with tough mucus, in typhoid conditions ; a bluish, 

(242) 



PAKULIS — EPULIS. 243 

grayish, slate-colored stripe or line on the gums is a sign of lead poisoning ; a 
purple line is found in old age, and a pink line, especially on the gums of the 
lower jaw by paleness of the remaining gums, is often met with in phthisical 
persons. 

Swelling of the gums is either of a congestive and inflammatory nature — 
in toothache, parulis — or of an (edematous and spongy nature (in scurvy, 
mercurial affections, noma, stomatitis). In such conditions the gums gener- 
ally bleed easily when being cleansed, or only slightly touched. 

Bleeding gums are said to have been observed also from suppressed 
menstrual or hemorrhoidal bleedings — vicarious bleeding. 

Ulcerated gums may originate from diseased states of the teeth, from 
general maladies or from constitutional maladies, such as scurvy, syphilis, 
mercurial poisoning, noma, stomatitis. 

The special diseases of the gums are : 

Parulis, Gumboil, Inflammatory Swelling of the Gums. 

This generally takes its origin in a diseased tooth, but may appear with- 
out any known cause. Its seat is almost always on the gums, covering the 
external side of the alveolar processes, and may reach to such a height as to 
swell up the cheek and corresponding side of the face, making chewing and 
talking a very difficult operation. It almost always ends in the formation 
of an abscess, which breaks and discharges. 

THERAPEUTIC HINTS.— Arnica, Hepar, Mercur., Silic. 

Epulis, a kind of Fungoid Growth on the Gums. 

This originates either in the gums, periosteum, or on the maxillary 
bone. When it begins in the gums or periosteum, there is a reddish or 
bluish-red, hard and painless swelling of a roundish or oval shape, growing 
out of the alveolar process or between the teeth. It is somewhat movable if 
it rests upon a broad pedicle; generally, however, it has none, and shows no 
distinct boundaries. In its further progress it assumes the form of an irregu- 
lar, fleshy lump, which, growing larger, overlaps one or more teeth; the 
adjoining teeth are pressed out of their position, and grow crooked or fall 
out. The swelling soon bursts through the mucous membrane, by which it 
has been covered, and presents a tuberous, grayish-red mass, which is either 
an entire mass or is split into different, irregular lobes by deep crevices. It 
bleeds easily, and, by sloughing, pieces of it fall off, forming cavities, which 
secrete a most offensive ichorous discharge. 

When it starts from the maxillary bone, we observe at first a swelling 



244 TEETH. 

of the bone, then the teeth fall out, and at last the morbid growth bursts 
forth. 

In some cases it has its seat in the antrum Highmorianum. 

THERAPEUTIC HINTS— Calc. carb., Chamom., Natr. mur., Thuja. 

Fistula of the Teeth. 

In consequence of inflammation of the periosteum lining the root of the 
teeth, and its consequent suppuration, or caries of the root and alveolar 
processes, a channel is gradually formed, which opens either on the inside of 
the mouth or outside of the face, where it discharges a morbid secretion, and 
forms hard, callous edges on its outlet. This is called a Fistula dentalis. 

THERAPEUTIC HINTS.— Compare Askalabotes, Calc. carb., Caus- 
tic, Ratan., Silic, Sulphur. 

The Teeth. 

The ossification of the dental sacks of the twenty milk-teeth takes place 
in the fifth month of pregnancy. Their eruption, as a general rule, not how- 
ever without many exceptions, takes place in the following groups : 




1. The lower two incisors between the fourth and seventh months, fol- 
lowed by a pause of from three to nine weeks ; 

2. The four upper incisors — at first the two central, then the two lat- 
eral — between the eighth and tenth months, followed by a pause of from six 
to twelve weeks ; 

3. The first two molars of the upper, then the lower incisors, and lastly 
the molars of the lower jaw, between the twelfth and fifteenth months, fol- 
lowed by a pause until the eighteenth month ; 

4. The canine teeth (eyes and stomach teeth) between the eighteenth 
and twenty-fourth months, followed by a pause of from two to three mouths ; 

5. The four second molars between the twentieth and thirtieth months. 
This period of first dentition is often attended with serious ailments of 



ODONTALGIA, TOOTHACHE. 245 

the child. We find it complicated frequently with ulcers on tip of tongue or 
other portions of the mouth; with abnormally increased secretion of the 
fluids of the mouth, slobbering; with conjunctival blennorrhcea, especially 
during the eruption of the eye-teeth and upper molars ; with catarrhal affec- 
tions of the alimentary canal — diarrhoea and vomiting, and of the respiratory 
organs — catarrh on the chest; with cutaneous eruptions, such as: urticaria, 
pomphi, lichen, prurigo, eczema, and impetigo (crusta lactea) ; with disor- 
ders of the nervous system — spasms and eclampsia ; and with fever, a general 
elevation of the body temperature. How is this? Can such a comparatively 
small irritation, as of necessity must be combined with the teeth piercing 
through the gums, cause all such mischief? Or is it not rather one of those 
common mistakes, where a thing is supposed to be the cause of another thing, 
because it is found simultaneously with the same ? May not it and the other 
have both a still deeper, yet common cause? And this cause is the develop- 
ment of the brain, which at that time is greater and move rapid than at any 
other period of life, lasting to the seventh year of life. The soft tissue of the 
brain grows denser, and the distinction between its cortical and medullary, or 
gray and white substance, becomes more marked, whilst the yellowish sub- 
stance, which had formed a line of demarcation between them, gradually 
fades away. The brain of infants is, compared with the remaining body, 
very voluminous ; being in the proportion of 1 : 8, whilst in adults it is in 
the proportion of 1 : 40 or 50. And still it grows on rapidly up to the sev- 
enth year, so that the brain of an infant, which weighs at its birth, say three- 
quarters of a pound, weighs in its second year nearly one pound and a half, 
until up to the seventh year it attains a weight of two pounds and a half and 
more. (Burdach.) It is clear, that such great and marked changes in the 
central organ may naturally be attended by a liability to disturbances in its 
own sphere and other peripheric organs, and this is the reason why the period 
of dentition, which is in itself only the result of this interior development of 
the brain, is attended by so manifold and serious disturbances. I hope this 
will be sufficient to prove the absurdity of the practice of lancing the gum? 
during infancy. 

The teeth become loose from mercurial poisoning, in scurvy and syphi- 
litic affections. 

The decay of the teeth is ascribed to microscopic parasites, and to a want 
of silicea in the system. 

A decay near the gums of the teeth is a sign of sycosis. 

Odontalgia, Toothache. 

Toothache has many causes: decay of the teeth and exposure of the 
nerve; various affections of different organs of the body; taking cold, etc. 



246 TEETH. 

The best treatise on this painful affection, the curing of which has won many 
a friend to Homoeopathy, is that of Dr. Hering in his Domestic Physician. 
With the kind permission of its author, I shall insert it here with some 
additions. 

Most in the front-teeth. — Bellad., Caustic, Carb. veg., Chamom., 
China, Coffea, Ignat., Mercur., Natr. mur., Nux mosch., Nux vom., 
Phosphor., Phosph. ac, Rhus, Silic, Staphis., Sulphur. 

Most in the eye and stomach-teeth. — Aeon., Calcar., Hyosc, Rhus, 
Staphis. 

Most in the molars or back-teeth. — Arnica, Bellad., Bryon., Calcar., 
Carb. veg., Caustic, Chamom., China, Coffea, Hyosc, Ignat., 
Mercur., Nux mosch., Nux vom., Phosphor., Phosph. ac, Pulsat., 
Rhus, Silic, Staphis., Sulphur. 

Most in the upper-teeth. — Bellad., Bryon., Calcar., Carb. veg., China, 
Natr. mur., Phosphor. 

Most in the lower-teeth. — Arnica, Bellad., Bryon., Carb. veg., Caustic, 
Chamom., China, Hyosc, Ignat., Mercur., 'Nux vom., Phosphor., 
Pulsat., Rhus, Silic, Staphis. 

One-sided. — Aeon., Bellad., Chamom., Mercur., Nux vom., Pulsat. 

On the left side. — Aeon., Ap. vir., Arnica, Carb. veg., Caustic, Chamom., 
China, Hyosc, Mercur., Nux mosch., Phosphor., Rhus, Silic, 
Sulphur. 

On the right side. — Bellad., Bryon., Calcar., Coffea, Laches , Natr. mur., 
Nux vom., Phosph. ac, Staphis. 

A whole row of teeth. — Chamom., Mercur., Rhus, Staphis. 

In hollow teeth. — Ant. crud., Bellad., Bryon., Calcar., Carb. veg., 
Caustic, Chamom., China, Coffea, Hepar, Hyosc, Laches., Mer- 
cur., Nux mosch., Nux vom., Phosphor., Phosph. ac, Pulsat, 
Rhus, Silic, Staphis., Sulphur. 

In the gums. — Ant. crud., Arnica, Bellad., Bryon., Calcar., Carb. veg., 
Chamom., China, Hepar, Hyosc, Laches., Mercur., Natr. mur., 
Nux mosch., Nux vom., Phosphor., Phosph. ac, Pulsat., Rhus, 
Silic, Staphis., Sulphur. 

upper.— Bellad., Calcar., Natr. mur. 

lower. — Caustic, Phosphor., Staphis., Sulphur. 

interior of. — Arnica, Natr. mur., Phosph. ac, Pulsat., Rhus, 

Staphis. 

swollen. — Aeon., Bellad., Calcar., Chamom., Carb. veg., Caustic, 

China, Hepar, Laches., Nux vom., Natr. mur., Phosphor., Pul- 
sat., Rhus, Sulphur. 



ODONTALGIA, TOOTHACHE. 247 

Gums painful. — Ap. vir., Arsen., Calcar., Carb. veg., Caustic, Laches., 

Mercur., Nux mosch., Nux vom., Phosphor., Staphis., Sulphur. 
bleeding. — Bellad., Calcar., Carb. veg., Caustic, Laches., Mercur., 

Nux mosch., Nux vom., Phosphor., Staphis., Sulphur. 
ulcerated. — Bellad., Calcar., Carb. veg., Caustic, Hepar, Laches., 

Mercur., Natr. mur., Nux vom., Phosphor., Staphis., Silic. 
pressing. — Aeon., Arnica, Bryon., Carb. veg., Caustic, China, 

Hyosc, Ignat., Natr. mur., Nux mosch., Nux vom., Phosphor., 

Bhus, Silic, Staphis., Sulphur. 

inwards. — Rhus, Staphis. 

outward. — Phosphor. 

asunder. — Phosph. ac 

as if from congestion of the blood, as if the teeth were 

too close. — Aeon., Arnica, Bellad., Chamom., Calcar., China, 

Coffea, Hepar, Hyosc, Nux vom., Pulsat. 
As if pulled out or wrenched. — Arnica, Caustic, Nux mosch., Nux 

vom., Phosph. ac, Bhus. 
Too long. — Arnica, Arsen., Bellad., Bryon., Calcar., Carb. veg., Caustic, 

Chamom., Laches., Hyosc, Natr. mur., Nux vom., Bhus, Silic, 

Sulphur. 
Loose. — Arnica, Arsen., Bryon., Carb. veg., Caustic, Chamom., China, 

Hepar, Hyosc, Ignat., Mercur., Natr. mur., Nux mosch., Nux 

vom., Phosphor., Pulsat., Bhus, Staphis., Sulphur. 
As if too loose. — Arsen., Bryon., Hyosc, Mercur., Bhus. 
Blunt. — Aeon., China, Dulcam., Ignat., Laches., Mercur., Natr. mur., 

Nux mosch., Phosphor., Phosph. ac, Pulsat, Silic, Staphis., 

Sulphur. 
Sore, bruised. — Arnica, Arsen., Bellad., Bryon., Calcar., Carb. veg., 

Caustic, Ignat., Natr. mur., Nux vom., Phosphor., Pulsat., Bhus. 
Burning. — Chamom., Mercur., Natr. mur., Nux vom., Phosphor., Pulsat., 

Bhus, Silic, Sulphur. 
Gnawing, scraping. — Chamom., Nux vom., Rhus, Staphis. 
Digging. — Ant. crud., Bryon., Calcar., China, Ignat. 

Boring. — Bellad., Calcar., Laches., Mercur., Natr. mur., Nux vom., Phos- 
phor., Phosph. ac, Silic., Sulphur. 
Jerking, twitching. — Ap. vir., Ant. crud., Arsen., Bryon., Bellad., Cal- 
car., Caustic, Cepa, Chamom., Coffea, Hepar, Hyosc, Laches., 

Mercur., Nux vom., Pulsat., Bhus, Sulphur. 
Drawing, tearing. — Ant. crud., Bellad., Bryon., Carb. veg., Calcar., Cepa, 

Chamom., China, Glonoin., Hyosc, Laches., Mercur., Nux vom., 

Phosph. ac, Bhus, Staphis. 



248 TEETH. 

Cutting, piercing. — Aeon., Ant. crud., Bellad., Bryon., Calcar., Caustic, 

Chamom., China, Laches., Mercur., Nux vom., Nux mosch., 

Phosphor., Phosph. ac, Pulsat, Rhus, Silic, Staphis. 
Beating, pulsating. — Aeon., Arnica, Arsen., Bellad., Calcar., Caustic, 

Chamom., China, Coffea, Glonoin., Hyosc, Laches., Mercur., 

Natr. mur., Phosphor., Pulsat., Rhus, Staphis., Sulphur. 
Intermittent. — Bellad., Bryon., Chamom., Coffea, Calcar., China, Mercur., 

Nux vom., Pulsat., Rhus, Silic, Staphis., Sulphur. 
Constant, day and night. — Bellad., Calcar., Caustic, Natr. mur., Silic, 

Sulphur. 
During the day only, better in the night. — Mercur. 
, none in the night. — Bellad., Calcar., Mercur., 

Nux vom. 
During the day only, worse in bed. — Ant. crud., Mercur. 
Worse in the night. — Aeon., Ant. crud., Arsen., Bellad., Bryon., Carb. 

veg., Chamom., China, Coffea, Hepar, Hyosc, Mercur., Natr. 

mur., Nux mosch., Nux vom., Phosphor., Phosph. ac, Pulsat., 

Rhus, Silic, Staphis., Sulphur. 
By night only, not during the day. — Phosphor. 
Most before midnight. — Bryon., Chamom., China, Natr. mur., Rhus, 

Sulphur. 
after . — Arsen, Bellad., Bryon., Carb. veg., Chamom., China, 

Mercur., Natr. mur., Pulsat., Phosphor., Rhus, Staphis., Sulphur. 
When awaking. — Bellad., Carb. veg., Laches., Nux vom. (See Sleep.) 
In the morning. — Arsen., Bellad., Bryon., Caustic, Carb. veg., China, 

Hyosc., Ignat., Natr. mur., Nux vom., Phosphor., Phosph. ac, 

Pulsat., Rhus, Staphis., Sulphur. 
At noon. — Coccul., Rhus. 
After noon. — Calcar., Caustic, Mercur., Nux vom., Phosphor., Pulsat, 

Sulphur. 
Towards evening. — Pulsat. 
At night. — Ant. crud., Bellad., Bryon., Calcar., Caustic, Hepar, Hyosc, 

Ignat., Mercur., Nux mosch., Nux vom., Phosphor., Pulsat., Rhus, 

Staphis., Sulphur. 
Every other day. — China, Natr. mur. 
Every seventh day. — Arsen., Phosphor., Sulphur. 
In Spring. — Aeon., Bellad., Bryon., Calcar., Carb. veg., Dulcam., Laches., 

Natr. mur., Nux vom., Pulsat, Rhus, Silic, Sulphur. 
In Summer. — Ant. crud., Bellad., Bryon., Calcar., Carb. veg., Chamom., 

Laches., Natr. mur., Nux vom., Pulsat. 
In Autumn. — Bryon., China, Mercur., Nux vom., Nux mosch., Rhus. 



ODONTALGIA, TOOTHACHE. 249 

In Winter. — Aeon., Arsen., Bellad., Bryon., Calcar., Carb. veg., Caustic, 
Chamom., Dulcam., Hepar, Hyosc, Ignat., Mercur., Nux mosch., 
Nux vom., Phosphor., Phosph. ac, Pulsat., Rhus, Silic, Sulphur. 

Caused by damp night-air. — Nux mosch. 

damp air. — Mercur. 

cold damp weather. — Nux mosch., Cepa, Rhus, Natr. sulph. 

wind. — Aeon., Pulsat., Rhus, Silic. 

draught. — Bellad., Calcar., China, Sulphur. 

Taking cold. — Aeon., Bellad., Bryon., Calcar., Caustic, Chamom., China, 
Coffea, Dulcam., Ignat., Hyosc, Mercur., Nux vom., Nux mosch., 
Phosphor., Pulsat., Rhus, Staphis., Sulphur. 

, when overheated. — Glonoin., Rhus. 

, by getting wet. — Bellad., Calcar., Caustic, Hepar, Laches., Nux 

mosch., Phosphor., Pulsat., Rhus, Sulphur. 

Suppressed perspiration. — Chamom., Rhus. 

Getting worse from cold air. — Bellad., Calcar., Hyosc, Mercur., Nux 
mosch., Nux vom., Sabad., Silic, Staphis., Sulphur. 

in the mouth. — Aeon., Bellad., Bryon., Calcar., Caustic, Hyosc, 

Mercur., Nux mosch., Nux vom., Phosphor., Pulsat., Silic, Sta- 
phis., Sulphur. 

opening of the mouth. — Bryon., Chamom., Caustic, Hepar, Nux 

vom., Phosphor., Pulsat. 

breathing. — Pulsat. 

drawing air into the mouth. — Ant crud., Bellad., Bryon., Cal- 
car., Caustic, Hepar, Mercur., Natr. mur., Nux mosch., Phos- 
phor., Silic, Staphis., Sulphur. 

cold washing. — Ant. crud., Bryon., Calcar., Chamom., Mercur., 

Nux mosch., Nux vom., Pulsat., Rhus, Silic, Staphis., Sulphur. 

eating cold things. — Bryon., Calcar., Chamom., Nux vom., Pul- 
sat., Rhus, Sabad., Staphis., Sulphur. 

drinking cold things. — Bryon., Calcar., Chamom., Caustic, Hepar., 

Laches., Mercur., Natr. mur., Nux mosch., Nux vom., Pulsat., 
Sabad., Silic, Staphis., Sulphur. 

rinsing of the mouth with cold water. — Sulphur. 

cold in general. — Arsen., Ant. crud., Calcar., Carb. veg., Mercur., 

Natr. mur., Nux mosch;, Nux vom., Pulsat, Phosphor., Rhus, 
Silic , Staphis., Sulphur. 

In the open air. — Bellad., Calcar., Caustic, Chamom., China, Hyosc, 
Mercur., Nux mosch., Nux vom., Phosphor., Pulsat., Rhus, Sta- 
phis., Sulphur. 

, staying. — Bellad., Bryon., Chamom., Hyosc, Mercur., Nux vom., 

Phosphor., Staphis., Sulphur. 



250 TEETH. 

In the open air, walking. — Nux vom., Phosphor., Staphis. 

In a room. — Ap. vir., Ant. crud., Chamom., Hepar, Nux vom., Pulsat., 

Sulphur. 

after coming out of the open air. — Phosphor. 

In a warm room. — Bryon., Cepa, Chamom., Hepar., Nux vom., Pulsat, 

Phosphor. 
Warm stove. — Arsen., Pulsat. 
External warmth. — Bryon., Chamom., Hepar, Mercur., Nux mosch., Nux 

vom., Phosphor., Phosph. ac, Pulsat., Rhus, Staphis., Sulphur. 
Something warm. — Bryon., Calcar., Carb. veg., Chamom., Coffea, Laches., 

Mercur., Natr. mur., Nux vom., Phosph. ac, Pulsat, Silic, 

Sulphur. 
Eating warm things. — Bryon., Calcar., Chamom., Nux vom., Phosphor., 

Pulsat., Silic. 
Something hot. — Bellad., Calcar., Phosph. ac. 
Drinking warm things. — Bryon., Chamom., Laches., Mercur., Nux 

mosch., Nux vom., Pulsat., Rhus, Silic. 
Warm bed. — Bellad., Bryon., Chamom., Mercur., Nux vom., Phosphor., 

Phosph. ac, Pulsat, Rhus. 
Getting warm in bed. — Chamom., Mercur., Phosph. ac, Phosphor., 

Pulsat. 
Drinking. — Chamom., Calcar., Caustic, Laches., Mercur., Pulsat., Rhus, 

Silic. 

cold or warm. — Laches., Natr. sulph. 

water. — Bryon., Calcar., Carb. veg., Chamom., Mercur., Nux vom., 

Pulsat., Silic, Staphis., Sulphur. 

wine. — Aeon., Ignat. [Nux vom. after wine.'] 

malt liquors. — Nux vom., Rhus. 

coffee. — Bellad., Carb. veg., Chamom., Coccul., Ignat., Mercur., 

Natr. sulph., Nux vom., Pulsat., Rhus. 

tea. — China, Coffea, Ignat., Laches. 

Smoking tobacco. — Bryon., Chamom., China., Ignat., Mercur., Nux vom. 

Salty things. — Carb. veg. 

Eating. — Ant. crud., Arnica, Bellad., Bryon., Calcar., Carb. veg., Caustic, 

Chamom., Coccul., Hepar, Hyosc, Laches., Mercur., Nux mosch., 

Nux vom., Phosphor., Phosph. ac, Pulsat, Rhus, Silic, Staphis., 

Sulphur. 
Only while eating. — Coccul. 
After eating. — Ant. crud., Bellad., Bryon., Calcar., Chamom., China, Coffea, 

Ignat, Laches., Mercur., Natr. mur., Nux vom., Rhus, Staphis., 

Sulphur. 



ODONTALGIA, TOOTHACHE. 251 

Chewing. — Arnica, Arsen., Bellad., Bryon., Carb. veg., Caustic, China, 
Coccul., Coffea, Hyosc, Ignat., Mercur., Natr. mur., Nux vom., 
Phosphor., Phosph. ac, Pulsat, Silic, Staphis., Sulphur. 

Only while chewing. — China. 

Swallowing. — Staphis. 

Biting. — Arsen., Bellad., Bryon., Calcar., Carb. veg., Caustic, China, Coffea, 
Hepar, Hyosc, Laches., Mercur., Nux vom., Phosphor., Phosph. 
ac, Pulsat., Rhus, Silic, Staphis., Sulphur. 

something soft. — Veratr. 

soft food. — Coccul. 

hard food. — Mercur. 

Touched by the food. — Bellad., Ignat., Nux vom., Phosphor., Staphis. 

Picking. — Pulsat. 

Cleaning. — Carb. veg., Laches., Phosph. ac, Staphis. 

Touching. — Ant. crud., Arnica, Arsen., Bellad., Bryon., Calcar., Carb. veg., 
Caustic, China, Coffea, Hepar, Ignat., Mercur., Natr. mur., Nux 
mosch., Nux vom., Phosphor., Pulsat., Rhus, Staphis., Sulphur. 

with the tongue. — Carb. veg., China, Ignat., Mercur., Phosphor., 

Rhus. 

even very softly. — Bellad., Ignat., Nux vom., Staphis. 

Pressing on the teeth. — Caustic, China, Hyosc, Natr. mur., Staphis., 
Sulphur. 

Sucking the gums. — Bellad., Carb. veg., Nux mosch., Nux vom., Silic 

Rising. — Ignat., Mercur., Platina. 

Moving the body. — Arnica, Bellad., Bryon., China, Mercur., Nux vom., 
Phosphor., Staphis. 

the mouth. — Caustic, Chamom., Mercur., Nux vom. 

Talking. — Nux mosch. 

Deep breathing. — Nux vom. 

Being at rest. — Arsen., Bryon., Chamom., Pulsat., Rhus, Staphis., Sulphur. 

Sitting. — Ant. crud., Mercur., Pulsat, Rhus. 

too much. — Aeon. 

While lying down. — Arsen., Bellad., Bryon., Chamom., Hyosc, Ignat., 
Mercur., Nux vom., Phosphor., Pulsat, Rhus, Staphis., Sulphur. 

on the painful side. — Arsen., Nux vom. 

on the painless side.— Bryon., Chamom., Ignat, Pulsat. 

in bed. — Bryon., Chamom., Nux vom., Pulsat. 

In bed. — Ant. crud., Bellad., Bryon., Chamom., Mercur., Nux vom., Phos- 
phor., Pulsat. 

Sleep with yawning. — Staphis. 

When going to sleep. — Ant. crud., Arsen., Mercur., Sulphur. 

While asleep. — Mercur. 



252 TEETH. 

When awaking. — Bellad., Bryon., Calcar., Carb. veg., Laches., Nux vom., 

Phosphor., Silic., Sulphur. 
Mental emotions. — Aeon. 
Vexation. — Aeon., Chamom., Rhus, Staphis. 
Passion. — Nux vom. 

Mental exertions. — Bellad., Ignat., Nux vom. 
Reading. — Ignat., Nux vom. 
Noise. — Calcar. 

Being talked to by others. — Arsen., Bryon. 
For women. — Aeon., Ap. vir., Bellad., Calcar., Chamom., China, Coffea, 

Hyosc, Ignat., Nux mosch., Pulsat. 
Menstruation, before. — Arsen. 

, during. — Calcar., Carb. veg., Chamom., Natr. mur., Laches., Phos- 
phor. 

— , after. — Bryon., Calcar., Chamom., Phosphor. 

During pregnancy. — Ap. vir., Bellad., Bryon, Calcar., Hyosc, Mercur., 

Nux mosch., Nux vom., Pulsat., Rhus, Staphis. 
While nursing. — Aeon., Arsen., Bellad., Calcar., China, Dulcam., Mercur., 

Nux vom., Phosphor., Staphis., Sulphur. 
For children. — Aeon., Ant. crud., Bellad., Calcar., Chamom., CofFea, Ignat., 

Mercur., Nux mosch., Pulsat., Silic. 
For irritable, nervous persons. — Aeon., Bellad., Chamom., Coffea, 

China, Hyosc, Nux mosch. 
For persons who have taken much mercury. — Carb. veg., Bellad., 

Hepar, Laches., Staphis. 
who drink much coffee. — Bellad., Carb. veg., Chamom., Coccul., 

Mercur., Nux vom., Pulsat., Silic. 
Getting better from : 
Cold air. — Nux vom., Pulsat. 
Wind. — Calcar. 
Uncovering. — Pulsat. 

Drawing air into the mouth.— Nux vom., Pulsat. 
Cold washing.— Bellad., Bryon., Chamom., Pulsat. 
External cold. — Bellad., Bryon., Chamom., China, Mercur., Nux vom., 

Phosphor., Pulsat, Staphis., Sulphur. 
Cold hand. — Rhus. 

Finger wet with cold water. — Chamom. 
Holding cold water in the mouth. — Bryon., Cepa, Coffea, Clemat, 

Natr. sulph. 
Cold drinking. — Bellad., Bryon., Chamom., Mercur., Nux vom., Phosphor., 

Pulsat., Rhus, Sulphur. 
In the open air. — Ant. crud., Bryon., Cepa, Hepar, Nux vom., Pulsat. 



ODONTALGIA, TOOTHACHE. 253 

In the room. — Nux vom., Phosphor., Sulphur. 

External warmth. — Arsen., Bellad., Calcar., Charaom., China, Hyosc., 

Laches., Mercur., Nux mosch., Nux vom., Pulsat., Rhus, Staphis., 

Sulphur. 
"Wrapping up the head. — Nux vom., Phosphor., Silic. 
Eating something warm. — Arsen., Bryon., Nux mosch., Nux vom., 

Rhus, Sulphur. 

Drinking . — Nux mosch., Nux vom., Pulsat., Rhus, Sulphur. 

Getting warm in bed. — Bryon., Nux vom. 

Drinking.— Bellad. 

Smoking tobacco. — Mercur. 

When eating. — Bellad., Bryon., Chamom., Phosph. ac, Silic. 

After . — Arnica, Calcar., Chamom., Phosph. ac, Rhus, Silic. 

When chewing. — Bryon., China, Coffea. 
Biting. — Arsen., Bryon., China, Coffea. 
Picking the teeth, so that they bleed. — Bellad. 
Picking the teeth.— Phosph. ac. 

Rubbing . — Mercur., Phosphor. 

Touching the teeth. — Bryon., Nux vom. 

Sucking the gums. — Caustic. 

Pressing upon the teeth. — Bellad., China, Bryon., Iguat., Natr. mur., 

Pulsat., Phosphor., Rhus. 
Moving. — Pulsat, Rhus. 
When walking. — Pulsat., Rhus. 
When at rest. — Bryon., Nux. vom., Staphis. 
Sitting up in bed. — Arsen., Mercur., Rhus. 
Getting up. — Phosphor., Nux vom. 
When lying down. — Bryon., Mercur., Nux vom. 

on the painful side. — Bryon., Iguat., Pulsat. 

painless . — Nux vom. 

lying down in bed. — Mercur., Pulsat. 

In bed. — Sulphur. 
When going to sleep. — Mercur. 
After sleep. — Nux vom., Pulsat. 
The pains extend 

to the jawbones and face.— Hyosc, Laches., Mercur., Nux 

vom., Rhus., Sulphur. 
to the cheeks. — Bryon., Chamom., Caustic, Mercur., Silic, Sta- 
phis., Sulphur. 
into the ears. — Arsen., Bryon., Calcar., Chamom., Hepar, 

Laches., Mercur., Staphis., Sulphur. 



254 TEETH. 

The pains extend 

into the eyes. — Caustic, Chamom., Mercur., Pulsat., Staphis,, 

Sulphur. 
into the head. — Ant. crud., Arsen., Chamom., Hyosc, Mercur., 
Nux vom., Rhus, Staphis., Sulphur. 

With headache. — Ap. vir., Glonoin., Laches. 

rush of blood to the head. — Aeon., Calcar., China, Hyosc., 

Laches., Pulsat. 

swollen veins of the forehead and hands. — China. 

heat in the head. — Aeon., Hyosc, Pulsat. 

burning of the eyes.— Bellad. 

■ flushed cheeks. — Aeon., Arnica, Bellad., Chamom., Mercur., Nux 

mosch., Nux vom., Phosphor., Pulsat., Rhus tox., Sulphur. 

pale face. — Aeon., Arsen., Ignat., Pulsat., Staphis., Sulphur. 

swelling of the cheek. — Arnica, Arsen., Bellad., Bryon., Cha- 
mom., Laches., Mercur., Natr. mur., Nux vom., Pulsat., Phosphor., 
Phosph. ac, Staphis., Sulphur. 

salivation. — Bellad., Dulcam., Mercur. 

dry mouth and thirst. — China. 

without thirst. — Pulsat. 

dry throat and thirst. — Bellad. 

chilliness. — Pulsat., Rhus. 

heat. — Hyosc, Rhus. 

warm perspiration. — Hyosc. 

chilliness, heat, thirst. — Laches. 

diarrhoea. — Chamom., Coffea, Dulcam., Rhus. 

constipation. — Bryon., Mercur., Nux vom., Staphis. 



1. Arnica after the extraction of a tooth; it will stop the bleeding and 
accelerate the healing of the gums. After the insertion of artificial teeth, it 
relieves the pain in the swelling ; after filing out carious teeth — which is 
sometimes a very useful operation— mix a few globules of it in a teaspoonful 
of water, and put some of it on the parts which have been filed. In very 
intense pain, occurring after the tooth has been drawn, sometimes Hyosc. 
is of use. Arnica is sometimes good for throbbing toothache, with a sensa- 
tion as if the tooth were being forced out from its socket by the blood ; hard 
swelling of the cheeks. 

2. Coffea will remove the severest pains, which drive the patients 
almost frantic ; they cry, tremble and do not know what to do ; the pain is 
indescribable; it is momentarily relieved by holding cold water in the mouth. 
For stinging, jerking pain, or intermitting aching and pain when chewing, it 
is to be preferred to all other remedies. 

3. Aeon, must be given in all those cases where the patients are almost 



255 

frantic with pain, which is indescribable, and which Coffea has failed to 
relieve : also for throbbing pains, occasioned by taking cold, with determina- 
tion of blood to the head ; burning in the face ; it is particularly suitable for 
children; when it is no longer efficacious, give Chamom. or Bellad. 

4. Glonoin. for toothache from taking cold, after having been over- 
heated, if the beating of the pulse is felt in all the teeth, or a drawing in all 
the teeth ; pain extending to whole right side of face, having waves of spon- 
taneous exacerbation, without being influenced by anything specially. 

5. Chamom., particularly in children — and in persons who are fre- 
quently vexed, and who drink much coffee— also in females before menstrua- 
tion ; pain in hollow teeth, after taking cold when in perspiration, or when 
the patient is very irritable and inclined to cry; when the pain is insupport- 
able, and aggravated periodically, worse during the night ; when no particu- 
lar tooth can be pointed out as the painful one ; or when the tooth is hollow 
and loose, and feels as if too long ; or when the pain extends through the 
whole set, and every tooth feels too long ; also when it extends through the 
laws into the ear, and through the temples into the eyes; when there is 
crawling continually, or scraping sensation in the nerve of the hollow tooth, 
after which the pain increases ; drawing and tearing, or boring and throbbing 
pain ; when at its height, the pain is stinging and jerking, and extends to the 
ear ; the patient cannot bear the warmth of the bed, and the pain generally 
commences soon after meals, particularly after eating or drinking anything 
warm; when it grows much worse after drinking cold water — also after 
coffee ; cannot be relieved by anything but dipping a finger into cold water 
and applying it to the tooth ; when, while the pain lasts, the cheek is red 
and hot, or the cheek and gums are swollen and of a painful red color; 
when the glands under the chin are painful and swollen, accompanied with 
great weakness, particularly in the joints; with pain in the articulation of 
the jaw on opening the mouth, extending to the teeth. 

6. Nux mosch. suits children, women — particularly during preg- 
nancy — and all people with a cool, dry skin, who never perspire; for pains 
from taking cold in damp, cold weather, or from the night-air; for pains 
which get worse if air, particularly cold, damp air, is drawn into the mouth ; 
if warm water or warm applications ease the pain ; for toothache which is 
increased by the shaking of the body in going up or down stairs ; if the 
pain commences on the right side and goes to the left; for pains as if a tooth 
were wrenched out; worse from much talking; the teeth become easily blunt. 
Frequent yawning, sleepiness and swooning; profuse menstruation. 

7. Nux vom. for toothache in persons of a hasty temper, with ruddy 
complexion, who love coffee and ardent spirits — have little out-door exercise, 
or who have taken cold ; when a healthy tooth is painful and feels loose, or 
the teeth seem too long, with jerking, shooting pains in the lower jaw; a 



256 TEETH. 

drawing pain extending into the temple, or a pain from a hollow tooth, 
affecting the whole face and even the bones, or extending over the whole 
side; or for drawing and burning pains in the nerves of a tooth, as if it were 
wrenched out, accompanied by violent stitches, which affect the whole body, 
particularly on inspiration ; when a dull pain in the bones changes to a tear- 
ing pain, which passes through the teeth and jaws, or where there is a boring, 
gnawing, tearing pain on one side; sometimes jerking or rheumatic pains, 
attended with a prickling sensation ; when they chiefly commence in bed or 
in the evening, preventing chewing, grow worse or return as soon as the 
mouth is opened in the cold air; or when reading or thinking; or when the 
tearing pains become worse from drinking anything cold and better from 
external warmth; in general the pains are worse after eating and exercise; 
when along with the tearing pains the glands beneath the lower jaw are 
painful, and particularly when a swelling appears on the gums, which seems 
about to burst. 

8. Pulsat. for persons of a mild, quiet, timid disposition, or for women 
and children of a fretful temper ; when the pain is only on one side ; for 
toothache which is prevalent in the spring, accompanied by earache and 
headache, confined chiefly to one side; when there is a stinging pain in the 
decayed tooth, accompanied by great sensitiveness of the left side of the 
face, extending to the ear, with heat in the head and chills over the whole 
body; but particularly when there is a gnawing pain in the gums, and 
pricking as of pins, with tearing and jerking in the tooth itself, as if the 
nerve were stretched and then suddenly relaxed ; or for jerking or tearing in 
the tooth as if it would start from the jaw, and aggravated by cold water, 
the heat of the bed, a warm room, or by taking anything warm into the 
mouth ; cold air relieves it — the toothache always ceases in the open air, but 
returns in the warm room and gets worse; worse when sitting, better when 
walking about — worse from picking the teeth, better from pressure — chew- 
ing does not make it worse; it comes on mostly towards evening, rarely 
before, and is accompanied by chilliness and pale face, or with congestion of 
blood to the head; or with heat without thirst; especially for toothache 
caused by drinking chamomile tea. 

9. Ignat. in cases where the foregoing remedies appear to be indicated, 
but are insufficient, and the patient is of a more tender and sensitive disposi- 
tion, sometimes cheerful, at other times inclined to tears; particularly for 
persons who grieve much; when the jaw-teeth feel as if crushed; when there 
is a boring pain in the front teeth, and a soreness in all the teeth ; worse after 
drinking coffee, after smoking, after dinner, in the evening, after lying down, 
and in the morning on waking. 

10. Hyosc. in very sensitive, nervous, excitable persons; the pain 
almost drives the patient mad — it is a tearing or throbbing, extending to the 



ODONTALGIA, TOOTHACHE. 257 

cheeks and along the lower jaw; or there is a tearing, raging pain in the 
gums, with a buzzing sensation in the tooth, which is loose, and feels, when 
chewing, as if it were coming out; or jerking, throbbing, drawing, tearing, 
which extends to the forehead ; violent tearing pains in different teeth, as if 
the blood were pressed into them, occasionally accompanied by flushes of 
heat, with determination of blood to the head; it is aggravated by cold 
air; generally comes on in the morning, and is sometimes accompanied by 
jerking in the fingers and arms, especially in persons who are subject to 
convulsions. 

11. Bellad. is frequently best adapted to females or children, particu- 
larly when the pain and anguish cause great restlessness, running about, or 
where there is depression, and a disposition to cry ; when the teeth and gums 
are painfully sensitive ; when biting produces a feeling as if there were ulcers 
at the roots, with stinging, cutting, jerking, tearing pain ; and more especi- 
ally for a drawing pain, which is worse after going to bed, and during the 
night; or for pricking pains in a hollow tooth, day and night; or a pain in a 
hollow jaw-tooth, as if too much blood were forced into it, with heat in the 
gums and throbbing in the cheeks — nothing mitigates the pain but picking 
the gum until it bleeds; or the gums are swelled, with burning and stinging 
pains, discharge of much saliva, the cheek swelled, sometimes the eyes hot 
and the throat dry, with great thirst — frequently the pain returns in the 
morning on awaking, or recommences some time after dinner; the teeth 
ache when exposed to the open air, when touched, from biting, when food or 
hot liquids come in contact with them — pressing hard upon the cheeks some- 
times gives relief. 

12. China, for mothers who are nursing — or persons, who, otherwise 
cheerful, become cross and irritable ; the teeth are covered with dark sordes ; 
the pain comes on periodically, and is throbbing, tearing, jerking or drawing, 
with great pressure, as if the blood were forced into the teeth, or boring and 
numbness about the teeth — worse on motion or when touched, and returning 
on exposure to a draught — the gums swell, the mouth is dry, there is thirst, 
the blood rises to the head, veins of the forehead and hands swell, and the 
sleep during the night is uneasy, although the pain is not so great. 

13. Mercur., for children; in general when there are tearing pains in 
several teeth at once, in hollow ones and those adjoining them — the pain 
affects the whole side of the face, or drawing and stinging pains extend to 
the ear; it is particularly troublesome during the night; or for excruciating 
jumping pains in the teeth, especially at night, with stitches extending to the 
ear and the head, which drive the patient out of bed ; also for stinging pains 
iu a decayed tooth, worse after eating or drinking anything cold or warm ; 
the pain is generally increased by cold, and particularly by damp air, is less 
severe when in a warm place, or when the cheek is rubbed — sometimes the 

17 



258 TEETH. 

air, when rushing in, causes pain in the front teeth ; or the toothache is only 
felt during the day and ceases during the night, and is followed by perspira- 
tion, and in the morniug the same pains return again, in paroxysms, with 
longer or shorter intervals, alternating with giddiness or tearing in the limbs ; 
the teeth are almost always loosened, the gums swell or become white and 
ulcerated, are detached from the teeth, burn and ache when touched ; or they 
begin to itch, to bleed and to suppurate, with tearing through the roots of 
the teeth, or with painful swelling of the cheeks. 

14. Hepar, after Mercur. or Bellad., when the painful swelling of 
the gums continues, or for a throbbing pain as if blood were entering the 
tooth, or a drawing pain ; the pains worse after eating, and in a warm room, 
or at night. 

15. Carb. veg., when Mercur. or Arsen. gives some relief, without 
effecting a perfect cure ; also in persons who have taken much calomel, par- 
ticularly when the gums bleed, and are detached from the teeth ; the teeth 
are loosened, become ulcerated, and ache when touched by the tongue ; worse 
after eating, with drawing and tearing pains in the incisors. 

16. Sulphur is most suitable for jumping pain in hollow teeth — ex- 
tending to the upper and lower jaw, or to the ear; for swelling of the gums, 
attended with throbbing pain, bleeding of the gums and swelling around old 
stumps ; for toothache in the evening, or in the air, from draught, worse when 
rinsing the mouth with cold water. 

17. Phosphor, for toothache from washing or from having had the 
hands in cold or warm water. 

18. Cepa for toothache with cold in the head, which gets better when 
the catarrh becomes worse, and which gets worse when the catarrh ceases ; 
from damp, cold weather, and wind; it commences on the left and goes to 
the right side; is worse in the warm room; throbbing, drawing, pressing 
pains, with swelling of the cheek; worse when chewing; better from cold 
water ; the teeth become yellow ; for people who have an offensive breath, or 
who are fond of being in the open air and like to wash themselves frequently. 

19. Arsenic, when the teeth are loose and elongated, with constant 
jerking or burning, and tearing in the gums, worse when touched, when lying 
on the affected side, and when at rest, and also from cold ; the pains are 
mitigated by the heat of the stove, by hot applications, or by sitting up in 
bed; it is particularly indicated when the pains are very debilitating. 

20. Ant. crud. is the principal remedy for pains in hollow teeth, of a 
boring, digging, tearing, jerking character, which sometimes penetrate into 
the head ; the pains are aggravated in the evening in bed, after eating, by 
cold water ; and better when walking in the open air. 

21. Bryon. for passionate, irritable, cross, obstinate people; pain 
occasionally in hollow, but more frequently in healthy teeth ; shooting pains 



ODONTALGIA, TOOTHACHE. 259 

■with twitching towards the ear; tearing pain extending to the cheek, and 
acute pains as if caused by an exposed nerve ; sensitiveness and pain in the 
decayed teeth from contact with the air ; the teeth feel as if too long and 
loose, and when chewing they feel as if they would fall out. The pains are 
aggravated by smoking or chewing tobacco ; from the introduction of any 
thing warm into the mouth — better in the open air — sometimes relieved by 
cold water, but only momentarily, and also when lying on the affected cheek, 
but worse when lying on the other. Likewise, when the pain shoots from one 
tooth into the other, and also into the head and cheeks. 

22. Rhus for the same painful sensation of elongation and looseness of 
the teeth, as Bryon., and also wmen they feel as if they were asleep (China, 
Dulcam.), and hollow T , or sensitive to the air; the gums are swollen, burn, 
and itch like an ulcer, or they are sore and detached from the teeth ; for 
jumping, shooting, or drawing pain, as if the teeth were being torn out 
(Pulsat.), or pressed into their sockets, (Staphis.) or for slow pricking or 
throbbing or tearing in all the teeth, extending into the jaws and temporal 
bones, with a painful soreness of one side of the face, from taking cold, or 
from vexation, worse in the air, insufferable during the night, and mitigated 
by heat; sometimes accompanied by an offensive smell from the carious 
teeth. It suits best for quiet persons (unlike Bryon.) who are disposed to 
sadness and melancholy, or are easily agitated and frightened (similar to 
Bellad.). 

23. Staphis., when the teeth become black and hollow, the gums pale, 
white, ulcerated, and swollen — aching when being touched; intense gnawing, 
drawing, or tearing pains in decayed teeth, particularly in the roots, or ex- 
tending through a whole row, or when the pain shoots from a hollow tooth 
into the ear, with throbbing in the temple — worse in the open air, from 
drinking anything cold, from eating, and particularly during the night or 
toward morning. 

24. Laches., pain in all the decayed teeth during rush of the blood to 
the head; drawing, tearing, throbbing, boring pain in the jaw-bones; hollow 
teeth feel too long ; pain extending down the throat ; better when pus is dis- 
charged; gums swollen, bleeding easily, or they are bluish-red, beating and 
burning, worse from anything warm; toothache worse after warm and cold 
drinks, after eating and awaking; with headache, beating over the eyes, 
stitches in the ears, swelling of the cheek ; pains in the limbs of the opposite 
side, chills, fever and thirst. It is particularly suited for colds in damp, 
warm, spring weather; during menstruation, the smaller the discharge the 
greater the pain, at the cessation of the menstruation ; for melancholic and 
choleric persons, for persons of vivid imagination ; after long-continued grief, 
and after the abuse of mercury. 

25. Phosph. ac. is suitable for bleeding and swollen gums; tearing 



260 TEETH. 

pains which are worse when warm in bed, and also from heat and from cold, 
burning in the front teeth during the night; pains from hollow teeth, extend- 
ing into the head. 

26. Ap. vir. for the most violent pains in the gums, also for jerks and 
throbbing in the molars, with involuntary, sudden biting together of the 
teeth, headache and bleeding of the gums. 

27. Silic. for tedious, boring, tearing pains, day and night, worse dur- 
ing the night, spreading over the whole cheek, also into the bones of the face ; 
discharge of offensive matter from openings near the roots of the teeth, or 
from the gums; swelling of the jaw. 

28. Dulcam. is sometimes useful for toothache proceeding from cold, 
particularly when accompanied by diarrhoea, and when Chamom. does not 
answer ; also when there is at the same time confusion of the head, or when 
the toothache is accompanied by profuse salivation (similar in this to Bel- 
lad, and Mercur.) and the teeth feel blunt. 

29. Calcar., for toothache in pregnant females; pains in hollow teeth, 
especially around loose stumps; pressing, drawing, jerking soreness; drawing, 
pricking, rooting, gnawing, grubbing, throbbing pains, with swelled gums, 
which are sore, bleed easily, throb and pain; it is only suitable when there 
is determination of blood toward the head, particularly during the night; 
when the pains are caused by taking cold, or are aggravated by cold or a 
draught of air; the patient can neither bear warm nor cold drinks — even 
noise makes it worse. Fistula dentalis. 

30. Caustic, for toothache arising from breathing in the open air, 
generally attended with stinging, throbbing pain, and a feeling of soreness ; 
or the teeth feel painfully loose and lengthened, as if forced out of their 
sockets (Arnica, Phosph. ac); when there are ulcers at the roots of the 
teeth, the gums suppurating are swollen and very tender. The pain fre- 
quently affects the whole of the left side of the face, especially at night when 
the patient lies on it, and is equally sensitive to heat and cold ; in long-con- 
tinued or often-returning colds. After grief; melancholy mood; profuse, 
badly-smelling sweat at night. 

31. Clemat., drawing, stitching, worse at night; better for a short 
time by holding cold water in the mouth, or sucking at the tooth, and in the 
open air. 

32. Kali bichr., pain in molar bones worse from coughing. 

33. Kali carb., stitch pain, and tearing up into the head and eye, with 
dizziness; chilliness, dry skin and bad alkaline smell from mouth; worse 
from chewing. 

34. Magn. carb. and phosph., pain is worse at night, drives out 
of bed. 



TONGUE. 261 

35. Natr. sulph., pahi is better from holding cold water in mouth, and 
is brought on again by taking hot water or hot coffee in the mouth. 

36. Petrol., abscess at root of tooth, with swelling of left lower jaw, 
painful to touch and on stooping. 

37. Plant, maj., aching in decayed teeth, or shooting up left side of 
face ; face red. Is a popular remedy. 

38. Sabad., hot or cold food or drink, also cold air produce or increase 
the pain. 

39. Sepia, chronic cases; caries; waterbrash during pain ; meclimaxis; 
leucorrhoea. 

40. Spigel., pain leaves during eating and reappears afterwards, with 
palpitation of the heart. 

41. Sulph. ac, pain begins slowly to increase, growing to an almost 
unbearable degree when it suddenly ceases. 

42. Thuja, with decay of the teeth commencing close to the gums. 

Swelled Face. 

When the cheek remains swollen after the toothache has ceased, it may be 
removed by giving Pulsat., if Mercur. or Chamom. have been previously 
taken for the pain; or Mercur. after Pulsat. or Bellad. ; or Bellad. 
after Mercur.; or Sulphur, after Bellad., Bryon., Arsen., etc. If the 
swelling is red, as iu erysipelas, Mercur. should be given ; if less red, but 
hard and stiff, Arnica. Hepar, when the swelling begins to soften, and 
appears as if about to suppurate, followed by a dose or two of Laches., if 
Hepar does not effect a speedy abatement of the swelling, and then by 
Hepar again or by Mercur., if the latter have not been taken before. 



THE TONGUE. 

To this remarkable piece of furniture of the human economy great 
attention has been paid by physicians of all shades and in all times. And, 
indeed, it often presents quite characteristic diagnostic as well as therapeutic 
hints. The most important of these features are the following: 

1. Its Color. 

It is either too red all over, as in scarlet fever, with considerably raised 
papillae — whence the name strawberry tongue — or red and dry, as in inflam- 
mations of the brain and its membranes ; in inflammation of the thoracic 
viscera and mucous membranes of the stomach and intestines; or red on the 
edges and on the tip, or a red, dry streak in the middle of the tongue in typhoid 



262 TONGUE. 

fevers, or red, clean and glossy, indicating great fever heat, congestion to the 
head, impending delirium, and, in gastric fevers, the transition into the 
typhoid state ; and if, at the same time, cracked, ulceration of the bowels ; or 
red, moist and smooth, in chronic affections of the stomach. 

A pale tongue is found in chills ; in spasms ; after loss of vital fluids ; in 
chlorosis, dropsy and general exhaustion. When it sets in in exanthematic, 
gastric or bilious fevers, it denotes a fatal issue. 

A lead-colored tongue is found in cholera, in mortification of the lungs 
and stomach, in scirrhus of the tongue. 

A lead-colored tongue, with thrush, denotes impending death, under all 
circumstances. 

A bluish tongue is a sign of impeded circulation of the blood, and, 
therefore, it may be found in paroxysms of asthma, whooping-cough, croup, 
bronchitis, pneumonia, heart diseases, dropsy of the chest and cyanosis. 
Scurvy and mercurial inflammation of the tongue have also a bluish hue. 

2. Its Humectation. 

A moist tongue is, in general, a favorable sign. But in putrid fevers, 
with exhausting perspiration, it has no such favorable meaning. 

A constantly moist tongue in soporous conditions denotes great exhaus- 
tion. 

A dry tongue is found in a great many different morbid conditions, espe- 
cially in feverish affections, particularly in such as have a tendency to senso- 
rial disturbances. 

Great dryness of the tongue in typhus cerebralis is, according to Schoen- 
lein, an unfavorable sign. 

Dryness of the tongue in infants is a forerunner of thrush or internal in- 
flammation. 

3. Its Temperature. 

A hot tongue is found in congestive and inflammatory states of different 
parts of the body ; in infants before thrush appears. 

A cold tongue is found in chills, violent spasms, after great loss of blood, 
internal mortification, apoplexy, cholera. In fevers it denotes greatest pros- 
tration and impending death. 

4. Its Covering or Coating. 

We must bear in mind that the tongue is coated or furred without indi- 
cating any disordered state of the system — in the morning by an empty 
stomach ; after siesta ; after night-watching, and with habitual smokers of 
tobacco. 



EXAMINATION OF TONGUE. 263 

A coating of the root of the tongue does not mean much ; in a slight de- 
gree every one has it, even in the best of health. 

A coating on the tip of the tongue is said to be found in phthisical 
persons. 

One-sided coating is said to be found in one-sided complaints, as proso- 
palgia, paralysis; in one-sided lung diseases; in affections of the liver and 
spleen. 

A patchy or map tongue, the so-called pityriasis linguae, is produced 
merely by a stouter layer of epithelium around the places of thinner cover- 
ing. A systemic cause for this affection is not known, although it may possi- 
bly be connected with some abnormal states of the stomach. 

A thick, white coating occurs most extensively in affections of the fauces ; 
but also in gastric derangements. 

The yellow coating is generally believed to be bilious ; single yellow streaks 
on a white-coated tongue indicate obstinacy of the disease. 

A peculiar buff leather appearance is presented in cases of enteritis and 
hepatitis ; also in tonsillitis. 

A dark brown coating exists in malignant fevers, and in haemorrhages 
from the mouth. 

A black coating, in dysentery, indicates exhaustion — mortification — death. 
In jaundice it denotes organic diseases of the liver, spleen, such as induration, 
tubercles, abscesses. In small-pox it is quite an unfavorable sign. 

5. Its Form and Size. 

We find a large, long tongue most conspicuously in chronic hydrocepha- 
lus and cretins. 

A small tongue, if not congenital, in atrophy, consumptive diseases, and 
long-standing paralysis of the tongue ; especially if caused from an irritation 
of the brain or spinal marrow. 

A sudden diminution in size denotes, in inflammatory diseases of the 
lungs and liver, formation of abscesses ; also general exhaustion ; especially 
in putrid and typhoid fevers. 

A gradual decrease, in acute diseases, denotes gravity and obstinacy of 
such diseases, and is a sign of a dangerous affection of the brain. (Sprengel.) 

A broad tougue is found in rachitis, scrofula, inclination to abdominal 
affections and in intermittent fevers. 

A narrow, pointed tongue is said to be found in persons who are subject 
to spitting of blood, tuberculosis, and internal inflammations. 

A thick, swollen tongue is found in rachitis, cretins, chronic dropsy of 
the head, in obstinate dyspnoea and chronic inflammation of the mucous 
membrane of the stomach ; also in intermittent fevers, catarrhal affections, 



264 TONGUE. 

mercurial salivation, inflammation of the tongue, in old drunkards; after 
death by strangulation or suffocation. 

A swollen and heavy tongue in old age is the forerunner of apoplexy ; the 
same in drunkards. In fevers, if associated with dryness and stammering 
speech, it denotes congestion of the brain. In croup, pleurisy and pneumonia, 
it is a bad sign, just as bad as its sudden diminution, without improvement of 
the other symptoms. (Hippocrates.) 

A thin, like a small, tongue is found in atrophy, consumptive diseases. 

Tumors on the tongue, if hard, brownish-red, with bluish blood-vessels 
interwoven, are of a scirrhous nature. 

Single lumps and fleshy excrescences on the tongue are found in elephan- 
tiasis. 

6. Its Consistency. 

We find a hard tongue associated with great dryness of the tongue in 
congestion, inflammation, in fevers, in tonic spasms, in scirrhus and other 
degeneratioDs of the substance of the tongue. 

A soft tongue we find in catarrhal affections, in chronic mucous diar- 
rhoea, gastric derangements and in paralysis of the tongue. When soft, the 
teeth generally show their imprints on its sides — often found after mercurial 
poisoning. In brain diseases a soft tongue is a bad sign. 

7. Cracks and Fissures 

On the dry tongue, sometimes deep, bleeding and suppurating, are found in 
typhoid fever, in small-pox, dysentery. 

8. Paralysis 

Of the tongue, which manifests itself by an imperfect, stammering speech, 
is often the consequence of apoplexy, softening or other affections of the 
brain. 

Its immobility and its trembling are signs of torpor of the brain, especially 
in consequence of typhoid conditions, puerperal fever and septicaemia. 

THERAPEUTIC HINTS.— A red tongue all over with considerable 
raised papillae: Arum triph., Bellad., Hyosc, Merc, com, Tart, 
emet. 

Bed, glistening tongue: Kali bichr., Laches. 

Bed tip: Arg. nitr., Morphium. 

Bed tip in the shape of a triangle: Rhus tox. 

Bed tip, undefined and red borders : Sulphur. 

Bed borders: Bellad., Bryon., Morphium, Nux vom., Sulphur. 






EXAMINATION OF TONGUE. 265 

Red streak in the middle of a yellowish-coated tongue: Ver. vir. 

Lead-colored tongue: Arsen. 

Bluish tongue : Arsen., Digit., Mur. ac, Thuja. 

White, thick coating: Ant. crud., Arsen., Bryon. and many others. 

Whole tongue as if painted white: Glonoin. 

White coating and cracks across the middle: Kobalt. 

White coating only on one side: Rhus tox. 

A white streak on both sides: Caustic. 

In the middle only: Bryon., Phosphor. 

On the root only, strongly marked: Sepia. 

Map tongue: Arsen., Lac. vac, Laches., Natr. mur., Nitr. ac, 
Tarax. 

Yellow coating: Many remedies. 

Brown coating: Arsen., Bellad., Cactus, Coccul., Kali bichr., 
Merc, prot., Plumbum, Secale, Silic, Spongia, Sulphur. 

A dry, white tongue, without thirst: Bryon., Pulsat. 

Dry, white, without thirst and paralyzed : Nux mosch. 

Dry, white, and feeling as if burnt or scalded: Psorin., Pulsat., 
Sepia. 

Dry and cracked: Arsen., Bellad., Chamom., Kali bichr., 
Rhus, tox., Ver. alb. 

Dry and red: Arg. nitr., Bellad., Chamom., Hyosc, Laches., 
Lycop., Morphium. 

Dry, red and cracked at the tip: Kali bichr., Laches., Rhus tox., 
Sulphur. 

A black coating: Arsen., China, Elaps, Laches., Mercur., 
Opium, Secale, Ver. alb. 

A soft tongue, with imprints of teeth: Mercur., Rhus tox., Stramon. 

A clean tongue with gastric and other derangements: Cina, Digit. 

Trembling and inability to protrude the tongue in typhoid conditions : 
Laches. 

Heavy, trembling tongue, with falling of lower jaw in typhoid conditions : 
Lycop. 

Spasmodic darting of the tongue out of mouth in typhoid • conditions : 
Lycop. 

Protruding of tongue with silly expression in diphtheria: Lycop. 

Protruding, cold and lame : Hydr. ac 

Paralysis of tongue: Aeon., Arsen., Bar. carb., Bellad., Caustic, 
Dulcam., Graphit., Hyosc, Laches., Nux mosch., Opium, Plum- 
bum, Stramon. 

Difficulty of moving the tongue: Anac, Bellad., Calc carb., Lycop. 



266 TONGUE. 

Heavy tongue: Anac, Bellad., Carb. veg., Colchic, Lycop., 
Mur. ac, Natr. mur., Plumbum. 

Stiffness of tongue: Borax., Colchic, Euphras., Laches., Natr. mur. 

Glossitis, Inflammation of the Tongue. 

We understand by this name an infiltration of the parenchyma of the 
tongue, which is either confined to only a portion of the tongue, Partial 
glossitis, or pervades the entire organ, Glossitis diffusa universalis. A 

mere superficial inflammation of the mucous membrane of the tongue 
belongs as part to inflammatory processes of the general mucous membrane 
of the mouth. 

The most important symptom of an Universal glossitis is the rapid 
swelling of the tongue, which in a day or two may acquire such dimensions 
as to prevent by its pressure upon the pharynx and epiglottis not only 
swallowing, but also breathing and to cause death by suffocation in a few 
hours. The patient is seized with paroxysms of asphyxia, as in croup, 
becomes cyanotic and suffocates, if breathing is not restored. The tongue, 
not having room in the mouth, also protrudes, and presses side wise between 
the back teeth, causing deep indentations with immediate disposition to the 
formation of ulcers. The neighboring lymphatic and salivary glands also 
become swollen. The pain is severe, and extends to the ears and throat. Its 
course is rapid, terminating either, as before stated, in death by suffocation, 
or in a gradual subsidence of the swelling, or in the formation of an abscess, 
which mostly breaks through the surface of the tongue. Even gangrenous 
destruction of large portions of the tongue has been observed as a result of 
mercurial glossitis, and at times there remain circumscribed indurations, 
with a disposition to renewed attacks. 

Partial glossitis usually commences as a painful tumor from the size 
of a pea to that of a bean on the back part of the tongue, which gradually 
suppurates, finally breaks and discharges. It is not attended with any 
special disturbance of the general health. 

The Causes of a genuine parenchymal glossitis are not clear by any 
means. Some have recorded epidemics of this disease ; others have observed 
it as a consequence of anthrax poison; others as the result of mercurial 
poisoning, and still others as the effect of the sting of a wasp, bee, or hornet. 
Sporadic cases of glossitis have in nowise been etiologically explained. The 
most fatal are those caused by the poison of anthrax — Glossanthrax — or 
carbuncle of the tongue. 

THERAPEUTIC HINTS —If anthrax, bee, wasp and hornet-stings, 
and mercurial poisoning are set down as causes of glossitis, we naturally will 
find powerful remedies for this disease in : 



CANCER OF THE TONGUE. 267 

Anthrac, especially when there is great burning and a disposition to 
gangrene ; after Arsen. 

Apis, when there is stinging and burning pain, with blisters on the 
tongue. 

M ere. sol., when there is ulceration, and great flabbiness of the tongue, 
with salivation. 

Besides compare: Plumbum, Kan. seel., Sepia, and 

Arsen., great burning and tendency to gangrene. 

Laches., blisters which change into ulcers. 

Petrol., fetid salivation. 

Sulphur, ulcerated tongue. 

Camphora, or Natr. mur., when caused by an insect sting. 

Cupr. ac, Calc. carb., Hepar, Nitr. ac, Sulphur, after abuse of 
mercury. 

Canthar., after scalding the tongue. 

Calc. carb., Carb. veg., Conium, Hepar, Lycop., Mezer., 
Silic, Sulphur, when indurations remain and the case becomes chronic. 

Arnica, Hypericum, traumatic origin. 

Asaf., Hepar, Nitr. ac, Staphis., mercurial poisoning. 

Cancer of the Tongue 

Is of the epithelial kind and commences usually at the edge, near the tip of 
the tongue, as a small, hard lump, which after a while forms an ulcer of a 
roundish shape, with raised edges and uneven bottom. It distinguishes itself 
from every other ulcer by its continuous encroachments, by its hard, larda- 
ceous bottom, by the viscid, milky juice which can be squeezed out by press- 
ure upon its edges, and by the lancinating, boring, burning pains, with 
which it is attended, robbing the patient of rest at night, and not unfre- 
quently leading him to suicide. By-and-by the adjacent parts of the tongue 
begin to swell, and the cancer itself spreads either upon the superior or 
inferior surface of the tongue. In its further progress the motion of the 
tongue becomes impeded, and the swallowing of solid food impossible. A 
great deal of saliva is secreted, and as the swallowing is painful and difficult, 
the patient spits all the time. The glands under the tongue, and also the 
lymphatic glands of the neck become affected ; they swell and harden ; the 
tongue becomes firmly attached to the bottom of the mouth, so that its 
motion is almost destroyed ; it gradually is transformed into a thick, short- 
ened, misshapen lump, with round protuberances upon it, which break and 
emit a terrible smell. Sometimes the glands of the neck and the region of 
the parotid glands swell to such an extent that it is impossible for the 
patient to open the mouth, and he gradually sinks under excruciating suf- 



268 THE SALIVARY GLANDS AND THEIR DUCTS. 

fering, starvation and exhaustion. The disease is slow, lasting from one to 
three years. 

THERAPEUTIC HINTS.— Compare Arsen, Caustic, Carb. an. and 
veg., Conium, Hydrast., Laches., Nitr. ac., Phytol., Sepia, Silic, Sulphur. 
Galium ap. (Clifton and Bailey), Mur. ac. (Cooper). 

Sedum acre, sempervivum tectorum. 



THE SALIVARY GLANDS AND THEIR DUCTS. 

There are three pairs of such glands : the parotid, which is situated near 
the ear on each side; the submaxillary, lying in the posterior angle of the 
submaxillary triangle of the neck on each side ; and the sublingual, which is 
imbedded beneath the mucous membrane of the floor of the mouth on each 
side of the frsenum linguae. The excretory ducts of the parotid, called 
Stenon's ducts, open at the internal surface of the cheeks, opposite the second 
molar tooth of the upper jaw; those of the submaxillary, called Wharton's 
ducts, open by the side of the frsenum linguae; and those of the sublingual, 
which are seven or eight in number, also open in this same locality. The 
product which they pour forth into the mouth is the saliva. This very im- 
portant fluid is greatly altered by disease; but still, all the microscopical 
and chemical researches have failed to reveal any facts which can be con- 
sidered of diagnostic value. 

The saliva varies in Quantity. 

There is normally less secretion in the first four months of infancy, and 
also in the last years of old age. But its secretion may be abnormally les- 
sened by deficiency of beverage, or by different pathological conditions, 
which induce copious secretions of fluids, either through the skin, or kidneys, 
or serous membranes. 

An increase of saliva (salivation, ptyalism) may be caused by various 
drugs, as our Materia Medica shows; but the most known and the most 
virulent is that caused by mercury, being accompanied by a most sickening, 
penetrating smell from the mouth, swelling and inflammation of the gums, 
loosening and falling out of the teeth, stomatitis, and ulceration of the 
mucous membrane. We find an increase of saliva also in many diseases of 
the cavity of the mouth, of the tongue, in caries of the teeth, in necrosis of 
the jaw, during the eruption of the milk teeth, in acute and chronic irrita- 
tions of the parotid and submaxillary glands, during the eruption of small- 
pox in the mouth; sometimes at the commencement of typhus; in conse- 
quence of irritation of the trifacial, the facial and the glosso-pharyngeal 
nerves ; in consequence of diseases of the stomach, of the pancreas and spleen ; 



PAROTITIS. 269 

in interrnittents ; during pregnancy, menstrual disturbances, climaxis and in 
many hysterical conditions. 

The Color of the saliva may also be changed. 

A blue color has been observed in slow poisoning cases by lead. 

Yellow, even greenish saliva has been found in liver complaints and 
jaundice. 

A red, bloody saliva in different morbid conditions, when it becomes 
mixed with blood, as in haemorrhage from the mouth or nose, inflamed and 
bleeding gums, etc. But has also been found in suppression of hemorrhoidal 
and menstrual discharges. After external injury of the head, bloody saliva 
is, like bleeding from the ears, a sign of fracture of the skull bones. 

Its Chemical reaction in a healthy state is slightly alkaline; if it be 
acid, it indicates a disturbance in the digestive organs. It may also become 
acid in diseases of the intestines, in rachitis, gout, and in scrofulous condi- 
tions. In a normal state, saliva contains more or less sulphocyanide of 
potash or soda, which can be easily detected by adding a drop of sesquioxide 
of iron to some saliva, which changes it to a deep red color. During small- 
pox this substance seems to be wanting in the saliva, and be present in the 
contents of the pustules. 

Parotitis. 

1. Its idiopathic form is known under the name of Mumps. It fre- 
quently appears epidemically, and is contagious. Children from two to 
fifteen years of age are most prevalently affected, while nurslings and old 
people are exempt. One attack protects against re-infection. 

Its outset may not be marked by any precursory symptoms ; sometimes 
it is preceded by pains in the limbs, headache, loss of appetite, chilliness and 
feverishness towards evening; sometimes by vomiting and diarrhoea, great 
anxiety, fainting, even convulsions. Its period of incubation is estimated 
from about six to eight or ten days. The inflammation of the gland mani- 
fests itself by pain in the region where the affected gland is situated, espe- 
cially when opening the mouth, and a swelling below the lobe of the ear — 
almost always only on one side, — which rapidly increases, and gives to the 
face an odd look. This swelling is of a doughy feel and never sharply cir- 
cumscribed ; it i3 caused by enlargement of the gland itself, and still more 
by an oedematous infiltration of the adjacent connective tissue, and may, 
indeed, attain to such an enormity that the movements of expression of the 
face become entirely suspended, giving to the patient an idiotic appearance. 
It also extends to the tonsils, the pharynx, and may invade even the larynx, 
when corresponding symptoms will develop. The skin over the swelling is 
either pale, waxy, glistening or somewhat reddened, or of a purplish hue. 



270 SALIVARY GLANDS. 

Besides stiffness, pain and incapability of all movements which talking, 
chewing and swallowing would require, the patients are sometimes troubled 
with hardness of hearing, pain in the ear, salivation or great dryness in the 
mouth, loss of appetite, vomiting, constipation and even with symptoms of 
cerebral hyperemia, the result of pressure upon the veins in the neck. 

As a rule only one parotid is thus attacked; sometimes, however, the 
inflammation goes from one side to the other successively, and this lengthens 
the course of the disease for a few days; a simultaneous attack of both glands 
has not been observed. 

The elevation of temperature and increased rapidity of the pulse, in 
most epidemics, is of no great amount; by the fourth or fifth day usually all 
fever has left; in some cases, however, a rise of temperature in the evening 
to 104° F. for several days, has been observed. 

In most cases the local and general symptoms have culminated in from 
three to six days, when they gradually subside in about the same length of 
time, so that the entire morbid process is completed in from one to two weeks. 

At times, however, we meet with complications in pubescent youths and 
men, consisting of an inflammation of one testicle, most commonly that of 
the right side, or of both sides successively, in the same manner as a bilateral 
parotitis. It does not set in until the parotideal inflammation has ceased, 
and is attended with a renewal of the fever. In some cases there is an 
epididymitis combined with an acute hydrocele and oedema of the subcuta- 
neous connective tissue of the scrotum ; in severe cases there is also a gonor- 
rhoea-like discharge from the urethra aud burning pain during micturition. 
Patients suffering with gonorrhoea, on the contrary, are according to Blondeau, 
not at all disposed to orchitis, and the mumps generally pursues its course 
free from all complications. 

In the female sex a metastatic swelling of the mammae or the external 
genitals, of the ovaries or of the inguinal glands, has been observed, while 
in still other cases the conjunctiva and mucous membrane of the throat, 
urethra and vulva have become involved. Some cases terminate in gangre- 
nous destruction of the gland for unknown causes. 

THERAPEUTIC HINTS.— Bellad., brigU red swelling, especially 
on right side ; fever and brain symptoms. 

Mercur., pale swelling, little fever, often indicated. 

Rhus tox., dark red swelling, especially on left side, or going from left 
to right; restlessness and fever. 

Euph. off., if Rhus tox. should not help, also dark red color, with 
burning and stinging pain. 

Carb. veg., if Mercur. should not be sufficient or should have been 



PAROTITIS. 271 

abused ; lingering fever ; also when there are hoarseness or metastatic symp- 
toms of the stomach. 

Coccul., if Carb. veg. should not relieve the lingering fever. 

Arsen., Aurum, Carb. veg., Nux vom., Pulsat., in metastasis 
to testicles. 

Arnica, testicles inflamed; great tenderness; loose stools during day; 
complains of hardness of bed on which he lies. 

Apis, Laches., Pulsat., Sulphur, metastasis to female organs. 

2. The symptomatic form of parotitis, called Deuteropathic or Me- 
tastatic parotitis, is most frequently associated with typhus in all its forms, 
with scarlet fever, measles, and small-pox; with pyaemia, puerperal fever, 
dysentery, typhoid cholera, and in the tropics, with yellow fever. 

The swelling of a metastatic parotitis is much harder and more defined, 
and also more prone to suppuration than that of mumps. In fact, absorption 
occurs only rarely in metastatic parotitis ; it goes on to suppuration or even 
to mortification, if the patient lives long enough. If it breaks in time and 
discharges fully, cicatrization by granulation may follow; or new abscesses 
in other parts of the gland may form and fistulous openings be the result ; 
or the walls of the abscess may be transformed into an ichorous cavity and 
finally become gangrenescent, involving by degrees adjacent parts by further 
infiltration and gangrene. In the latter case the discharge assumes a cadav- 
erous odor and consists of gangrenous shreds ; the external skin darkens and 
becomes black. 

Its Prognosis depends much upon the nature of the disease which it 
attends. As a rule it may be stated, "that it is the more unfavorable and 
dangerous the earlier it appears in connection with typhus, scarlatina, etc., 
while its course is mostly favorable when it occurs during convalescence from 
these infectious diseases." 

THERAPEUTIC HINTS.— When suppurating: Arsen., Hepar, 
Phosphor., Silic. 

When fistulous openings have formed: Lycop., Nitr. ac, Phytol. 

When indurated : Bar. mur., Calc. carb., Carb. veg., Clemat., 
Conium, Iodium, Kali carb., Lycop., Silic, Sulphur. 

When gangrenous : Arsen., Kreos., Laches. 

After scarlet fever: Arsen., Bar. mur., China, Kali carb., 
Laches., Lycop., Nitr. ac, Rhus tox., Silic 

Ranula, Frog. 

It consists of a swelling on the floor of the mouth under the tongue, 
either in the middle, or on one side of the frsenum linguae, caused by a widen- 



272 THE TONSILS. 

ing of Wharton's duct in consequence of obstruction by minute foreign 
bodies which have become lodged there aud incrustated. It presents itself 
on inspection as a soft, elastic, fluctuating and transparent kind of blister or 
bag, whose sheath is similar to a fine serous membrane, and the contents of 
which consist of a gluey, transparent, pale-yellowish or brownish fluid, of 
alkaline reaction, and without microscopic elements. It varies considerably 
in size and form, the latter depending somewhat on the former. When 
small it is globular; but as it increases its shape is modified by the surround- 
ing tissues. Cysts and abscesses are also formed in this locality with which 
ranula must not be confounded. 

THERAPEUTIC HINTS.— Compare Apis, Bellad., Calc. carb., 
Fluor, ac, Mercur., Mezer., Nitr. ac, Thuja. 

Ambra grisea, " excoriating feeling in mouth, preventing eating, with 
an insipid, rancid taste." (Gilchrist.) 

THE TONSILS 

Lie between the two palatine arches and generally project distinctly beyond 
them, though in a variable degree. Their form is that of an oval disc, some- 
times of a flattened globe. Their size varies much, so that no positive vol- 
ume can be determined on. Their free superior surface, being moderately 
red, presents from ten to sixteen round or linear openings, which are barely 
visible ; sometimes they are wider and more like fissures. They lead into 
longer or shorter fissures (lacunae, sinuses), running perpendicularly or ob- 
liquely in various directions, and sometimes giving off branches. The lacu- 
nae are lined with a thin but uniform layer of epithelium. The tissue sur- 
rounding the lacunae consists of follicles and interfollicular tissue. The fol- 
licles are composed of reticular tissue, with few capillaries, and of small, 
round cells imbedded in them. The interfollicular tissue is of an essentially 
similar character, only it is richer in capillaries, and contains small arteries 
and veins. The framework of the tonsils consists of a fibrous connective tis- 
sue, by which they are also surrounded and fastened to different pharyngeal 
muscles. 

Inflammation of the Tonsils; Amygdalitis; Tonsillitis; An- 
gina tonsillaris. 

There is a Simple catarrhal inflammation of the mucous membrane 
covering the tonsils, which is in most cases only part of a general pharyngeal 
catarrh. A Lacunal or Follicular catarrh of the tonsils is deeper, pro- 
duces a thin or thick whitish, yellowish, curdy substance which, when thick, 



TONSILLITIS. 273 

adheres tightly and consists of epithelium and pus. It may be confounded 
with herpetic angina, mild diphtheritis, or even with superficial abscess of the 
tonsil. The tonsils in such cases are always more or less swollen and the pala- 
tine arches inflamed. This morbid process yields mostly in a few days after a 
spontaneous evacuation of the epithelial and purulent contents ; or the con- 
tents may dessicate, and then become foul, or calcareous. Those little, cheesy 
lumps, which at times with some patients, when hawking forcibly, fly out of 
the mouth, are of this origin. In still other cases it may give rise by exten- 
sion to a Parenchymatous amygdalitis, which is characterized by a high 
grade of congestive hyperemia and serous infiltration, in consequence of 
which the tonsil or tonsils — for it may be unilateral or bilateral — become 
enormously swollen. This state of things results either in a return to the 
normal form by absorption, or in an infiltration of small cells, both in the 
interior of the follicles and between them, and a consequent new formation 
of reticulated substance giving rise to a permanent hypertrophy of the ton- 
sils ; or in the formation of several abscesses. Sometimes an abscess forms 
in the connective tissue surrounding the tonsils — Peritonsillar or Retro- 
tonsillar abscess — most frequently between the tonsil and the affected pala- 
tine arch, usually the anterior arch. This affection ordinarily involves but 
one tonsil, sometimes the other, several days afterwards, forms a walnut-sized 
protuberance, which usually terminates in perforation, followed by a rapid 
return to the normal condition. This formation of abscesses is commonly 
known under the name of Quinsy. 

In clinical practice we cannot always distinguish between these different 
pathologico-anatomical forms; neither does it matter. Either of them, with 
the exception of the superficial catarrhal form, may be accompanied with 
great pain, swelling of one or both tonsils, impossibility of swallowing and 
talkiug, of opening the mouth or moving the head. They are mostly asso- 
ciated with hyperemia, or collateral oedema of the pharynx, extending 
sometimes into the Eustachian tubes, with pain in the ears, or to the larynx, 
with dyspnoea or paroxysms of suffocation, especially on lying down. Fever 
attends all more severe cases, especially those with suppuration ; the temper- 
ature may rise to 104° F., with morning remissions and evening exacerba- 
tions. There is loss of appetite; sometimes headache, delirium, and even 
convulsions have been observed in children at the commencement. 

The duration of a superficial and lacunal tonsillitis varies between 
three and eight days, while a parenchymatous amygdalitis and a tonsillitis 
with abscess lasts at least eight days, frequently a week and a half, and even 
as long as two or three weeks. Persons once affected by tonsillitis are liable 
to repeated attacks. Fatal terminations are exceedingly rare. 

THERAPEUTIC HINTS.—" The much recommended timely open- 
18 



274 TONSILS. 

ing of tonsillar abscesses is of little use, because it is very seldom successful, 
and, even when it succeeds, hardly ever relieves the patient. It is somewhat 
different in anterior peritonsillar abscess; but even then the relief to the 
patient is seldom as great as after spontaneous discharge. Deep incisions 
are not advisable, owing to the contiguity of carotid artery." (Wagner, 
allopathic authority.) 

It is strange, that in some " homoeopathic" works we find the use of the 
Bistory still advocated. 

Amm. mur., both tonsils swollen; can neither swallow, talk, nor open 
the mouth ; after taking cold. 

Apis, stinging, burning pain when swallowing; dryness in mouth and 
throat; red, highly inflamed tonsils; oedematous swelling of fauces and 
glottis. Fears open air, yet cannot stand the warm room ; thirstlessness. 

Bar. carb., liability to tonsillitis after slight cold, or suppressed 
sweat of feet ; tonsils tend to suppurate ; especially right side. 

Bellad., especially right side; parts bright red; also swelling of the 
neck, externally, painful to touch and motion ; cerebral symptoms. 

Hepar, sticking pain as from a fishbone in the throat when swallow- 
ing; tendency to suppurate ; after mercury. 

Ignat., in follicular catarrh, almost specific. 
Kali hydr., or Iodium. (Kafka.) 

Laches., especially left side; choking when drinking; fluids are driven 
out through the nose ; worse in afternoon, after sleep, from slightest touch ; 
can't bear bedclothes near the neck. 

Mercur., dark redness; fetid ptyalism; very offensive smell from 
mouth ; aphthae or thick coating on the tongue. 

Phytol., "pain at the root of the tongue or to the ears when swallow- 
ing, much dryness of the throat, with soreness, fauces and tonsils appear 
dark, perhaps of a bluish cast." (Wm. Jeff. Guernsey.) 

Plumbum, angina on left side, with copious flow of purplish saliva 
and spasms. 

Silic, in stubborn cases where abscesses are forming, yet don't break, 
especially left side. 

Sulphur, when, after the bursting of the abscess, the parts still remain 
irritated, and the patient does not recover as fast as he should. 
For chronic enlargement and induration : 

Bar. carb. and mur., Calc. carb. and jod., Ignat., Lycop. 
Phosphor., mucus in throat removed with difficulty; it is white, nearly 
transparent, in lumps and quite cold when it comes into the mouth. 

Phytol., enlarged tonsils and uvula; tonsils of a bluish cast ; harrassing, 
hawking cough, after every cold. 
Psorin. and Sulphur. 



ANGINA FAUCIUM. 275 

THE UVULA AND SOFT PALATE. 

These parts may be variously affected, being always more or less 
involved in diseases of the neighboring tissues. We have ansemia, hyper- 
emia, haemorrhage, inflammation, oedema, ulceration, phlegmon, thrush, 
diphtheritic exudations, atrophy, syphilitic affections, morbid growths and 
cancer presented to our observation, and also motor and sensory disturb- 
ances. 

Paralysis may be limited to the muscles of the soft palate, or may 
occur with paralysis of other muscles, most frequently those supplied by the 
facial nerve, or in connection with catarrh, phlegmonous inflammation, 
morbid growths, etc., and in consequence of diphtheritis, the most frequent 
form. Its various forms interfere more or less with swallowing, talking and 
breathing. 

Anaesthesia of the soft palate, mostly with diminished reflex irritability, 
is found in insane patients, and also in consequence of the influence of some 
substances upon the periphery (ice, bromide of potassium, morphine, lye, 
etc.). Diphtheritic paralysis is almost always combined with anaesthesia. 

Hyperesthesia occurs as well with the maintenance of a normal ap- 
pearance of the parts, as in the various disturbances of circulation and the 
inflammations. 

What in common life is styled "falling of the palate" is an inflamma- 
tion and oedema of the llYllla, by which it becomes greatly enlarged, 
causing a constant hacking and hemming, and interfering with swallowing 
and breathing. 

THERAPEUTIC HINTS.— The remedies which act especially upon 
the uvula and soft palate, are: Aeon., Argent., Bellad., Coffea, Crot. tigl., 
Gelsem., Hepar, Ignat., Iodium, Kali bichr., Laches., Merc, sol., Merc, subl., 
Xatr. mur., Nitr. ac, Xux vom., Phosphor., Phytol., Sulphur. 

Angina Faueium, Angina Catarrhalis, Sore Throat. 

This catarrhal affection frequently involves the mucous membrane which 
covers the soft palate, tonsils and back part of the throat (fauces). The 
parts redden and swell, are at first dry and afterwards covered with a whitish 
tough phlegm, which especially assumes on the tonsils to a certain degree an 
appearance of diphtheritis. In its acute form it is mostly attended with some 
fever, painful deglutition, a heavily coated tongue, bad taste and an increase 
of saliva. Deglutition in bad cases, where the palatine and pharyngeal mus- 
cles are involved, becomes utterly impossible, so that an attempt at swallow- 
ing causes either choking or an expulsion of the fluid through the nose. For 



276 FAUCES. 

this reason, also, the voice of the patient assumes a nasal twang in talking. 
Sometimes the inflammation extends higher up into the naso-pharyngeal 
cavity, affecting the Eustachian tubes and causing hardness of hearing and 
stitch-pain in the ears. 

It is caused either by atmospheric influences and a constitutional dispo- 
sition (idiopathic form), or is part and portion of certain acute diseases, such 
as scarlet fever, small-pox, measles, etc. (symptomatic form). At times an- 
gina faucium prevails epidemically. 

THERAPEUTIC HINTS— Aeon., dryness with burning, stinging 
and drawing in the throat, making swallowing painful, feverishness, impa- 
tience and restlessness. Cold west and north-west winds. 

Apis, burning, stinging pain, or pressing as from a hard body; redness 
and swelling of tonsils, uvula and tongue; abundant collection of soapy 
saliva ; painful deglutition or impossibility to swallow. 

Bellad., scarlet redness; stitches extend into the ear; painful deglu- 
tition or impossibility to swallow, the fluid escaping through the nose ; swell- 
ing of cervical glands ; red face ; congestion to the head ; headache ; fever. 

Bryon., gastric derangement; tongue heavily coated, dirty yellowish; 
insipid, pappy taste; constipation; chilliness; motion increases the pain; 
irritableness. 

Ignat., lump in throat; pain in throat worse between the acts of swal- 
lowing ; whitish tough mucus in spots on tonsils, simulating diphtheria. 

Laches., throat feels constricted; lump in throat; constant desire to 
swallow, though difficult and painful; neck sore to touch; all symptoms 
worse on left side, in the morning after sleep, and in the afternoon. 

Merc, sol., redness and swelling of the parts; whitish, smeary concre- 
tions on tonsils; tongue thickly coated, whitish; flow of slime and saliva 
from mouth; constant inclination to swallow; pain in parotid glands and 
muscles of the neck. Fever exacerbation in the evening. 

Merc. corr. subl., when there is no swelling of the tonsils. Very 
often subdues the inflammation quickly when given at the commencement. 
(Bolle.) 

Nux vom., catarrh in head and throat, with a feeling of soreness, raw- 
ness, scraping and the sensation of a lump in throat on swallowing; after 
taking cold. 

Petrol., feeling of great dryness in the throat, with abundant accumu- 
lation of mucus at the same time. Stinging, burning pain in throat during 
deglutition, extending into the ears and neck. Great thirst and costiveness. 

Pulsat., dark, bluish redness with varicose veins, scraping rawness and 
dryness in throat, without thirst. 

Sanguin., throat feels sore and as if scalded by hot drinks; dry and 



ANGINA FAUCIUM. 277 

constricted; drinking does not relieve the dryness; mucous membrane feels 
as if it would crack, is red and inflamed. 

Chronic Sore Throat, Angina Granulosa or Follicularis. 

It is characterized by little, roundish, elevated spots, like peas split in 
half, which stand either singly, scattered over the pharyngeal wall of the 
fauces, or in rows or ridges extending from above downwards ; or the mucous 
membrane of that locality appears smooth, but dry and glistening; or it is 
covered with a tough, whitish or yellowish-greenish mucus, or brownish and 
bloody crusts or skinny substance, which is very difficult to detach. In 
these cases the catarrhal affection extends up into the na&o-pharyngeal 
eavity, and is mostly connected with chronic nasal catarrh ; but it also may 
spread downwards to the larynx, where its presence causes laryngeal irrita- 
tion and cough. The color of the fauces varies from a bright redness with 
enlarged veins radiating in various directions, to a deep brown-red hue ; in 
still other cases there is very little redness. Usually it is attended with very 
little pain, perhaps some raw feeling or scraping, and with scarcely any dif- 
ficulty in swallowing. The great annoyance of the patient is a feeling of 
dryness and the accumulation of tough phlegm which he constantly tries to 
remove by hemming and hawking, especially in the morning. In conse- 
quence of these, sometimes very violent efforts of cleansing the throat, small 
blood-vessels burst, which may unnecessarily alarm the patient, when he 
finds himself spitting blood. It is a very stubborn complaint and exercises 
a depressing influence upon the patient, who is kept in constant fear of going 
into consumption. 

This kind of chronic catarrh is frequently found with public speakers, 
clergymen and the like, wherefore it has received the popular name of 
preacher s sore throat, an application which, like many popular definitions, is 
not altogether well defined. For although the so-called preacher's sore 
throat in many cases may be attended with a chronic catarrh of the fauces, 
the sudden giving out of the voice, or hoarseness after loud and forced 
speaking, is mainly the effect of overstraining the muscles of the soft palate 
or vocal cords. 

THERAPEUTIC HINTS. -Alum., soreness, rawness, hoarseness, 
dryness, or secretion of thick, tough phlegm; worse in the afternoon and 
evening, better from eating and drinking warm things. 

Arum triph., constant hawking; profuse secretion from posterior nares 
and fauces; hoarseness, worse from talking. 

Arg. nitr., collection of thick, tough phlegm, causing gagging; wart- 



278 FAUCES. 

like excrescences; feeling of a pointed body in the throat when swallowing, 
belching, breathing, or moving the neck. 

Arnica, great hoarseness from preaching or public speaking. 

Caustic, burning in the throat, worse on stooping; hoarseness from 
singing. 

Elaps, sore throat, offensive discharge from the nose, occasional epis- 
taxis. Posterior wall of throat covered with a dry, greenish-yellow mem- 
brane, wrinkled and fissured, which extends to the nares. Occasionally 
portions of it become detached and are expelled either by mouth or nose. 
Stuffiness at root of nose and dull aching from there to forehead. Smell 
gone. Catamenia generally profuse and dark. 

Kali bichr., secretion of very ropy or stringy phlegm through the 
posterior nares and fauces. 

Laches., much inclination to swallow, although it is very painful, with 
spasmodic contraction of the throat; worse on left side, and worse after 
sleep; can't bear any pressure about the neck. 

Lycop., the fauces look brown-red; worse on right side; sometimes a 
hard green-yellowish phlegm is hawked up in the morning. 

Natr. carb., slight redness and continual sensation of rawness and 
scraping; diminished secretion, with constant desire to hawk and hem; 
collection of mucus in the night; painfulness of throat on swallowing and 
gaping. 

Natr. mur., always after local applications of nitrate of silver; feel- 
ing of great dryness in the throat, and yet a constant hawking up of a trans- 
parent, thin mucus. Sensation of a plug in the throat; uvula elongated; 
the action of the muscles of deglutition is diminished; the food goes the 
w T rong way, or does not go down at all. 

Petrol., in dry, sore throat, with mucous secretions; stitches into the 
ears during deglutition, and burning in the neck. 

Phosphor., when the throat is very dry, fairly glistening. 

Plumbum, when the disease spreads from left to right. 

Phytol., dryness, feeling as if a ball of red-hot iron had lodged in the 
fauces, when swallowing; can't eat hot fluids; choking sensation. 

Sapo sodse, after burning the throat by swallowing hot things. 

The following hints in the form of a repertory have been prepared by 
Dr. F. M. Selfridge: 

Uvula and fauces dark red, Arg. nitr. 

Uvula elongated, Bromium, Wyethia. 

Swelling and elongation of the uvula, Iodium, Kali hydr. 

Uvula relaxed, with a sense of a plug in the throat, not relieved by 
swallowing, Kali bichr., Laches. 

Uvula elongated, fauces purple and swollen, Laches. 



ANGINA FAUCIUM. 279 

Thick, tenacious mucus, obliging him to hawk, Arg. nitr. and Merc, 
iod. ; mucus cannot be raised by hawking, Caustic. ; mucus in fauces and 
posterior part of the pharynx, mornings, difficult to hawk up, Kali carb. 

Rawness, soreness and scraping in the throat, Arg. nitr., Caustic. 

Wart-like excrescences in the throat, feel like pointed bodies when 
swallowing, Arg. nitr. 

Posterior wall of pharynx dark red, glossy, puffed, showing pale red 
vessels, Kali bichr. 

Burning and dryness of fauces and pharynx, Arg. nitr., Sanguin., 
Wyethia. 

Burning in pharynx, extending to stomach, Kali bichr., Sanguin., 
Wyethia. 

Dryness of roof of mouth, fauces and throat, Bellad., Wyethia. 

Throat feels raw and sore, looks red and shining, Bellad., Sanguin. 

Throat feels constricted, as if tied, Laches, or Iodium. 

Dryness of the throat posteriorly, Caustic, Wyethia. 

Constant hemming to clear the throat, Wyethia ; of tough phlegm, 
Iodium. 

Must swallow continually, feels as if the throat was too narrow, Caustic. 

Must swallow on account of the dryness of the throat, yet without 
affording relief, Wyethia. 

Throat dry with frequent empty swallowing, Iodium, Mercur., 
Wyethia. 

Salivary glands much swollen, Iodium, Mercur. 

Constant urging and desire to swallow, Bellad. 

Increased flow of tough, ropy saliva, Wyethia. 

Dryness in the posterior nares, Wyethia. 

Sensation as if something was in the nasal passages ; an effort to clear 
them through the throat affords no relief, Wyethia. 

Difficult deglutition, Bellad., Wyethia. 

Swelling of mucous membrane of fauces and pharynx, Bromium, 
Wyethia. 

Mucous follicles swollen, giving a granular appearance to pharynx, 
Wyethia. (Clinical.) 

Tonsils swollen and inflamed, Bromium. 

Inflammation of the throat with burning pain, Iodium. 

Ulcers on fauces discharging cheesy lumps of offensive smell, Kali 
bichr. 

Hawking of mucus with pain in throat-pit, Caustic. 

Hawks copious blue mucus in the morning, Kali bichr. 

Dry cough with tickling in the larynx, Bellad.; in the throat-pit, 
Sanguin.; large quantities of mucus, Iodium. 



280 



FAUCES. 



Paroxysms of cough, brought on by phlegm in the larynx, Kali carb. ; 
by fits of passion or laughing, Arg. nitr. 

Cough with copious green sputa, Kali hydr. 

Cough with involuntary discharge of urine, Caustic. 

Internal soreness of larynx and throat-pit, worse in morning, Arg. nitr. 

Internal soreness of larynx, painful to touch, Bromium. 

Hoarseness, Arg. nitr., Bellad., Bromium, Kali bichr. 

Hoarseness with rawness and dryness of larynx, Laches. 

Hoarseness, worse in morning and evening, Caustic. 

Hoarseness lasting all day, I odium. 

Hoarseness with pain in chest, Kali hydr. 

Chronic laryngitis of singers, raising the voice causes coughing, Arg. 
nitr. 

Dry hacking cough caused by tickling of epiglottis, Wyethia and 
Bellad. 



Digest to Acute and Chronic Inflammation of Throat. 



Dryness of fauces: Aeon., Alum., Arg. 
nitr., Caustic, Pulsat, Sanguin., Wyeth. 

, glistening, shining: Bellad., Phos- 
phor., Kali bichr., Sxnguin. 

and constricted : Sanguin. 

, feels as if mucous membrane would 

crack: Sanguin. 

, with burning, stinging and drawing 

in the throat, making swallowing pain- 
ful: Aeon. 

, with frequent empty swallowing: 

Iodum, Mercur., Wyeth. 

, with abundant mucus at the same 

time: Petrol. 

, not relieved by drinking : Sanguin. 

of posterior nares : Wyeth. 

of roof of mouth and throat: Bellad., 

Wyeth. 

Burning: Iodum. 

and stinging : Aeon., Apis. 

Soreness, rawness and scraping: Alum., 
Arg. nitr., Bellad., Caustic., Elaps, Natr. 
carb., Nux vom., Sanguin. 

, without thirst: Pulsat. 

and red: Bellad., Natr. carb., Sanguin. 

Redness, dark: Arg. nitr. 

and bluish with varicose veins : Pulsat. 

, puffed, pale red vessels: Kali bichr. 



Merc. 



Redness, brownish: Lycop. 

, purple and swollen : Laches. 

, scarlet : Bellad. 

and inflamed: Sanguin. 

, with burning : Iodum. 

and swelling : Mercur. 

without swelling of tonsils : 

corr. subl. 

Swelling of mucous membrane of fauces : 
Bromium, Wyeth. 

Mucous follicles swollen, granular ap- 
pearance : Wyeth. 

Ulcers on fauces discharging cheesy lumps 
of offensive smell : Kali bichr. 

Wart- like excrescences, feel like pointed 
bodies when swallowing : Arg. nitr. 



Secretion in fauces of mucus, in the 

night: Natr. carb. 

, large quantities: Iodum. 

, copious, blue : Kali bichr. 

, thick and tough : Alum. 

, causing gagging : Arg. nitr. 

, obliging to hawk : Arg. nitr., Merc. sol. 

, hard and green : Lycop. 

, dry, greenish-yellow membrane, 

wrinkled and fissured, extending to 

nares: Elaps. 



DIGEST TO ACUTE AND CHRONIC INFLAMMATION OF THROAT. 



281 



Secretion in fauces and posterior nares, 

ropy, stringy, Kali bichr. 

, difficult to kaAvk up : Kali carb. 

, profuse: Arum triph. 

of soapy saliva: Apis. 

, tough, ropy saliva : Wyeih. 

, slime and saliva flowing from mouth : 

Merc. sol. 
Uvula elongated and swollen : Bromium, 

Iodum, Kali hydr., Wyeih. 

and fauces purple : Laches. 

, dark red : Arg. nitr. 

, with a sense of a plug, not relieved 

by swallowing: Kali bichr., Laches. 
Redness and swelling of uvula, tonsils 

and tongue : Apis. 
Tonsils swollen and inflamed: Bromium. 
with a smeary concretion on them: 

Merc. sol. 
, with whitish, tough mucus on them 

in spots, simulating diphtheria: Ignat. 
Salivary glands swollen: Iodum, Mercur. 



Throat feels constricted : Laches. 

, as if tied : Iodum, Laches. 

, sore to touch, can't bear any pressure 

about neck: Laches. 
Choking sensation: Phytol. 
Lump, plug, hard body, as of a: Apis, 

Ignat., Laches., Natr. mur. 

, when swallowing : Nux vom. 

Pointed body when swallowing, belching, 

breathing or moving head : Arg. nitr. 
Ball of red-hot iron, as of a, when swallow- 
ing: Phytol. 
Hoarseness : Alum., Arg. nitr., Bellad., 

Bromium, Kali bichr. 

, < morning : Caustic. 

, <C evening : Carb. veg. 

, all day : Iodum. 

, from public speaking, talking : Arnica, 

Arum triph. 

, singing : Caustic. 

, with rawness and dryness of larynx : 

Laches. 
, with pain in chest : Kali hydr. 



Constant desire to swallow, though diffi- 
cult and painful, with spasmodic con- 
traction of throat : Laches. 

Must swallow, feels as if throat were too 
narrow : Caustic. 

, on account of dryness of throat, afford- 
ing no relief: Wyeth. 

Deglutition painful : Apis, Bellad., Natr. 
carb. 

, cannot eat hot fluids : Phytol. 

, with dryness and a feeling as if a 

ball of red-hot iron had lodged in throat : 
Phytol. 

, as of a pointed body in the throat : 

Arg. nitr 

Throat painful on swallowing and gaping : 
Natr. carb. 

, and belching, breathing and moving 

the neck : Arg. nitr. 

Deglutition difficult : Bellad., Wyeth. 

, the food goes the wrong way, or does 

not go down at all : Natr. mur. 

impossible : Apis. 

, fluid escaping through nose : Bellad. 

Pain in throat, worse between the acts of 
swallowing : Capsic, Ignat. 

Hawking and hemming constant : Arum 
triph., Natr. carb., Wyeth. 

of tough phlegm : Iodum. 

, with pain in throat-pit : Caustic. 

of transparent, thin mucus with great 

dryness in throat : Natr. mur. 

, caused by a feeling as if something 

were in the nasal passages, which is not 
relieved by hawking : Wyeth. 

, does not raise the mucus : Caustic. 



Constant urging to swallow: Bellad. 
Laches., Mercur. 



Irritable : Bryon. 

Impatient and restless : Aeon. 

Headache, and congestion to head : Bellad. 

Stitches extend to ears : Bellad. 

Red face : Bellad. 

Stuffiness at root of nose and dull aching 

from there to forehead : Elaps. 
Offensive discharge from nose, occasional 

epistaxis: Elaps. 
Pain in parotid glands and muscles of 

neck: Mercur. 
Swelling of cervical glands : Bellad. 



282 



FAUCES. 



Tongue heavily coated, whitish : Merc. sol. 

, dirty, yellowish : Bryon. 

Insipid, pappy taste : Bryon. 
Great thirst and costiveness : Petrol. 
Gastric derangement and costiveness : 

Bryon. 
Catamenia generally profuse and dark : 

Flaps. 
Cough, dry, hacking from tickling of 

epiglottis: Bellad., Wyeth. 

, with tickling in larynx : Bellad. 

in throat-pit : Sanguin. 

in paroxysms from phlegm in larynx : 

Kali carb. 
from fits of passion or laughing : Arg. 

nitr. 

, with copious green sputa : Kali hydr. 

, with involuntary discharge of urine : 

Caustic. 
Internal soreness of larynx and throat-pit, 

better in morning: Arg. nitr. 
, painful to touch : Bromium. 



Chronic laryngitis of singers, raising the 

voice causes coughing : Arg. nitr. 
Fever : Aeon., Bellad. 

, better in evening : Merc. sol. 

Throat symptoms worse on left side : 

Laches. 

, right side : Lycop. 

, spread from left to right: Laches., 

Plumbum. 

, right to left : Lycop. 

, worse in afternoon : Laches. 

, and evening : Alum. 

, in morning after sleep : Laches. 

, from motion : Bryon. 

Better from eating and drinking warm 

things: Alum. 
Brought on by taking cold : Nux vom. 
cold west and north-west winds : Aeon., 

Hepar. 

swallowing hot things : Sapo sod. 

After local applications of Nitrate of 

silver : Natr. mur. 



Ulcers in the Fauces, Ulcerated Sore Throat. 

Chronic catarrh may terminate in ulceration ; or the ulcers may be the 
consequence of a scrofulous diathesis ; or they may have a syphilitic origin. 
The diagnosis of these different conditions might be accurately determined 
by a correct history. Besides, the diagnosis will be facilitated by considering 
that catarrhal ulcers are superficial; the scrofulous ulcer is deep, but has 
flabby, perhaps jagged edges, which do not project; the syphilitic ulcer, how- 
ever, is deep and rounded, with elevated serpiginous and defined borders. 



THERAPEUTIC HINTS —Compare Angina Faucium. 

Alum., the inflamed parts are spongy; the ulcerated surface secretes a 
yellow-brownish, badly-smelling pus ; a boring pain from the fauces to the 
right temple and head. 

Aurum, putrid, cheese-like smell from the mouth; deep ulcers affecting 
the bones ; after the abuse of mercury. 

Baptis., putrid, dark looking ulcers; fetid breath; great prostration. 

Hepar, after the abuse of mercury in syphilis. 

Hydrast., extensively used by western Homoeopathic physicians for 
ulcerated sore throat ; no characteristics given. 

Kali bichr., deep ulcers, eating even through the velum palati; bones 
of the nose affected ; fetid discharge from the nose ; syphilitic origin. 



RETRO-PHARYNGEAL ABSCESS. 283 

Kali hydr., syphilitic and mercurial cachexia combined. 

Laches., spasmodic contraction of the fauces when swallowing, etc. 
Compare Inflammation of Fauces. 

Mercur., ptyalism, fetid smell; secondary syphilis. 

Nitr. ac, after the abuse of mercury; syphilis. 

Sanguin., rush of blood to the head; flying heat; throbbing in the 
head from the nape upwards ; distended veins in the temples. 

Retropharyngeal Abscess. 

This affection is either an acute suppuration of the connective tissue 
between the posterior wall of the fauces and the vertebrae, occurring not un- 
frequently in children up to the tenth year of age, or it is the consequence of 
diseases of the cervical vertebrae, such as caries, fracture, especially of the atlas 
and axis. Acute suppuration of the retro-pharyngeal connective tissue 
usually takes a rapid course and develops symptoms like phlegmonous sore 
throat, in varying degrees of intensity, such as : fever, sleeplessness, dyspnoea, 
difficulty in deglutition, pain increased on motion of the head, stiffness in 
holding the head, spasms in young children, and convulsive paroxysms. 

Suppuration from vertebral affections is much slower in its course and 
its symptoms are less prominent, with the exception of an inability to turn 
the head, and the difficulty of swallowing. 

The abscess, left to itself, opens spontaneously and discharges its contents 
into the lower pharynx ; or fistulous tracks are formed towards the thoracic 
cavity, or towards the skin of the neck. 

A fatal termination may ensue by suffocation from the discharge into 
the larynx, especially daring sleep; or from compression of the larynx by 
the enormous size of the tumor ; or from secondary disease of the larynx or 
thoracic organs caused by descent of pus into the thorax. These various 
possibilities determine our prognosis. 

Its Diagnosis we can make out by inspection and palpation, as its 
location (posterior wall of fauces) distinguishes it from amygdalitis ; or the 
symptoms of vertebral affections render it at once distinguishable from other 
complaints. 

THERAPEUTIC HINTS.— Main remedies : Hepar, Silic. 

Acute suppuration of the connective tissue: Apis, Bellad., Bryon., 
Laches., Mercur., Pulsat., Khus tox. 

Affection of cervical vertebrae: Arnica, Asaf., Calc. carb., Hepar, 
Lycop., Mercur., Mezer., Phosphor., Silic, Sulphur. 

Impossibility to swallow; fluids regurgitate through the nose: Aurum, 
Bellad., Laches., Lycop., Mercur., Nitr. ac, Phosphor. 



284 FAUCES. 

Deep Inflammation of the Connective Tissue of the 
Throat; Angina Ludovici. 

" It is a very acute inflammation and suppuration of the cellular tissue 
beneath the chin, in the environs of the submaxillary glands, which has been 
named after its earliest describer, 'Ludwig,' and which has appeared epi- 
demically at various times." 

The inflammation generally begins on one or the other side of the 
hyoid bone, rarely in the middle, just over the bone. There is extensive in- 
filtration with disposition to undergo purulent or even ichorous degeneration. 
Post-mortems have shown the connective tissue and muscles of the entire 
submental region transformed into a semi-fluid, brownish mass, mixed with 
necrotic shreds of connective tissue; the submaxillary and parotid glands 
destroyed by gangrene ; the neighboring parts intensely infiltrated even as 
far as the pharynx and larynx; and the periosteum of the lower jaw loosened. 

The swelling in the hyoid region sets in with lighter or severer, or even 
complete typhous symptoms ; it grows rapidly, gets harder and larger until 
it covers the entire anterior half of the throat as far down as the sternum. 

The skin over it is tightly stretched and reddened; the lower jaw be- 
comes immovable and deglutition impossible. Respiration and circulation 
are greatly interfered with by compression of the larynx, trachea and the 
main internal jugular vein, and speech is made difficult or impossible by the 
pressure of the tumor under the tongue, which pushes it to the roof of the 
mouth and renders it immovable. It is attended with headache, vertigo, 
delirium. 

In some cases the swelling may entirely subside without suppuration, 
although absorption goes on but slowly ; in most cases suppuration sets in 
and the result is a shreddy pus, or a gangrenous ichor, with subsequent 
gangrenous destruction, septicaemia, embolism in various organs, death ; or in 
more favorable cases fistulous ulcerations, strongly contracting cicatrices, 
which produce torticollis and impeded mobility of the neck, as also caries 
and necrosis of the jaw-bones. 

Its Causes are said to be : topical irritations, catching cold, especially 
during times of prevalent rheumatism and erysipelas; and exanthematic, 
typhoid and puerperal conditions. Of late no epidemics of this kind have 
been observed. 

THERAPEUTIC HINTS .— I find only one case mentioned in our 

literature, by Dr. J. C. Burnett, which was cured by Aeon, and Iodurn, 
and later Nux vom. and Iodum, in alternation. Compare Raue's Annual 
Record, 1874, page 108. 



THRUSH. 285 

I should suppose that Anthrac. and Laches, might be of great service 
in this destructive disease. 

THE MUCOUS MEMBRANE OF THE MOUTH IN 

GENERAL. 

This is a continuous membrane covering the inside of the cheeks and all 
the organs within the cavity of the mouth except the teeth, lining the fauces, 
and extending thence upwards into the nose and downwards into the 
oesophagus, stomach, and intestines, and by way of the larynx and trachea 
into the finest bronchial tubes. 

The Parasitic Sore Mouth of Infants— Thrush. 

"It is neither connected with inflammation, nor with the formation of 
ulcers, but depends upon the abundant development of a microscopic fungus, 
the o'idium albicans (Robin), which combines with the epithelium into thick, 
white membranes, and covers a great portion of the surface of the mouth." 
(Vogel.) 

"We may frequently foretell its coming, when we observe that the mouth 
of the infant is getting dry, hot, red and sticky and its secretion gives an 
acid reaction. Then after a few hours white points of the size of a pin's head 
appear mostly at first on the inner surface of the cheeks, quickly spreading 
over various other places and soon covering in some cases the entire buccal 
cavity, and even the pharynx and oesophagus with a white membrane. 
After a while its white color turns yellowish or brown if bleeding occurs from 
rough handling. The first few days this membrane adheres firmly to the 
mucous membrane; later, on about the third or fourth day, it becomes loose 
and can easily be wiped away. 

According to Reubold this fungus confines itself to the squamous epi- 
thelium solely, and therefore the larynx, trachea, and the nasal cavities, the 
stomach and intestines remain free from it. It has been found, however, on 
the lowest portions of the rectum, upon the female genitals, and excoriations 
of the external skin, especially in the vicinity of the mouth, on the chin and 
neck. 

During the continuance of this fungous growth the mouth of the nurs- 
ling is hot. has an acid reaction and is sensitive to touch in a degree that 
even nursing sometimes is painful to the child. But as long as the affection 
is not complicated with intestinal catarrh, its course is quite mild and short, 
and passes away in a few days if proper attention is paid to cleanliness. 
Even if a reproduction should occur, it offers no special difficulty to cleans- 
ing and leaves the substance of the mucous membrane intact. 



286 MUCOUS MEMBRANE OF MOUTH. 

It is different with artificially fed children when an intestinal catarrh 
is superadded to the trouble. Under it the child may sink with signs of a 
follicular enteritis. 

Causes. — The formation of this fungus is favored by acid fermentation. 
The secretion of the mouth is a mixture of saliva and mucus. The saliva is 
of alkaline reaction, more so after a meal, less so on an empty stomach. The 
buccal mucus, however, has an acid action, which is visibly increased on con- 
tact with atmospheric air, when acid fermentation at once begins. In young 
infants the secretion of mucus is in preponderance over the secretion of saliva ; 
there is therefore a physiological tendency to acidity in a young child, and if 
in addition to it, the child is nourished artificially and improperly by sub- 
stances which easily undergo acid fermentation (sucking-bags, poor milk from 
badly cleansed bottles, etc.), an outbreak of thrush is sure to follow. We 
find, therefore, that thrush attacks more frequently children artificially fed 
than those who suck their mothers' breast, and for this additional reason that 
the latter in sucking draw the saliva out of their salivary glands, while the 
easy flow from the bottle requires nothing but swallowing. I would rather 
have the baby fed by the spoon, as in this way chewing motions are induced 
and a more thorough mixture of the food with saliva is insured. 

We find thrush also in adults, but it is of rare occurrence, and then 
always in consequence of protracted and exhausting diseases, such as phthisis, 
diabetes, cancer, etc. — setting in shortly before death. Its pathological 
character is identical with that described above, and its causes are the same 
— anomalies in the chemical composition of the fluids of the mouth, accele- 
rated acid fermentation and absence of the movements of chewing. 

THERAPEUTIC HINTS.— The remedy must be chosen according to 
existing symptoms which accompany this affection. 

Wash the mouth always after nursing with a rag dipped in water or a 
mixture of wine and water. 

^thusa, vomiting of milk in lumps; diarrhoea. 

Arsen., in adults and children ; great burning, exhaustion, deep illness. 

Baptis., last stage of consumption. 

Borax, great heat and dryness in the mouth. 

Chamom., child is fretful, wants to be carried about all the time; has 
colic, and green, sour stools. 

Hepar, when worse on inside of lower lip. 

Mercur., confluent thrush, changing into cankers; ptyalism; bad 
smell from the mouth ; feverishness ; green slimy stools. 

St aphis., thrush changing into canker-sores with a bluish-red or 
yellowish bottom ; more or less flow of saliva and bad smell. 



STOMATITIS ULCEROSA. 287 

Sulphur, sour smell from the mouth ; stools slimy with much straining, 
or painless ; worse in the morning. 

Sulph. ac, after borax, increased flow of saliva, yellowish color of the 
skin. 

Stomatitis Ulcerosa ; Formation of Ulcers in the Cavity 

of the Mouth. 

The mucous membrane of the mouth is subject to catarrhal inflamma- 
tions. When in addition to congestion, swelling, pain, and increased secre- 
tion, a loss of substance associates at any point, we have Ulcerous 
Stomatitis. Its forms are various. 

Aphthae, or Cankers of the mouth. They are either the consequence 
of Catarrhal erosions, forming ulcers of a superficial nature; or of 
Follicular inflammation, producing ulcers of greater depth; or in con- 
nection with Labial herpes or Hydroa, when they evidently have the same 
etiological significance. Aphthae occur chiefly in children. The follicular 
form is frequently found in women during menstruation, pregnancy or lacta- 
tion. Often a few hours are sufficient to bring about aphthous ulcers. They 
are chiefly situated on the mucous membrane of the lips and cheeks, espe- 
cially where it is reflected on the gums, less frequently on the gums them- 
selves, on the palate, or on the tongue. Their floor is whitish, yellow, their 
edges are reddened, somewhat raised, on account of the adjoining catarrhal 
stomatitis; they are of an oval form and may attain the size of a bean. The 
follicular ulcers are small, circular and excavated. All cause great sensi- 
tiveness of the mouth, interfere materially with speaking and chewing, and 
are attended with an increased secretion of mucus and saliva, which, how- 
ever, is not marked by any great intensity of nauseous odor, as we always 
find in Stomacace, or Putrid sore mouth, which is a destructive ulceration 
of the border of the gums, producing extensive swelling of the entire mouth 
and a cadaveric breath. It is mainly a disease of children, after their first 
dentition has been completed, but not found very frequent in private practice. 
Apart from children it has appeared epidemically among soldiers. Very 
often, when it appears sporadically, its cause can be traced to the abuse of 
mercury, or an enfeebled state of the system, uncleanliness, poor food, and 
atmospheric influences. The morbid process usually begins at the margin of 
the gums of the lower jaw, creeps gradually backwards, and attacks some- 
what later those portions of the mucous membrane of the lips, cheeks, and 
tongue, which are in direct contact with the affected gums. The surface of 
the tongue, the hard and soft palate, as well as the pharynx, remain free from 
it. It is characteristically marked by great fetor, and a profuse, distinctly 
acrid secretion, flowing constantly from the mouth. On pressure the gums 



288 MUCOUS MEMBRANE OF MOUTH. 

bleed easily, or bleed spontaneously, coloring the saliva brownish-red. The 
tongue is thickly coated and swollen, showing distinct impressions of the 
teeth. The adjacent lymphatic glands are also tumefied. The fever attend- 
ing it is ordinarily but slight. 

•Ulcers dependent on some dyscrasia, such as syphilis, scorbutus, etc., 
will be spoken of in their respective places. 

THERAPEUTIC HINTS.— Aphtha. 

Arum triph., superficial ulceration; tumefaction of lips; catarrhal 
burning and biting sensation in mouth and throat. 

Calc. carb., during dentition. 

Hydrast., follicular and catarrhal ulcers with exceedingly tenacious 
mucus in the mouth. 

Laches., canker sores on tip of tongue. 

Lycop., under the tongue near the fraenulum. 

Mercur., on the gums, with ptyalism. 

Natr. mur., on tongue, gums and cheeks with great burning and im- 
peded speech. 

Nux vom., gums inflamed, putrid smell from mouth; constipation. 

Sulphur, after Nux vom. or Mercur.; bloody saliva; disturbed sleep. 

Sulph, ac, on gums which bleed readily; ptyalism; great weakness; 
ecchymosed spots on skin. 

Stomacace. 

Arsen., edges of tongue ulcerated with great burning and pain; diar- 
rhoea and great prostration. 

Baptis., gums ulcerated, loose, dark red or purple; intolerable fetid 
breath; can swallow only liquids; loose, offensive stools; after abuse of 
mercury. 

Helleb., sores flat, yellowish, with raised edges upon an inflamed basis; 
ptyalism ; fetid smell from the mouth ; glands swollen on neck and under 
the jaw. 

Hepar, after abuse of mercury. 

Kali mur., main remedy of the old school. 

Mercur., ulcerated gums, tongue and cheeks; loose teeth; fetid smell. 
Burning pain, worse in night ; diarrhoea with tenesmus. In fact it is proven 
to have produced this disease in its worst forms ; it must, therefore, in many 
idiopathic cases, be almost specifically indicated. 

Nitr. ac, after the abuse of mercury with fetid and acrid saliva, 
which causes sores on lips, chin and cheeks. Pustules with red circumfer- 
ence, here and there on body. 

Nux vom., ulcerated gums, foul and painful swelling of gums; pirn- 



DIPHTHERIA, DIPHTHERITIS. 289 

pies and painful blisters in the mouth; ptyalism at night, bloody saliva; 
fetid odor from mouth ; constipation. 

Phytol., edges of tongue ulcerated, tip very red; secretion of mouth 
very thick and tenacious. Mercurial ptyalism. 

Rhus tox., great restlessness, especially in the night; bloody saliva 
runs out of the mouth. 

Staphis., ulcers with a bluish-red or yellowish bottom; gums swollen, 
painful, spongy, bleeding readily ; increased bloody saliva ; fetid breath. 

Sulphur, gums ulcerated, swollen, receding and readily bleeding; 
bloody saliva; fetor; diarrhoea; sleeplessness. Frequently indicated after 
Nux vom. 

Diphtheria, Diphtheritis. 

A disease of miasmatic-contagious nature. The latest experimenters 
(Oertel, Klebs and many more), ascribe it to the action of parasitic fungi or 
bacteria, the micrococcus diphtheriticus, while others (Wagner, etc.), still 
contend that its specific poison is entirely unknown. I shall not waste time 
to give a history of these two theories, since special expositions of both views 
have been given in Vols. I and II of Ziemssen's Cyclopedia and other 
works. 

Diphtheria may localize itself in different organs. 

1 . In the throat, at times spreading to the upper pharyngeal and nasal 
cavities, into the Eustachian tubes and lachrymal ducts. It produces a 
fibrinous exudation which first appears on one of the tonsils, seldom simulta- 
neously on both, in the form of roundish, dead white patches of various sizes, 
at the beginning closely adherent to the underlying mucous membrane and 
detachable, for the most part, only at the expense of a haemorrhage. As 
they grow, they cover larger and larger areas, finally enveloping the tonsils, 
uvula, and the walls of the pharyngeal cavity in one sheet of false membrane. 
This membrane, after a continuance of several days, becomes gray, even 
blackish, and less adherent to the subjacent tissue; it consists of fibrinous 
exudation, the interspaces of which contain serum, or blood or pus corpuscles. 
"Not unfrequently globular bodies, which consist of finely punctated masses 
of fungus, are found in one or more layers, upon the surface of the croup 
membrane, and later in spots between the uppermost flattened layer of 
epithelium and the croupous reticulum." (Wagner.) According to Oertel, 
the colonies of micrococcus penetrate to the subepithelial tissue. 

After several days continuance the false membrane loosens by means of 

infiltration with serum or pus corpuscles, and a continual growth of new 

epithelium. The mucous membrane underneath is hypersemic, sometimes 

dotted with variously numerous haemorrhages, for the most part considerably 

19 



290 MUCOUS MEMBRANE OF MOUTH. 

infiltrated with serum, sometimes with sero-pus. In septic cases the false 
membrane undergoes a rapid necrosis, and proportionally with its decompo- 
sition and putrefaction, large quantities of different varieties of bacteria ap- 
pear besides the micrococcus. The membrane assumes a dark brown color, 
and is infiltrated in broad streaks by blood corpuscles from frequent capillary 
haemorrhages. An extension into the nose is characterized by a thin, puru- 
lent, greenish discharge, which excoriates the contiguous parts of the exter- 
nal nose. 

2. In the larynx, trachea and bronchi. This forms a chief danger of 
diphtheria, and resembles in all its symptoms true croup. In a series of 
cases it sets in with the pharyngeal affection at .the same time, in others it 
follows soon after, or develops not before three or four days, or even a week 
later. It occurs oftener in children than in adults, and much more fre- 
quently in severe than in mild cases. Its characteristic signs are the long 
drawn respiration, frequent, dry coughs, toneless, hoarse voice, great restless- 
ness, and pain in the throat. 

3. In the kidneys, causing an inflammation of their parenchyma, with 
haemorrhages and growths of micrococcus. (Oertel.) At the bedside it 
manifests itself as albuminuria, which, when found in the beginning, is said 
to denote unusual severity of the attack. In fact its intensity is thought by 
some writers proportionate to the severity of the disease, which others deny. 
In light cases it scarcely ever occurs ; in severe cases it is found in one-half 
their number ; it sets in sometimes not until several days, sometimes not un- 
til towards the termination of the disease, and is, as regards the quantity of 
albumen discharged, very irregular, sometimes even intermitting for days. 
(Wagner.) 

4. In the heart, especially in long-continued and severe cases, which are 
apt to terminate suddenly in death by paralysis of the heart. On post-mor- 
tem examination the muscles of the heart appear pale, soft, friable, fatty de- 
generated. 

5. In the stomach, either by direct poisoning from swallowing the diph- 
theritic masses, or by an extension of the affection through the oesophagus 
into the stomach. It causes here, as it does in the fauces, inflammation of 
the mucous membrane, exudation of fibrine, formation of ulcers and sloughs, 
and haemorrhage. 

6. In the brain and in the spinal cord. Post-mortem examinations have 
shown venous hyperaemia in the vascular linings and substance of the brain 
and spinal cord, also capillary haemorrhages of various sizes scattered over 
different portions of these organs, with consequent softening of the surround- 
ing substance. Buhl found in one case the spinal nerves of both sides, at the 
point of junction of their anterior and posterior roots, almost doubled in their 



291 

thickness, and dark red on account of extravasation of blood, and in part 
yellow and softened. 

The period of Incubation occupies, according to a number of well- 
attested observations, from two to four or five days. 

Diphtheria is not in all cases of a like nature ; we meet mild, severe and 
septic forms of this disease. 

Its mild forms, which, by some, are designated as Catarrhal diphtheria, 
usually commence with fever and soreness in the throat. The temperature 
may rise from 101° to 105° F. in the first days, showiug always evening ex- 
acerbations with a corresponding acceleration of the pulse from 120 to 140. 
From the fourth or sixth day the temperature gradually declines. The 
fauces look at the beginning only inflamed, but show in a short time the 
characteristic patches first on one tonsil, and then on the other, extending 
also in some cases upon the contiguous portions of the palatine arches, and in 
some upon the lateral portions of the uvula. With this we find the lym- 
phatic glands of the jaw, regularly, somewhat swollen, a distinctive feature 
of diphtheria from a mere catarrhal inflammation of the throat. The fever 
is, in most instances, attended with more or less, sometimes excessive, languor 
and debility from the outset, with headache, pain in the back, also at times 
with gastric symptoms, seldom vomiting. The disease may not reach a higher 
degree, but terminate in from five to fourteen days in recovery ; but there 
may take place from about the fourth to the sixth day, a sudden rise of fever, 
with a rapid spread of the false membrane in the fauces, when the disease 
has assumed one of 

Its severer forms, which some writers have designated as Croupous 
diphtheria. In some cases this grave character shows from the beginning, 
by the greater intensity of the symptoms above described. The false mem- 
brane rapidly gains in thickness and extent, spreading either upw r ard through 
the pharynx into the nasal cavities, affecting the Eustachian tubes or the 
lachrymal ducts, or even the conjunctivae, or downwards into the larynx, 
trachea and bronchi, or through the oesophagus into the stomach. Its color 
gradually turns to a dark brown or even blackish hue, in consequence of 
haemorrhage underneath and decomposition of its substance with a corre- 
sponding terrible stench. The cervical and submaxillary glands swell to a 
still greater extent; the urine becomes scanty, dark colored and rich in salts 
and shows in at least one-half, if not in more cases, signs of albuminuria in 
different degrees, often, though not always, nearly proportionate to the 
intensity of the disease. If the morbid process descends to the stomach, its 
functions become disturbed, there is loss of appetite, nausea, at times vomit- 
ing, and oftener constipation than diarrhoea. The affection of the heart 
ordinarily does not become apparent until at a later period, when there is 
not a trace left of diphtheritic appearance in the throat. But the jDatient 



292 MUCOUS MEMBRANE OF MOUTH. 

remains weak, pale, without appetite, has frequent nausea and vomits all he 
eats. This symptom, whether it is derived directly from a diphtheritic 
condition of the stomach or by a mere reflex action from the brain, is, as far 
as my experience goes, always a very ominous sign; the patient usually dies 
with paralysis of the heart. 

The septic or gangrenous forms of diphtheria are especially characterized 
by extensive disorganization of the tissues, by capillary hemorrhages on the 
surface of the mucous membrane and general blood poisoning. One series 
of these malignant cases is developed from the croupous form, while others, 
a less frequent series, begin to be gangrenous from the onset, especially in 
malignant epidemics. Its phases follow each other in quick succession. 
The false membranes form on a livid oedematous mucous membrane, and 
soon undergo ichorous disorganization ; the discharges from the mouth and 
nose become stinking and corroding ; the cervical and submaxillary glands 
swell enormously, and there is oedema of the surrounding connective tissue. 
The face of the patient becomes bloated, pale, wax-like; his pulse small, 
weak, irregular and sometimes remarkably slow; the temperature is occa- 
sionally high, as much as 107i° F v but usually it is diminished. Not un- 
frequently death is preceded for a few minutes by convulsions, or it instantly 
follows the sudden raising of the patient; sometimes the evidences of collapse 
continue for several days. 

Diphtheria is often found in connection with Scarlatina, when it may 
set in during the prodromal stage, sometimes during the height of the ex- 
anthem, less frequently after its disappearance, or even not till the end of 
the second week of the disease. It exhibits the same three forms as described 
above. It also has been found secondarily in typhoid fever, pyaemia, puer- 
peral fever, erysipelas, whooping-cough, measles, and in chronic diseases, 
such as: tuberculosis of the lungs, extensive pleural exudations, chronic 
diseases of the kidneys (Bright's disease, so-called second and third stages)-, 
chronic suppurative inflammations of the joints and chronic diseases of the 
liver, especially in topors. 

As Sequelae, we must mention especially different forms of paralyses, 
which may occur after any of the forms of diphtheria. "They appear most 
commonly two weeks, sometimes one week, occasionally three or four weeks, 
after the healing of the local processes, and in some cases not until after 
convalescence. They most frequently affect the soft palate and consist in 
paralysis of both motion and sensation ; less often they affect the extremities 
in like manner: with or without the paralysis of the soft palate; sometimes 
they are all affected at the same time, or one after the other; preferably the 
lower extremities only; sometimes the sphincters also. Paralysis of the 
muscles of the eyes and of the larynx is more rare. Not unfrequently there 
are analogous conditions of the higher organs : either alone, or at the same 



DIPHTHERIA, DIPHTHERITIS. 293 

time with the paralysis mentioned, most frequently of the organs of vision 
(presbyopia, myopia, even total blindness), more rarely of the organs of 
hearing, smell and taste. Sometimes there is impotence. After a continu- 
ance of the paralysis for weeks or for months, complete recovery usually 
takes place — death but seldom." (Wagner.) According to the results of 
minute investigations, these functional disturbances in the different muscles 
must be attributed partly to morbid alterations in the muscles themselves 
(fatty degeneration), and partly to diseased conditions of the brain and 
spinal cord (see above). 

The Diagnosis of diphtheria is ordinarily not difficult, especially not in 
epidemics. But its mild forms might be mistaken for a catarrhal angina — 
compare the respective chapter — were it not for the general symptoms and 
the peculiar appearance of the diphtheritic exudation, which differs essen- 
tially from a mere secretion of catarrhal angina, forced out of the follicles as 
a yellowish, sticky mass which easily may be wiped off by a brush, or from 
follicular erosions which show a distinct loss of substance at their borders, or 
from aphthae which commence as small vesicles and gradually form ulcers. 
The severer forms can hardly be confounded with other diseases. Simple 
croup has no affections of the glands and kidneys, and scarlatina — even if 
diphtheria should be accompanied, as it happens in rare cases, by a slight 
erythema of the neck and breast — has no formation of false membrane in 
the fauces. 

The Prognosis of diphtheria, generally speaking, under homoeopathic 
treatment, is not bad. Of course, we meet difficult cases, even fatal ones; 
but the percentage of loss is small. Its danger lies principally in the possi- 
bility of its extension to the larynx, and its septic poisoning. 

THERAPEUTIC HINTS.— In looking over the homoeopathic litera- 
ture on this subject, leaving alone the allopathic, one feels almost tempted to 
exclaim: "Lord, hold on with thy blessings!" as the parson said, when he 
received the news that a son had been born to him, and a little while after, 
a daughter, and still a little while later, another son! Nevertheless they all 
were welcome, and each one showed its own individual character, and got its 
own share of parental love. 

There is no specific remedy for diphtheria nor for any other so-called 
disease. 

Acids, especially organic acids, have proved themselves in various de- 
grees capable of dissolving the diphtheritic membrane. 

Acet. ac. has not been given, to my knowledge, in diphtheria; but it 
has been found by Dr. Krebs, in Hamburg, Pa., very effective in croup. I 
can confirm his observations, especially when there is a bright redness of the 
face attending it. 



294 MUCOUS MEMBRANE OF MOUTH. 

Carb. ac. has been the sheet-anchor of Dr. Davidson, though it has by 
no means proved a universal remedy for diphtheria. Its indications are : 
low fever with great prostration, weak pulse and paleness of face ; absence of 
severe inflammation and pain in the throat, but abundant formation of false 
membranes, with great danger of septic poisoning and great foetor oris. 

Citr. ac. is recommended by Buchner, and thought better than 

Lact. ac. This latter has many throat symptoms, e. g., dryness and 
constriction similar to Laches. ; difficulty of swallowing solids, etc. 

Mur. ac, has proved curatively when there were: bleeding from the 
nose, the blood dark and putrid ; sordes on the teeth ; sore and scabby con- 
dition of the lips ; putrid smell from the mouth ; great general prostration ; 
typhoid condition. 

Nitr. ac, ulcers in the mouth; great pain on swallowing; excessive 
salivation ; stoppage of nose ; corroding discharge from the nose ; foetor oris ; 
fauces and glands swollen; great uneasiness; high fever; intermitting pulse. 
After overdosing with mercury ; syphilitic taint. 

Salicyl. ac, when there is little or no fever, but great weakness, diffi- 
cult deglutition, much inflammation, and the exudate soft. First centesimal 
dilution, a few drops in half a glass of water, one teaspoonful every half 
hour or hour, and the same as a gargle. (Oehme.) 

Sulph. ac. Oehme gives the following resume: tonsils bright red and 
swollen; exudate thick, grayish, or yellowish-w T hite, sticky, tenacious; lemon 
colored strings of mucus from posterior nares down to fauces; swallowing 
very difficult, liquids run out of the nose ; swallowing almost impossible ; 
breathing difficult on account of the accumulation of the exudate; speech 
thick, . indistinct, very difficult ; violent salivation ; excessive foetor oris ; 
pulse frequently small, w T eak; apathy; somnolence. Excessive paleness and 
weakness. 

Aeon. "At the beginning or in any stage when first called in until 
perspiration breaks out, and repeating only when perspiration ceases and the 
skin becomes dry and hot. Keep up sweating till convalescence sets in, aid- 
ing this process by the application of woolen cloths around the neck. Give 
cold water ad libitum, but no food, stimulants, tea or coffee." (Dr. Aaron 
Walker.) 

Ailanth., especially in scarlatinal diphtheria with livid and swollen 
throat, and tonsils studded with numerous deep, angry-looking ulcerations. 

Alcohol, diluted with water, recommended by Von Grauvogl as a 
gargle and applied by some in the form of a spray, has proved to be not the 
homoeopathic remedy, but a most beneficent adjuvant in the treatment of 
diphtheria, because of its antiseptic properties, its stimulating effects upon 
the system, and its non-interference with the homoeopathic remedy given at 
the time. Instead of alcohol, brandy, whisky or rum may be used. 



DIPHTHERIA, DIPHTHEEITIS. 295 

Amm. carb., obstruction of the nose; the moment he falls asleep he 
is aroused by the want of breath. 

Amm. caust., 15 drops to a glass of water, cured a case with croupous 
cough, which threatened suffocation every moment. The lower part of the 
pharynx covered with a white exudate, extending down as far as could be 
seen. Patient in the greatest agony, frequently jumping out of bed and 
gasping for breath. (Spranger.) Single observation. 

Apis mel., great debility from the beginning; pufhness around the 
eyes and oedematous swelling of face and neck ; bright red color, and puffy, 
glossy and varnished appearance of fauces; uvula oedematous; stinging, 
burning pain in throat and dryness ; pain in the ears when swallowing ; dif- 
ficult swallowing on account of irritation of the epiglottis ; sensation as of a 
rapid swelling of the lining membrane of the air-passages: hoarse cough; 
intense seusation of suffocation, could bear nothing about the throat; labored 
inspiration as in croup; headache; painful, or suppressed micturition; albu- 
minous urine; pain in shoulders and neck; darting, cutting, in periodical 
spells ; itchy, stinging eruption on the skin ; sensation of weakness in the 
larynx; weakness of feet and hands, even paralysis; marked prostration 
and depression ; nervous restlessness; high fever ; quick pulse; skin perspires 
and dries up in starts. Combination with scarlatina. 

Arnica helps us in two conditions: 1. Where we meet rapid decline of 
strength, small and rapid pulse after a too rapid course of the inflammatory 
fever (but the presence of Bright's disease may cause Arsen. to be preferable). 
2. After the infiltration had run its course, with tendency to necrotic ichor- 
rhamiia, in lymphatic persons subject to torpidity, with noisy deglutition, 
great debility, adynamia, excessive depression, and deep-seated co-affection of 
the whole nervous system and the brain, in short, absence of all erethismus 
after expulsion of the exudations. Physiological symptoms are: General 
loss of strength ; heaviness and paresis of the right ride, in contradistinction 
to Lachesis, and of the shoulder; foul breath; burning in the throat, with 
anguish from internal heat; stitching posteriorly, as if some hard substance 
were in the pharynx; noisy and difficult deglutition, prevented by a kind of 
vomiturition, as if the flood could not pass downwards. (Buchner.) 

Arsen., in the latter stages of the disease when there are: great rest- 
lessness, wants to change bed or room frequently ; constant desire for coM 
drink, but taking little at a time, or better from drinking hot water; all 
symptoms worse after midnight. Albuminuria ; paralysis of lower extremities. 

Ars. jod., cured a case with asthmatic and croupy symptoms; hoarse 
cough ; diphtheritic deposit covering mouth from fauces to outer lips, also 
external auditory canal ; pulse weak and slow ; great prostration ; bad odor 
from patient. (F. Bigelow.) 

Arum triph., burning in the throat; constant inclination to clear 



29G MUCOUS MEMBRANE OF MOUTH. 

the throat of collections of mucus which increases the burning and rawness ; 
haemorrhage from nose (M. Preston) ; the discharges from the nose and 
mouth are very acrid, and excoriate the skin wherever they come in contact 
with it; the lips are sore and swollen, and the skin peels off; the patient 
continually picks at his lips and nose, making them bleed ; nose stopped up, 
necessitating to breath with mouth open. Drink is refused on account of 
the great soreness of the mouth; the breath is very fetid, and the cavity of 
the mouth covered with diphtheritic deposits and ulcers ; great restlessness, 
the patient crying and throwing himself about into all sorts of positions. 
(Lippe.) 

Baptis., characterized by absence of pain, although the fauces and 
posterior nares are oedematously swollen with constant inclination to swallow. 
Stupefaction and drowsiness; mind wandering; low muttering. Oppressed 
breathing unto suffocation on account of pulmonary congestion. Rising in 
bed does not relieve ; the patient must go to the window for fresh air. Stools 
dark and blood-streaked. 

Bellad., in sudden attacks with fear of choking to death; great dry- 
ness and redness of the throat and great pain on swallowing. External 
swelling of the neck. High fever; great drowsiness with inability to fall 
asleep ; starting in sleep. Suitable only at the beginning. 

Bromium, Ozanan's favorite remedy. Is indicated by a hoarse, croupy 
cough with rattling in the larynx. 

Bryon., the patient is quickly prostrated, shuns all motion, and com- 
plains, on moving or when being moved, of pain everywhere; white tongue; 
feeling of dryness in the mouth without thirst, or else desire for large quanti- 
ties of water. Only in the beginning, " when the disease commences, or early 
presents an exanthema, or ulceration upon the border or anterior surface of 
the lower lip." (R. R. Gregg.) 

Calc. chlor., recommended and used by Dr. C. Neidhard. 

Canthar., burning and scraping in the throat with bloody expectora- 
tion ; too copious, or scanty and difficult urination ; the urine contains casts 
of the uriniferous tubuli; also albumen; extreme prostration; sinking, death- 
like turns; irritable rash upon the skin or showing through the epidermis. 

Gelsem., local tingling of parts during the fever; incipient paralysis 
or. anaesthesia; defective or impaired vision; objects appear a long way off, 
are seen double or inverted. 

Ignat. The honor of having first introduced this remedy for the treat- 
ment of diphtheria belongs to Dr. Boskowitz, of Brooklyn. I have given it 
for several years with the most marked effects, and so have several of my 
colleagues to whom I have recommended it. During an epidemic in Lehigh 
county, Pa., Dr. Wm. C. J. Slough did not lose a single case after he com- 
menced using Ignat., 200th trit., persistently, a teaspoonful every hour or 



297 

two, in spite of delirium, haemorrhage or other untoward symptoms. That 
epidemic was characterized by the following symptoms: "green vomiting; 
putrid throat, seldom painful (the painful cases were less likely to prove 
fatal); greenish-yellow patches ; delirium; headache; green stools; suppres- 
sion of urine; sometimes chilliness; sometimes high fever." I must confess 
I have not yet found any particular indications for this remedy; it acted 
well in all cases. Whether this be attributable to the genius epidemicus in 
this region of the globe is possible. If so, it will lose its efficiency when that 
changes. But there is no doubt that the provings of this drug present 
numerous hints for its application. 

Iodium, probably useful like Bromium in affections of the larynx. 

Kali bichr., the discharge from the nose is tough and stringy; pain in 
left ear on swallowing; swelling of the parotid glands; croupy cough; 
measle-like eruption ; red, raw shining tongue ; or also covered with a thick 
yellow coating; deep-seated ulceration in the fauces; mucus streaked with 
blood ; fetor from mouth ; all symptoms worse after sleep. 

Kali mur., sufficient in most cases; but when soft parts of the fauces 
are much swollen : Calc. sulph. (Schiissler.) 

Kali phosph., in maliguaut cases; offensive odor. (Schiissler.) 

Kreos., in malignant cases confined to the fauces with terrible foetor 
oris. 

Lac. can. The following proving by Dr. H. W. Taylor, is very sug- 
gestive : " Rolled and tossed about all night ; could not sleep on account of 
uncontrollable feeling of restlessness ; necessity to turn and shift about con- 
stantly. Palms of hands and soles of feet abnormally hot ; sighing frequently ; 
utter inability to lie half a minute in one position. Throat feels dry, husky, 
as if scalded by hot fluid. Dark red, angry streaks of capillaries in the 
fauces; the whole fauces dark red and tumid; round gray spot where the 
redness first began. Viscidity of saliva." Dr. Reissig, of New York, first 
used this remedy without divulging it. Dr. Dunham drew the secret out of 
him, and since then Dr. Swan and different other physicians of good repute 
have published very severe cases cured by it. I consider the above proving 
as furnishing the best indications for its application. Dr. C. Lippe gives the 
following characteristic indications: "The ulcers go from one side to the 
other and back again ; the ulceration has a glistening, shining appearance 
(Apis); the swelling of the glands changes sides and is painful to the touch, 
and the nasal discharge excoriates the nostrils and upper lip (Arum 
triph.). These characteristic ulcers, shining and glistening, may be found 
in any part of the body." If Laches, fails. 

Laches., when the membrane develops first on the left and then on 
the right side ; when there is more subjective suffering than the objective signs 
would warrant to suppose; when all the symptoms are worse after sleep. 



298 MUCOUS MEMBEANE OF MOUTH. 

Livid, dark red hue of the swollen parts ; fetid breath ; tenderness of neck to 
slightest touch; sense of suffocation from anything pressing on throat and 
neck ; external swelling of neck. Tendency towards the larynx with croupy 
cough and intolerance of any external pressure on the throat; badly smell- 
ing stools, even if formed ; dark, scanty urine of strong odor ; albuminous 
urine ; purplish eruption on the body ; delirium, which changes rapidly from 
one subject to another; somnolency; hard aching all over, which makes the 
patient constantly change his position. 

Lycop., the color of the fauces is of a brownish redness, the exudate 
commences on the right side and the pain is w 7 orse from swallowing ivarm 
drinks ; or " worse from cold food or drinks, and better from warm food or 
drinks." (R. R. Gregg.) The nose is stopped up, and the patient cannot 
breathe with his mouth shut; he keeps his mouth constantly open, slightly 
projecting his tongue, which gives him a silly expression; the nostrils are 
spasmodically dilated w T ith every inspiration ; on awakening out of a short 
nap, he is very cross, kicks and behaves naughty, or jumps up in bed, stares 
about and knows nobody, seemingly dreaming with open eyes; frequent jerk- 
ing of the lower limbs, mostly with a groan, awake or slumbering; great fear 
of being left alone ; cannot bear to be covered. All symptoms worse from 4 
o'clock, P.M. 

Merc. cyan. — This remedy was first recommended by Dr. Beck to 
Von Villers in a hopeless case of diphtheria, because of its having produced 
in five persons poisoned with this drug, gangrene of the velum palatinum and 
fauces. It proved successful. Ever since then Dr. Von Villers has used it 
in several epidemics under different latitudes with uniform success; higher 
dilutions operated better than lower. He began with the 6th and arrived 
at the 30th cent. Several physicians who never saw any result from it, gave 
the 2d or 3d trit. or dil. When an epidemic of diphtheritis prevails, he ad- 
ministers it in every case of inflammation of throat. Lately (Allgemeine 
Horn. Ztg.y Vol. 99, p. 43, 1879) Dr. Grubenmann in St. Gallen confirms Dr. 
Von Villers' observations by stating that in a late epidemic, he cured with 
this remedy in its 15th to 30th cent. dil. 50 cases, excluding all the light ca- 
tarrhal forms at that time, without ever seeing the disease spreading to the 
larynx or showing any paralytic sequelae. It has also cured cases where the 
disease had already invaded the larynx. Von Villers' indications are: 
" The presence of an exudate, which may be white, yellow, gray, or of any 
shade between. Adynamic fever and collapse already in the commencement. 
Frequently the exudate is in places where it cannot be seen." 

Merc, bin., left tonsil affected; velum elongated; gums and tongue 
more or less swollen and sensitive; constant collection of saliva and mucus in 
the mouth necessitates swallowing; swallowing of fluids or solids is painful. 



DIPHTHERIA, DIPHTHERITIS. 299 

Merc, prot., worse on right side; tongue coated thick on back part, 
of a buff-yellow color ; worse from warm drinks. 

Naja trip., suffocating spells on lying down, particularly when in bed ; 
must be taken up and held erect in order to procure easy respiration ; suffo- 
cative spells of cough after every sleep, however short. The cough is deep, 
hoarse; respiration wheezing, rasping, very tight and difficult, ameliorated 
during the morning from daylight to 11 a.m.; retention of urine; yellow 
watery stools. (M. Preston.) 

Natr. mur., swelling of the submaxillary glands and lymphatics; map 
tongue; burning in throat; after application of caustics, especially of nitrate 
of silver. 

Nux vom., feels better after a little sleep. (P. P. Wells.) 

Phytol., in cold weather, at the beginning with dryness and soreness 
of the throat, great headache, violent aching in the back and limbs; great 
prostration; cannot stand; gets faint and dizzy when rising up in bed. Sen- 
sation of a lump in throat, as if a red-hot ball of iron had lodged there ; 
whole face inflamed, swollen, sore, sensitive; deglutition almost impossible; 
cannot take hot fluids. " Phytol. is invaluable in the ulceration and pros- 
tration of diphtheria." (Aaron Walker.) 

Plumb, met. and jod., have been recommended and successfully used 
by Schiissler; where there is inclination of the exudate to mortify and slough 
off; also in implication of the larynx. This was before the introduction of 
his tissue-remedies. 

Rhus tox., when the child is restless, wants to be carried about, wakes 
up every now and then complaining of pain in the throat ; when a bloody 
saliva runs out of the mouth during sleep; when the parotid glands are 
greatly swollen ; when there are transparent, jelly-like discharges from the 
bowels at stool or afterwards. 

Sulphur, large yellowish deposit all around the posterior wall of the 
pharynx, all posterior to the uvula and isthmus faucium. After exposure 
to the diphtheritic poison, dark redness of the fauces, very painful; sleepless 
nights. Drinks very hastily; delirious; miliary, scarlatina-like eruption. 
Quite recently, pulverized sulphur, blown at the diseased surface, has been 
lauded as a universal cure for diphtheria. 

Post-diphtheritic paralysis. 

Apis, numbness of the extremities. 

Arg. met., anaesthesia of the roof of the mouth and fauces. 

Arnica, paralysis of right side. 

Arsen., paralysis of the lower extremities. 

Camphora, paralysis of the lungs. 

Caustic, paralysis of one arm and the muscles of deglutition. 



300 



MUCOUS MEMBRANE OP MOUTH. 



Gelsem., local tingling and incipient paralysis or anaesthesia; defec- 
tive or impaired vision. 

Kali brom., anaesthesia of fauces. 

Kali phosph. (Schiissler.) 

Laches., paralysis of left side. 

Nux vom., hemiplegia, left side. 

Phosphor., numbness of fingers and feet, with great weakness. 

Secale, numbness of the extremities; paralysis of some parts; painful 
tingling (like crawling of ants) on the tongue. 

Tart, emet., paralysis of the lungs. 

Besides compare: Arnica, Baryt., Coccul., Cuprum, Plumbum, Rhus 
tox., Stannum, Sulphur, Thuja, Zincum. 



Digest to Diphtheria. 



LOCAL SYMPTOMS. 

SENSATIONS. 

Absence of severe pain: Baptis., Carb. 

ac , Ignat. 
Burning : Arsen., Arum triph., Natr. mur. 
, with anguish from internal heat: 

Arnica. 

, like a red-hot ball of iron : Phytol. 

, scraping and bloody expectoration: 

Canthar. 

, stinging and dryness : Apis. 

Dryness and constriction similar to Lach- 

esis: Lac ac. 

and husky as if scalded : Lac. can. 

and redness with painful swallowing: 

JBellad. 

and soreness in the beginning : Phytol. 

Painful sensations: Sulphur. 

, complains when waking up : Rhus tox. 

more so than the appearance of throat 

would suggest: Lac. can. 
Stitching posteriorly as of a hard sub- 
stance in pharynx : Arnica. 

APPEARANCE. 

Inflamed: Sal. ac. 

and swollen : Calc sulph., Lac. can., 

Laches., Nitr. ac., Phytol. 

, oedematously with constant inclina- 
tion to swallow : Baptis. 

, livid: Ailanth., Laches. 



Redness, bright, puffy and glossy: Apis. 

, bright and swelling of tonsils : Sulph. 

ac. 

, brownish: Lycop. 

, dark: Sulphur. 

, angry streaks of capillaries: Lac. can. 

and dryness with painful swallowing : 

Bellad. 

Exudate, worse on right side : Merc. prot. 

, left side : Merc. bin. 

commence on right side : Lycop. 

, left side : Laches. 

, goes from one side to the other and 

back again: Lac. can. 

, abundant: Carb. ac. 

, covering the entire cavity of mouth : 

Arum triph. 

and extends to lips and external audi- 
tory canal: Ars jod. 

white, extending down pharynx: 

Amm. caust. 

yellow, posteriorly to uvula and isth- 
mus: Sulphur. 

gray : Lac. can. 

grayish, thick : Sulph. ac. 

greenish-yellow : Ignat. 

white, yellow, or any shade between : 

Merc. cyan. 

yellowish - white ; lemon - colored 

strings of mucus hang from posterior 
nares down : Sulph. ac. 



DIGEST TO DIPHTHERIA. 



301 



Exudate soft : Sal. etc. 

, necrotic tendency: Arnica, Kali 

phosph. 

gangrenous : Merc. cyan. 

mortifying and sloughing off: Plumb. 

met. andjW. 

putrid, seldom painful: Ignat. 

After expulsion absence of all erethism : 

Arnica, 
Ulceration, deep and angry - looking : 

Ail ant h. 

, deep-seated : Kali bichr. 

in the mouth: Nitr. ac. 

, glistening, shining like Apis: Lac. 

can. 

and prostration : Phytol. 

Gums and tongue swollen and sensitive: 

Mere. bin. 
Tongue red, raw, shining: Kali bichr. 
coated thick, of buff-yellow color, on 

back part : Merc. prot. 

white: Bryon. 

map-tongue: Laches., Natr. mur. 

Speech thick,indistinct, difficult : Sulph.ac 
Mouth sore, can't drink: Arum triph. 

dry without thirst : Bryon. 

Salivation, excessive: Nitr. ac-., Sulph. ac. 

Saliva viscid: Lac. can. 

bloody, runs out of mouth during 

sleep : Bh us tax. 
Mucus collects, must clear throat, makes 

burning and rawness worse: Arum triph. 

, necessitating swallowing: Merc. bin. 

streaked with blood : 

Sordes on teeth: Mur. ac. 
Mouth constantly open, slightly project- 
ing tongue, causing a silly expression: 

Lycop. 
Fcetor oris: Arnica, Arsen., Ars. jod., 

Arum triph., Carb. ac., Kali bichr., Kali 

phosph., Kreos., Laches., Merc, cyan., Mur. 

ac, Nitr. ac, Sulph. ac. 
Swallowing difficult : Arnica, Apis, Sal. 

ac, Sulph. ac. 

, liquids run out of nose : Sulph. ac. 

' of solids : Lact. ac. 

or fluids: Merc. bin. 

almost impossible: Phytol, Sulph. ac. 

painful: Nitr. ac. 



Swallowing painful in left ear: Kali bichr. 

in ears : Apis. 

, worse from cold food or drinks : Lycop. 

, worse from warm drinks: Lycop., 

Merc, prot., Phytol. 
Nose stopped up : Amm. carb., Nitr. ac. 
, must breath with mouth open: Arum 

triph., Lycop. 
Discharge from nose excoriating: Arum 

triph., Lac. can., Nitr. ac. 

tough and stringy : Kali bichr. 

Nosebleed: Arum triph., Ignat. 

, blood dark and putrid : Mur. ac. 

Nostrils spasmodically dilated with every 

inspiration: Lycop. 
Picking at nose and lips, making them 

bleed: Arum triph. 
Lips scabby and sore: Mur. ac. 

sore and swollen, skin peeling off: 

Arum triph. 

Eruption or ulceration upon the border 

and anterior surface of lower lip : Bryon. 
Fuffiness around eyes and cedematous 

swelling of face : Apis. 
Paleness of face : Sulph. ac. 
Bright redness of face: Acet. ac. 
Submaxillary glands and lymphatics 

swollen : Natr. mur. 

, changing sides : Lac can. 

External swelling of neck: Apis, Bellad., 

Laches. 
Parotid glands swollen: Kali bichr., Bhus 

tox. 
Tenderness of neck to touch: Apis, 

Laches. 
Larynx implicated: Bromium, Iodurn, 

Laches., Merc cyan., Plumb, met. and jod. 
, sensation of weakness in : Apis. 

and swelling of mucous membrane: 

Apis. 

Breathing labored: Apis, Ars. jod. 

, difficult : Sulph. ac. 

Suffocative sensation: Amm. caust., Apis, 

Laches., Naja trip. 

in sudden attacks : Bellad. 

, worse after sleep : Laches., Naja trip. 

, on lying down in bed : Naja trip. 

, can't bear anything about throat: 

Apis, Laches. 



302 



MUCOUS MEMBRANE OF MOUTH. 



Croupy cough: Amm. caust, Ars. jod., 
Bromium, Iodum, Kali bichr., Laches. 

Hoarse cough: Apis, Ars. jod., Bromium, 
Naja triph. 

SYSTEMIC SYMPTOMS. 
Stupefaction and drowsiness: Baptis. 
Delirium : Ignat., Sulphur. 
, changes rapidly from one subject to 

another: Laches. 
Low muttering : Baptis. 
Depression: Arnica. 
Apathy : Sulph. ac. 
Fear of being left alone : Lycop. 
Agony, jumps out of bed and' gasps for 

breath: Amm. caust. 
Faint and dizzy when rising up in bed : 

Phytol. 



Headache : Apis, Ignat, Phytol. 
Coaffection of brain and whole nervous 
system: Arnica. 



Impaired vision, objects appear a long 
way off, are seen double or inverted: 
Gelsem. 



No thirst, or desire for large draughts: 

Bryon. 
Constant desire for cold drink, takes 

little at a time : Arsen. 
Drinks hastily : Sulphur. 



Green vomiting : Ignat. 



Stools dark and blood-streaked : Bapti 

, green: Ignat. 

, jelly-like': Rhus tox. 

, offensive, even if formed : Laches. 

, yellow watery : Naja trip. 



Micturition too copious, or scanty and 

difficult: Canthar. 

, painful, or suppressed : Apis. 

, suppressed: Ignat. 

Retention : Naja trip. 

Urine dark, scanty, of strong odor: Laches. 

albuminous: Apis, Arsen., Canthar., 

Laches. 



Urine with casts of the uriniferous tubuli : 

Canthar. 



Oppressed breathing from pulmonary 

congestion ; must go to the window for 

fresh air: Baptis. 
Must be held up erect to procure easy 

respiration: Naja trip. 
The moment he falls asleep he is roused 

by want of breath : Amm. carb. 
Respiration Avheezing, rasping, tight and 

difficult, better from daylight to 11 a.m.: 

Naja trip. 
Sighing frequently: Lac. can. 



Pulse intermitting: Nitr. ac. 

quick : Apis. 

small and rapid: Arnica. 

weak and small : Sulph. ac. 

and slow : Ars. jod. 

and pale face : Carb. ac. 



Heaviness and paresis of right side: 

Arnica. 

, left side: Laches. 

Paralysis or anaesthesia: Gelsem. 

of lower extremities : Arsen. 

or only weakness of hands and feet : 

Apis. 
Abnormal heat of palms of hands and 

soles of feet : Lac. can. 
Jerking of lower limbs with a groan, 

awake or slumbering : Lycop. 
Violent aching in back and limbs: Ignat, 

Phytol. 
Aching all over, constantly .changing 

position: Laches. 
Darting, cutting pain in shoulders and 

neck, in periodical spells: 



Scarlatinal eruption: Apis, Sulphur. 

, purplish: Laches. 

Measle-like eruptions : Kali bichr. 
Eruption itchy, stinging : Apis. 
Irritable rash : Canthar. 
Ulcers, shining and glistening, may be 
found on any part of the body : Lac. can. 



Chilliness, sometimes: Ignat 



NOMA. 



303 



Little or no fever: Sal. ac. 

High fever: Aeon., Apis, Bellad., Ignat., 

NUr. ac. 
Inflammatory fever, rapid course : Arnica* 
Adynamic fever: Merc. cyan. 
Low fever with great prostration : Carb. ac. 
Typhoid condition: Mur. ac. 
During fever local tingling of parts: 

Gekan. 
Perspiration coming and drying up in 

starts: Apis. 



Drowsy with inability to fall asleep: 

Bellad. 
On awaking he is cross, kicks, behaves 

naughty, jumps up in bed, stares about 

and knows nobody, seemingly dreaming 

with open eyes: Lycop. 
Somnolency : Laches., Sulph. ac. 
Sleepless nights : Sulphur. 
on account of restlessness : Lac. can. 



Decline of strength, small rapid pulse: 

Arnica. 

, cannot stand : Phytol. 

Prostration: Apis, Ars. jod,, Bryon., 

Canthar., Mur. ac, Phytol. 
Weakness : Sal. ac. 

and excessive paleness: Sulph. ac. 

Adynamia: Arnica. 

Sinking, death-like turns: Canthar. 

Collapse early : Merc. cyan. 



Restlessness, nervous: Apis. 

, wants to change bed and room fre- 
quently: Arsen. 

, cries and throws himself about : Arum 

triph. 

, rolls and tosses about all night : Lac. 

can. 

, wants to be carried about: Rhus tax. 

Uneasiness : Ntir. ac. 



Debility: Arnica. 

from the beginning : Apis. 



Better from drinkiDg hot water: Arsen. 

warm food or drinks : Lycop. 

after a little sleep : Nux vom. 

"Worse from 4 p.m. : Lycop. 

after midnight : Arsen. 

after sleep: Kali bichr., Lach 

from motion : Bryon. 

from being covered : Lycop. 



Lycop. 



At the beginning : Aeon., Bellad., Bryon., 
Gels era. 

In the later stages : Arsen., Kali phosph,, 
Plumb, met. and jod. 

After exposure to the diphtheritic poi- 
son: Sulphur. 

For lymphatic subjects with torpidity: 
Arnica. 

Syphilitic taint: Xitr. ac. 

In cold weather: Phytol. 

After the application of caustics, espe- 
cially Xitrate of silver: Xatr. mur. 

mercurial preparations : Xitr. ac. 

Citr. ac. is better than Lact. ac. 

If Lachesis fails: Lac. can. 



Noma, Gangrene of the Cheeks. 

The first symptom of this malignant but rare disease is a small blister, 
situated in the middle of the cheek, or toward the comer of the mouth on 
the inside of the cheek. It is filled with a pale reddish or turbid grayish or 
brownish fluid. It bursts so soon that its formation is mostly overlooked, 
and appears afterwards as a superficial ulcer with an unclean basis, soon 
assuming a gangrenous character. Simultaneously with this blister, under- 
neath it, a small lump is found, which may be felt even outside on the cheek, 
which consists of infiltrated cellular and adipose tissue. Xow the gangre- 
nous destruction goes on rapidly, and on the outside appears an (edematous 



304 MUCOUS MEMBRANE OF MOUTH. 

swelling of the diseased cheek, often shining fatty or oily, or appearing livid, 
pale or marbled. By and by, there is also formed outside, mostly on the 
middle of the cheek, an inflamed spot or blister upon a hard basis, which 
soon covers itself with a dark crust. This crust being removed, gangrenous 
ulceration appears under it, like that on the inside of the cheek, which 
spreads with the same rapidity, destroying in a short time the greater part 
of the aifected side of the face. 

The general and concomitant symptoms seem at first to indicate nothing 
alarming. Generally the glands of the neck swell, and the face has a pale, 
cachectic aspect. Soon, however, there is a general sinking of strength, 
diarrhoea sets in, and death may ensue from exhaustion, before the gangre- 
nous destruction extends over the whole cheek. 

This disease is mostly found in childhood, and always in sickly children, 
or after scarlet fever, measles, typhus, and sometimes after small-pox. Adults 
are very seldom attacked by it, and then it appears only after typhus or 
puerperal fever, and especially after the abuse of mercury. 

THERAPEUTIC HINTS —The main remedies recommended are: 
Arsen., Helleb., Secale, China, Carb. veg., Kali phosph. (Schiissler.) 



NECK. 



General Observations. 

Ocular inspection of the neck externally, as a whole, presents various 
noticeable features. 

A short and thick neck, in consequence of hypertrophy of its muscles, is 
found in emphysema of the lungs; and 

A long thin neck mostly accompanies tuberculosis. 

A spasmodic contraction of the neck backwards denotes meningitis, with 
exudation on the base of the brain. 

The external jugular vein puffs out in the triangular space, which is called 
the interstitium intersterno-cleido-mastoideale, in all cases where the free 
circulation of the blood through the thoracic cavity is interfered with, as in 
diseases of the heart, and in consequence of continued violent coughing,- 
screaming, singing and the like. A pulsation of this vein is observed in 
insufficiency of the tricuspid valve. 

The carotid artery is seen to pulsate more strongly in feverish conditions, 
and where there is obstruction in the circulation within the brain ; its jumping 
pulsation is a sign of insufficiency of the valves of the aorta. 

The acromial and suprasternal regions sink in when the upper parts of 
the lungs shrink; and 

These regions become inflated during inspiration or expiration, when 
emphysema or caverns exist in the upper part of the lungs; also, during 
capillary bronchitis of infants. 

Swellings of the neck are of various nature : 

They are emphysematous when, in consequence of internal or external 
injuries of the larynx or trachea, air penetrates into the subcutaneous cellular 
tissue; or when, in consequence of a rupture or laceration of the lungs, the 
air is forced through the mediastinum into the cellular tissue of the neck. 

They are edematous in case of general dropsy, or when, by tubercular 
or scirrhous tumefaction of the lymphatic glands, the vena jugularis or 
20 (305) 



306 NECK. 

anonyma becomes compressed ; this causes at the same time an oedema of the 
face, or of the arm. 

There is a swelling of the lymphatic glands, either by infiltration with 
tubercular or scirrhous masses, or by becoming involved, secondarily, in 
inflammatory processes of the mouth, throat, face or scalp, of which we have 
spoken. 

Parotitis or mumps appear on the upper part of the neck in front and 
below the ear, while 

Bronchocele, Struma or Goitre, 

Which is an enlargement of the thyroid gland, appears lower, sometimes on 
one, sometimes on both sides of the neck. Simple enlargement or hyper- 
trophy of this gland is, according to Porta, found only in children and young 
persons, while in older persons struma is always a degeneration of this gland, 
coDsisting in formations of cysts, which contain a thick, gummy, jelly-like 
substance, of a yellow or brownish color, and which are known under the 
name of colloids. According to Schuh these colloids are either interspersed 
between the substance of the gland, or they form separate round or oval 
appendages upon the gland, without involving the gland itself into the morbid 
process. 

The struma of newborn children consists, as above mentioned, in a simple 
enlargement of either the entire gland, or of one of its lobes, and interferes, 
sometimes seriously, by its pressure upon the trachea, with the child's respi- 
ration. In severe cases it may produce death in a day or two, or even a few 
hours after birth. This is especially the case, should the swelling extend 
under the sternum, or the sternal portion of the clavicle, or in case the 
muscles underneath the hyoid bone prevent its extension exteriorly. 

In regard to the combination of struma with tuberculosis we may say that, 
where struma is developed, there tubercular affections of the lungs may be 
found, but they do not reach the stage of softening or phthisis, so that struma 
excludes tubercular phthisis. 

Basedow's or Graves' disease has been treated of, under the chapter on 
the eyes. 

THERAPEUTIC HINTS.— Bellad., heat and rush of blood to the 
head ; pain in swallowing ; gland painful to touch. 

Bromium, in juvenile subjects, with light hair, blue eyes, fair skin. 

Calc. carb., in scrofulous persons, worse towards new moon. 

Egg shell, divested of its inner coating, finely triturated, has been used 
successfully. 

Fucus vesiculosus. (R. N. Foster.) 



OESOPHAGITIS. 307 

I odium, inveterate cases; the harder they feel, and the more other 
symptoms are wanting, the more Iodium is indicated ; dark hair, dark eyes, 
dark skin. 

Natr. carb., pressing pain; round, hard swelling on the upper right 
part of the gland. 

Natr. mur., and also Natr. sulph. have been given with success. 

Spongia is recommended by Hahnemann for goitre in persons who 
live in valleys. Besides compare: Ambra, Amm. carb., Badiaga, Calc. fluor., 
Calc. jod., Caustic, Hepar, Kali jod., Laches., left side; Lycop., right side; 
Rhus tox., after hard straining; Sulphur. 

(ESOPHAGUS. 

The lower part of the pharynx narrows back of the laryngeal entrance 
into a tube through which the food in the act of swallowing is carried into 
the stomach. This tube is called oesophagus. Its inner wall lies entirely 
out of the reach of ocular inspection, and we must infer from other symptoms 
what its conditions are. The introduction of the probe, or bougie, teaches 
by mediate palpation merely, whether the passage is open or closed, and if 
closed, at what point ; and if it brings up in its fenestra some morbid pro- 
ducts encountered during its passage, it may also aid us in our diagnosis. 
Auscultation, first practiced by Hamburger, has thus far had no great prac- 
tical results. 

Oesophagitis, Dysphagia Inflammatoria. 

The mucous membrane of the oesophagus, although a continuation of the 
mucous liniug of the fauces, is little disposed to inflammation, because of its 
thick epithelial covering. Still inflammation may set in even here from 
thermal influences (taking cold), from mechanical irritation (by the lodgment 
of foreign bodies), and from chemical causes (the destructive action of corro- 
sive substances swallowed by accident or design). It may also be induced 
by spreading from continuous parts of its mucous membrane (of the phar- 
ynx or the stomach), or from inflamed parts outside of it, such as the ver- 
tebrae, the mediastinal connective tissue, or the lymphatic glands. And 
lastly it is found sometimes in cholera, typhus, pyaemia, variola, and scarla- 
tina. All these different forms of inflammation may produce ulcers of the 
oesophagus; the catarrhal form, although the most favorable in this respect, 
may in its protracted chronic form produce dilatation of this organ. Worse 
are the forms produced by corrosion, scalding, foreign bodies, etc., especially 
if they extend to the deeper layers, when danger of stricture from cicatricial 
contraction of the ulcers is always at hand. One of the most constant symp- 



308 OESOPHAGUS. 

toms of inflammation of the oesophagus in any of its forms is painful deglu- 
tition or even entire impossibility of swallowing with regurgitation of food or 
drink, hence the name Dysphagia illflammatoria. 

THERAPEUTIC HINTS —Aeon., violent pain in the middle of the 
chest through into the back, worse from motion. When swallowing, it feels 
as if the food remained lodged in the region of the heart ; lying on back im- 
possible. After mechanical injury. 

Arg. nitr., after burning with caustic ammonia; fauces red and 
swollen ; pain under the manubrium sterni ; face red and pupils contracted. 

Arnica, after mechanical injury. 

Arsen., cramp in oesophagus ; burning when swallowing ; food ejected 
as soon as it reaches the region of larynx. Chronic form with burning sore- 
ness behind lower end of sternum, worse when swallowing food ; can't bear 
closure of dress. 

Baptis., inability to swallow anything but liquids; great aversion to 
the open air. CEsophagus feels constricted from above down to stomach. 

Bellad., pressing pain, like contraction, and a feeling as though a 
foreign body had lodged fast in the oesophagus. 

Canthar., if caused by a burn. 

Capsic. has caused a dysphagia inflammatoria. 

Kali bichr., burning in the entire oesophagus; solid food is painful and 
difficult to swallow, leaving a sensation as though something remained there. 

Kali carb., liquids, still less solids, do not descend further than half 
way of the oesophagus, with pressure, stinging and burning in the middle of 
the chest and opposite vertebrse; gulping and coughing up of watery phlegm ; 
chilliness, dry mouth, nausea. 

Laches., an attempt to swallow solids causes a feeling as though some- 
thing had gone the wrong way, bringing on violent gagging. 

Mezer., violent burning and soreness in the upper half of the oesoph- 
agus; deglutition painful and difficult, especially after the abuse of mer- 
cury. 

Natr. mur., only fluids can be swallowed; solid food reaches only a 
certain place, whence it is ejected with fearful gagging and suffocation ; 
hawking up of phlegm in the morning; obstinate constipation. 

Nitr. ac., in syphilitic persons. 

Phosphor., inability of swallowing nourishment; weak and empty 
feeling across the abdomen with occasional shooting pain in that region ; sen- 
sation of heat extending up the back; great nervous irritability. 

Plumbum, fluids can be swallowed without difficulty; solids come 
back into the mouth again ; some hours after eating, burning in stomach and 
oesophagus; constipation; prostration; emaciation. 



STENOSIS (ESOPHAGI. 309 

Rhus tox., if caused by corrosive substances. 

Stramon., constriction and spasm of the muscles of the throat on each 
attempt to swallow; also paralysis of the muscles of the pharynx. 

Stenosis (Esophagi, Narrowing of the (Esophagus. 

This state of things may be congenital (a very rare occurrence) or the 
consequence of compression from morbid changes of neighboring organs, 
such as the glands of the neck and mediastinum, or large strumous masses 
when they extend far back so as to surround the tube ; or be caused by 
foreign bodies of various kinds which in the act of swallowing have stuck 
.fast, or have gradually grown there, to which latter class belong all fungoid, 
polypous and carcinomous growths ; or it may be the consequence of previous 
inflammation and its consequent contracting cicatrices, causing True stric- 
ture of the oesophagus; or it is a mere transient contraction of the muscular 
layer of the oesophagus, chiefly observed in hysterical or hypochondriacal 
patients, constituting Spastic stenosis. In all these cases the character- 
istic symptom is difficulty of deglutition. Where the occlusion forms gradu- 
ally, the patient at first merely feels some obstruction to the free passage of 
the food, especially if solid, which, however, is overcome by drinking a little 
water or other fluid; gradually, however, when the stricture becomes greater, 
the food does not go down by these means and it is either kept in that 
region of the oesophagus until it gradually works its way through the nar- 
rowed space, or it is ejected. The higher the stricture, the sooner will regur- 
gitation follow. 

THERAPEUTIC HINTS. -Bellad., when too large a morsel or a 
bone incites contraction of the oesophagus and holds it fast, Bellad. generally 
relieves this spasm and lets the swallowed body down. 

Bryon., the patient feels the swallowed food remaining about the 
middle of the chest, in the region of the upper third of the sternum, with 
choking sensation. Solid food must be washed down with water. 

Cicuta, when, after swallowing a sharp piece of bone, the oesophagus 
closes and there is danger of suffocation. 

Cundurango, first dilution; true stricture; burning at the spot where 
the food is arrested in its downward course; the obstruction is constant; lips 
very pale and tongue exsanguine. (J. Compton Burnett.) 

Fluor, ac, the impediment to the swallowed food appears to be in the 
region of the cardia. The swallowed morsel seems to touch a sore spot, 
causing considerable pain. 

Gelsem., warm fluids, spirituous fluids can partially be swallowed; 
cold drinks come up immediately. (Dr. Erwein.) 



310 (ESOPHAGUS. 

Hydroph., periodical spasms of the oesophagus, with constant pain- 
ful urging to swallow, but impossibility of doing it ; abhorrence of fluids, 
especially of water; burning, stinging in the throat; cough; gagging; diffi- 
cult and incorrect speech. 

Hyosc, spasmodic contraction after a previous injury of the oesopha- 
gus ; solid and warm food can be swallowed best ; fluids cause spasms in the 
throat, stop respiration and talking ; hiccough, nausea, spasmodic cough, and 
stiffness of the muscles of the neck. 

Naja trip., spasmodic contraction of the oesophagus. 

Oxal. ac, when there is a great deal of burning in the oesophagus. 

Ver. alb., spasmodic contraction with suffocation. 

Compare also the remedies under the foregoing chapter. 

Dilatation of the (Esophagus. 

Where there is stricture, the parts of the oesophagus above sometimes 
become dilated from the lodgment of food in that locality ; but not always, 
because the muscular layers eject again what cannot pass down. But when 
these muscles lose their contractile power, a dilatation of the tube above the 
stricture is unavoidable. It is greatest just about and above the stenosis and 
diminishes as it ascends. These dilatations of the oesophagus have been 
called Stagnation aktesiae. 

Then again dilatations of the oesophagus have been observed without any 
stenosis, either of the whole canal or of only a portion of the same ; they are 
usually widest near the middle of the tube. The wall of the oesophagus is 
in some cases thinned, in others thickened by muscular hypertrophy and the 
course of the tube is crooked, its lining membrane at times affected with 
erosions and ulcers, and its inner space filled with a brownish, pulpy mass, 
or small particles of food. " The greater number of these patients had suf- 
fered for many years from severe dysphagia, vomiting, regurgitation of food 
shortly after eating, and repeatedly from actual rumination." (Zenker and 
Von Ziemssen.) Of their remote cause nothing is known. 

A last variety of oesophageal dilatation are the Diverticula, which 
consist of protrusions or bulgings of a limited portion of the oesophageal 
wall, forming blind appendages to the normal canal. They are of two kinds : 
first, such which arise from pressure within the canal outward (Pressure 
diverticula), and secondly, such in which the wall of the oesophagus is 
pulled out by something exercising traction from without (Traction diver- 
ticula). The first are very rare and almost exclusively situated at the 
lowest part of the pharynx, just at the upper boundary of the oesophagus, 
and on the posterior wall, sometimes exactly in the median line, and some- 
times somewhat laterally. Here the arrangement of the muscular fibres 



DILATATION OP THE OESOPHAGUS. 311 

greatly favors a separation between their bundles, as they run in parallel 
lines in a very thin layer, transversely, from one side to the other, without 
being interlaced by oblique as above, or by longitudinal fibres as below this 
spot. Here foreign bodies are easily lodged, the continuous pressure from 
swallowing does satisfactorily explain the widening out of this portion of the 
oesophagus. It is an affection of advanced age, and causes great difficulty in 
swallowing, regurgitation of food, and the consequent symptoms of starvation. 

The Traction diverticula are of more frequent occurrence aud always 
found at the anterior wall of the oesophagus, mostly at a point corresponding 
to the bifurcation of the trachea, or else close by, above or below it, but 
sometimes also higher up or lower down. They are mostly funnel-shaped 
and of only a moderate depth. Their outside apex is grown to a firm, con- 
tracted tissue by which traction is exercised as from a cicatrice. The start- 
ing point has been an inflammatory swelling of the parts immediately ad- 
joining the oesophagus, leading at first to adhesion with a limited portion of 
the oesophageal w T all and afterwards by shrinkage to a pulling out of that 
portion of the oesophagus. It is in fact a disease of the tracheal and bron- 
chial glands, especially those at the bifurcation, incidental even to childhood. 
They do not cause dysphagia, but their ulceration and perforation at the 
apex, which may be set up by irritating substances, pieces of bones, etc., 
collected therein, causes a destructive process in the mediastinum aud in its 
further progress may perforate the bronchi, and cause bronchitis, gangrene 
in the lungs, ichorous pleuritis, pericarditis or even perforation of arterial 
trunks. 

The existence of these traction diverticula is in most cases not even 
suspected during life. However a frequent detention of food at a fixed spot, 
pretty low T down, particularly the slight delay of granular food, like barley 
or rice, should at least direct the attention of the careful practitioner in that 
direction, notwithstanding such symptoms may have several other explana- 
tions, and be sufficient reason to enjoin upon the patient the use of soft food 
and the habit of drinking after eating in order to wash out any remains of 
food from the diverticulum. 

THERAPEUTIC HINTS.— As dilatations are frequently associated 
with loss of muscular contractile pow T er, the following remedies which have 
proved beneficial in paralysis of the throat, should be consulted: Arsen., 
Bar. carb., Caustic, Conium, Calc. carb., Hepar, Iodium, Mur. ac, Stramon., 
Ver. alb. 



312 LARYNX AND TRACHEA. 

LARYNX AND TRACHEA. 

Auscultation. 

On putting the ear to the stethoscope, which must be evenly placed 
upon the larynx, we hear the rushing in and out of the air during the act of 
respiration much louder than on any other place. It may be imitated by 
blowing with compressed lips through the bore of the stethoscope, and is 
called laryngeal or tracheal respiration, for at the trachea too, it is heard iu 
the same degree. 

Some authors lay great stress upon the necessity of auscultating these 
organs. I cannot attach such great importance to it, either diagnostically, 
or still less therapeutically. The only benefit afforded by auscultation in 
diseases of the larynx and trachea, properly so called, is the possibility of 
localizing by it the source of obstruction, if there be any; but whether that 
obstruction arise " from inflammatory engorgement of the lining membrane, 
from solid effusion upon the internal surface, or from fluid effusion beneath 
it, or if in consequence of preceding ulceration any contraction exist, either 
in the rima glottidis, or in the course of the trachea, which gives rise to con- 
striction of the tube, and thereby impedes the free ingress and egress of air, 
or whether a foreign body, fixed in the oesophagus and pressing upon the 
trachea, or situated in the trunk itself of the air-passages, or a tumor, or a 
mere spasmodic action, be the cause of this constriction — auscultation telleth 
not. In each of these cases the noise is usually sufficiently obvious, and the 
evidence of obstruction is sufficiently clear, independently of auscultation. 
By the stethoscope we are enabled merely to say that obstruction exists and 
to indicate its seat; but the nature of that obstruction is not revealed by it." 
(H. M. Hughes.) 

Inspection, Laryngoscopy, is of much greater importance. We need 
for its execution a throat mirror and suitable illumination. The throat mirror 
is round and consists of white glass thoroughly polished and well silvered, and 
strongly fastened at an angle of 45° to a strong rod, one-sixteenth of an inch 
thick and six inches long, which terminates in a suitable handle, five or six 
inches long. The size of the mirror must be suited to the capacity of the 
patient's throat, from four-tenths of an inch to one and a quarter inches in 
diameter is its boundary ; the intermediate sizes, say seven-eighths of an inch 
in diameter, are probably the most convenient for general use. 

The illumination may be secured from the direct rays of the sun, from 
diffused daylight, or from artificial light (oil lamp, candle or gaslight). 

The direct rays of the sun and diffused daylight, the best of which comes 
from a window facing the north, thus being reflected from the northern sky 
(Dr. Woodvine), need no reflectors. With artificial light, reflectors are 
necessary. They are either held with one hand, which scarcely ever is prac- 



LARYNGOSCOPY. 313 

ticed on account of its inconvenience, or they are fastened upon the forehead 
of the examiner (compare the examination of the nose), or they are screwed, 
movable in every direction, on the handle of the throat mirror (an invention 
of Dr. Elsberg, Clinical Professor of Diseases of the Throat in the University 
of New York)* or they are added in different ways to the illuminating 
apparatus, generally complicated and expensive contrivances. 

Of all these means, Dr. Elsberg's seems the simplest and the one most 
easily applied. His directions for the employment of this apparatus, which 
he calls the pocket laryngoscope, are the following: 

" I will first suppose the examination is to be made in the daytime, in 
the absence of direct sunlight. Seat the patient with his back to the window, 
let him open his mouth and protrude his tongue by a strong effort of his will, 
and let him hold the tongue out with his index-finger and thumb of his right 
hand, covered by a handkerchief. As I want to give minute practical direc- 
tions, I must say here that a great deal of awkwardness is prevented by 
placing the handkerchief between the middle and index-fingers, turning it 
over so as to cover the index-finger and thumb spread far apart, and closing 
the little and ring finger upon the handkerchief; the thumb and index-finger 
then taking hold of the tip of the tongue, the thumb should rest against the 
chin, and by an outward and downward movement arch out the tongue. 
When the patieut does not succeed in properly holding out his tongue, the 
examiner must hold it with his left hand. The little mirror is warmed until 
the film of condensation which settles upon it passes off; its temperature may 
be ascertained by bringing its metallic back into contact with the examiner's 
cheek or the back of his hand ; it is then, without touching the tongue, intro- 
duced into the mouth, taking the uvula upon its back. Keeping the parts 
well illuminated by means of the reflector, on depressing the handle a little, 
the epiglottis will be seen in the mirror; and getting the patient to breathe 
deeply, say "a," laugh "hah, hah, hah!" as heartily as possible, etc., and 
very slightly moving the handle, the various parts of the interior of the 
larynx and neighboring organs will be brought into view. 

"When artificial light has to be employed, the patient should sit so that 
it is a little back of him, and on his right side. In all other respects the 
mode of examination is unchanged. The pocket laryngoscope may be used 
with sunlight, or diffuse daylight, or oil lamp, candle or gaslight; and in the 
latter case the ordinary high gas fixture answers the purpose almost as well 
as a drop light or stand. Ten minutes practice familiarizes anyone with 
its use. 

" For auto-laryngoscopy an extra looking-glass is necessary which, when 
the mouth can be illuminated by direct sun or artificial light, may be in the 
handle instead of the reflector; otherwise it must be placed in any convenient 
manner in front of the examiner." 



314 



LARYNX AND TRACHEA. 



It will be well to commence practicing this little art either on one's self 
or another healthy subject, in order not only to acquire the skill of intro- 
ducing the throat mirror and holding it in a suitable position for a full 
illumination of the larynx, but also on account of acquiring a thorough 
knowledge of the parts, their color and movements when ill a healthy con- 
dition ; abnormal condition will then at once spring into notice. 



Acute Catarrhal Laryngitis, Catarrh of the Mucous Lining 

of the Larynx. 

It may not amount to much more than a rosy injection of the posterior 
ends of the vocal cords and some of the parts adjoining ; it may extend to 
the ventricular bands (false vocal cords), to the arytenoid cartilages, upon 
the epiglottis and into the trachea, causing swelling, redness and ecchymotic 
spots of these parts; it may even terminate in oedema of the larynx and 
hemorrhagic extravasation upon its free surface, or hemorrhagic infiltration 
of the mucous membrane and the submucous connective tissue. These dif- 
ferent states naturally produce different symptoms of the disease. From a 
mere slight huskiness of voice the hoarseness may increase to aphonia, in 
consequence of the greater or less swelling of the vocal cords and the parts 
around them, and the innervation or alteration of the laryngeal muscles. 

The difficulty of breathing, which in adults rarely attains to any great 
degree, may in children increase to gasping and struggling for breath, sim- 
ulating croup, wherefore the name of Pseudo-croup has been adopted by 
most recent writers for this state of affairs. These attacks of stenosis are due 
partly to the relatively great amount of swelling of the mucous membrane in 
comparison with the narrowness of the true and false glottis, and partly to 
the secretion, which dries upon the parts during sleep and increases the 
obstruction. The child then rouses suddenly in the middle of the night with 
a harsh, croupy cough and distress for breath ; the stridor, however, is solely 
inspiratory, and the expiration takes place noiselessly. After the secretion 
is liquified, these symptoms abate. 

The cough, too, varies in its character. We observe paroxysmal, spas- 
modic attacks, resembling whooping-cough, followed by a drawn inspiration, 
also cough of various sounds and timbre, or without tone, in consequence of 
the greater or less swelling of the vocal cords and their adjoinings. At first 
it always sounds dry but becomes looser as the secretion of the inflamed parts 
increases. In the beginning it is very scanty, clear and transparent, some- 
times mixed with blood in the form of fine streaks, later it becomes more 
abundant and consistent, changing to yellow from the increased number of 
pus-cells. 

There is always more or less pain in the larynx, a disagreeable feeling 



ACUTE CATARRHAL LARYNGITIS. 315 

of dryness or irritation, as if from a foreign body. Its severity does not 
always correspond to the amount of the inflammation; the latter may be 
trifling and yet its annoyance great. 

Difficulty in swallowing occurs only when the epiglottis and the posterior 
surfaces of the arytenoid cartilages and ary-epiglottidean folds are consider- 
ably implicated in the inflammation. 

Such an acute attack lasts in some cases from five to nine days, in others 
weeks, and in still others it becomes chronic. 

Its Causes are very numerous. A predisposition to it seems to exist in 
persons who perspire easily, who are weakly, cachectic, and who keep them- 
selves too warmly clad, or too much housed up, etc. 

Exciting causes are all irritating agencies, such as breathing of cold air, 
dust, acrid vapors, screaming, singing, etc. ; taking cold; getting the feet cold ; 
sudden exposure of the neck to cold air, etc.; catarrhs, colds in the head, 
influenza, pharyngitis after drinking strong drinks; persons get hoarse after 
debauchery, all showing a spreading from contiguous parts; and some con- 
stitutional diseases, as measles, exanthematic typhus, syphilis, and especially 
tuberculosis, which latter generally causes a constant disposition to " catch 
cold in the throat." 

THERAPEUTIC HUNTS .— Aeon., in the beginning, after exposure 
to cold west winds ; fever with hot, dry skin, great restlessness and impatience. 
Waking up in the middle of the night with croupy cough and breathing, 
pain in the larynx and great anxiety. Also after straining the voice in 
singing. 

Bellad., spasmodic barking cough, waking suddenly about midnight; 
pain in larynx, headache, fever, drowsiness ; sudden loss of voice. 

Bromium, rough, scraping feeling in the throat, with oppression of 
breathing ; husky, hoarse voice ; croupy cough ; fair skin. 

Bryon., cough worse from motion, from entering a warm room, and 
with pain in pit of the stomach. From changes in the weather, either to 
warm or cold. 

Calc. carb., teething infants; rachitic children. Cough during sleep. 

Carb. veg., hoarseness worse in the evening; cough coming in spells, 
usually far apart. 

Caustic, entire loss of voice, or great hoarseness, worse in the morn- 
ing, with rawness and burning in the throat. 

Chamom., continued dry cough from tickling in the larynx, worse at 
night; cough during sleep; feverishness ; restlessness; impatience; irritable- 
ness. One or both cheeks flushed ; hot perspiration about the head. 

Drosera, constant tickling in the larynx, causing cough and preventing 
sleep at night. 1st dil. in water. (Baumann.) 



316 LARYNX AND TRACHEA. 

Dulcam., when the trouble gets renewed on every sudden change of 
the weather from warm to cold. 

Hepar, croupy cough, worse in the morning; hoarseness; in fall and 
winter from dry, cold west winds. 

Iodium, tickling cough; husky voice; constriction of larynx; worse 
in morning. 

Laches., dryness in throat; sore spot on left side of larynx; feeling as 
of a lump in the throat ; choking sensation in the throat ; cough excited from 
talking, laughing; irritation as if in pit of stomach. 

Mercur., chilliness during the fever whenever moving the feet to a 
cool place in the bed; easily perspiring without improvement; cold in the 
head. 

Nux vom., in the commencement with chilliness, headache, stoppage 
of nose. From exposure to draughts, or sitting in a cold room. 

Phosphor., constant tickling cough from the larynx, also with head- 
ache as though it should burst; cough dry; worse from evening until mid- 
night, with tightness across the chest. 

Pulsat., chilly, thirstless; worse in the evening and in a warm room. 

Rhus tox., tickling under the middle of the sternum; worse from talk- 
ing or laughing; pain in all the bones worse when being quiet. After 
straining the voice in singing or speaking. 

Rumex, dry cough in paroxysms, induced by hurried or deep inspira- 
tions, speaking, inhaling of colder air than usual, or any pressure upon the 
trachea in the pit of the throat. 

Sanguin., highly recommended by Dr. Nichol. 

Spongia, fever and irritation in throat, with hoarse, croupy cough, 
worse from evening; breathing wheezy; spells of choking in the middle of 
the night. 

Tart, emet., rattling cough and breathing; trembling pulse; sticky 
perspiration ; no thirst ; pale face ; peevishness ; drowsiness. 

Laryngitis Catarrhalis Chronica. 

The chronie catarrh of the larynx results often from continued exposure 
and neglect of an acute attack, or from a continuous series of irritations by 
overexertion of the voice in talking and singing, or from a chronic pharyn- 
gitis in consequence of the abuse of tobacco and alcoholic stimulants. 

We find swelling and injection of the mucous membrane either limited 
to certain parts, or diffused over the whole organ, with a velvety sponginess 
of its lining membrane. The redness shows less distinctly on the vocal cords 
than upon the other portions of the mucous membrane; the swelling and 
thickening of the vocal cords gives to their surface a granulated, and to 



LARYNGITIS CATARRHALIS CHRONICA. 317 

their edges an uneven appearance. The tumefaction of the epiglottis or of 
the ventricular bands, or of the ary-epiglottidean folds, amounts sometimes 
to distortion of these parts. With all this the affected parts are usually 
covered with dilated veins. Ulcerations, except in follicular inflammation, 
perichondritis, and oedema, are very rare results of this disease, but on the 
other hand, secondary chronic laryngitis is almost always accompanying 
syphilis, ulcerative processes, neoplasms, traumatic irritations and perichon- 
dritis. 

This state of things necessarily causes various alterations of the voice 
from slight huskiness, to deep hoarseness and loss of tone. It is always at- 
tended with clearing, hemming and hawking, when speaking, on account of 
the collection of phlegm in the throat, and the sensation of something there 
that ought to be removed. The secretion is either clear, transparent or 
whitish-gray, frothy with minute bubbles, or viscid, ropy, or yellowish from 
numerous pus-cells. There is also more or less cough excited by the laryn- 
geal irritation, which, like the voice, is hoarse and of an unusual timbre. 
The subjective sensations are mostly those of rawness, scraping, soreness and 
burning in the larynx, aggravated by the use of the voice. 

THERAPEUTIC HINTS— Any of the remedies detailed under the 
foregoing chapter may be indicated here. Besides these, one or the other 
of the following may be required : 

Arg. nitr., pharyngo-laryngeal catarrh. Weakness aud tremulous- 
ness; palpitation of the heart. 

Arsen., the lining of the larynx more or less injected, puffy or swollen ; 
voice oftener husky than hoarse, or dull without resonance or timbre. Sen- 
sation of dryness, fatigue and tickling in speaking; burning in throat. 
Delicacy of constitution ; disposition to tubercular deposits. 

Calc. carb., the lining of the buccal cavity extremely pale; soft palate 
and pharynx covered with dilated veins, coloring the parts bluish; throat 
dry. tongue white. Speaks in a whisper; an attempt to talk loud gives a 
muffled sound and causes a short, hoarse barking cough ; cough worse from 
evening till midnight. Complexion waxy ; lips almost white ; face puffy 
particularly the eyelids, with dark rings around the eyes; hands and feet 
cold and moist. Listless disposition ; disagreeably impressed by music and 
noise ; inability for mental or physical exertion, so weak, is hardly able to 
walk ; exertion causes palpitation and breathlessness ; night-sweats. 

Carb. veg., swelling of the vocal ligaments; the lining of the larynx 
and particularly of the ventricular bands, of a dingy purplish tint; hoarse- 
ness worse in damp weather and in the evening; loss of voice; expectoration 
moderate, lumpy and easy. Reduced vitality; venous capillary dilatation 
of pharyngo-laryngeal parts, and prevailing torpor of all functions; cold 
knees in bed. 



318 



LARYNX AND TRACHEA. 



Caustic, loss of voice; great hoarseness, worse in the evening; as soon 
as he tries to raise his voice to a higher pitch, it gives out, or becomes a 
squeak. Hoarseness of singers and speakers. 

Hepar, tuberculous disposition ; scanty, tenacious, muco-purulent secre- 
tion with difficult expectoration. Seated pain in one spot of the larynx, 
aggravated by pressure, speech, cough and breathing. 

Iodium, follicular catarrh with ulceration; constant tickling cough. 
Great hunger and yet emaciation. 

Kali bichr., pharynx bluish and with varicose veins; the vocal cords 
and the posterior parts of the larynx are red and puffy and covered with 
grayish mucus; sensation of dryness; tickling in larynx when speaking; 
voice rough and hollow; cough with scanty, stringy expectoration, provoked 
by speaking or laughing. 

Kali hydr., arytenoids of a purplish color, tumefied and granular; 
follicular ulceration; voice hoarse; sounds above the middle key impossible; 
dry cough ; sensation of dryness ; burning and tickling in larynx. 

Mangan., venous dilatation in the throat and pharynx; partial injec- 
tion of the ventricular bands ; hoarse voice in the morning, better after clearing 
up lumpy mucus; weak, anaemic individuals with disposition to tuberculosis. 

Natr. mur., follicular inflammation of pharynx; after swabbing the 
throat with nitrate of silver. 

Nitr. ac, ulcers in the larynx; toneless voice; previous mercurial 
abuse. 

Phosphor., lining of vocal cords highly injected with ulceration; sup- 
pressed voice; talking provokes tickling in larynx and spasmodic cough, 
followed by great dryness and burning in the throat. 

Sanguin., sensation of dryness, soreness and swelling in the larynx, 
and expectoration of thick mucus; redness in the throat; stoppage of the 
nose, with headache across the eyebrows. 

Sulphur, cough in the evening, before and when going to bed ; catarrh 
of other mucous membranes; disposition to skin affections; suppressed 
eruptions. 

Digest to Acute and Chronic Laryngitis. 



LOCAL SYMPTOMS. 

Pharynx red: Sanguin. 

, catarrh: Arg. nitr. 

, follicular inflammation : Natr. mur. 

, ulceration : Iodum, Kali hydr. 

, venous dilatation, bluish color: Calc. 

carb., Carb. veg., Kali bichr., Mangan. 
Throat dry: Arsen., Calc. carb., Laches., 

Phosphor. 



Throat burning : Arsen. 

and raw : Caustic. 

, scraping, rough, with oppressed 

breathing : Bromium. 

irritation : Spongia. 

red and swollen : Mercur. 

, feeling as of a lump, choking: Laches. 

, spell of choking in middle of night : 

Spongia. 



DIGEST TO ACUTE AND CHRONIC CATARRH. 



319 



Larynx, dryness, burning and tickling: 
Kali bichr., Kali hydr. 

, soreness and swelling: Sanguin. 

, constriction: Iodum. 

, pain: Aeon., Bellad. 

, seated sore spot, worse from pressive 

cough, speech and breathing : Hepar. 

, sore spot on left side : Laches. 

, injected, puffy : Arsen. 

, ulcers: Nitr. ac. 

Vocal cords, swelling: Carb. veg. 

, injected and ulcerated: Phosphor. 

, red and puffy and covered with gray- 
ish mucus: Kali bichr. 

Ventricular bands, injection: Mangan. 

and purplish : Carb. veg. 

Arytenoids, purplish, tumefied, granular: 
Kali hydr. 

Voice, loss of: Carb. veg., Caustic. 

, sudden : Bellad. 

, toneless: Nitr. ac. 

, whisper: Calc. carb. 

, rough and hollow : Kali bichr. 

, suppressed: Phosphor. 

, husky: Bromium, Iodum. 

and hoarse: Bromium. 

, oftener than hoarse: Arsen. 

, dull without resonance or timbre: 

Arsen. 

, sounds above middle key impossible, 

Kali hydr. 

, raising voice to a higher pitch, it 

gives out, or becomes a squeak : Caustic. 

hoarse : Bromium, Hepar, Kali hydr. 

, worse in evening : Carb. veg. 

, worse in morning: Caustic. 

, worse in morning, better after clear- 
ing up lumpy mucus: Mangan. 

, worse in damp weather : Carb. veg. 

of singers and speakers : Caustic. 

Breathing wheezy : Spongia. 

Cough, worse from evening till midnight: 
Calc. carb., Phosphor., Spongia. 

, barking, spasmodic, waking about 

midnight: Bellad. 

, croupy : Bromium, Spongia. 

, worse in morning: Hepar. 

, waking up in middle of night, with 

pain in larynx, anxiety, fever : Aeon. 



Cough dry : Kali hydr., Phosphor. 

in paroxysms: Rumex. 

from tickling in larynx : Chamom. 

, tickling : Iodum. 

from larynx: JDrosera, Phosphor. 

under middle of sternum : Rhus tox. 

, with headache, as though it should 

burst: Phosphor. 

, followed by great dryness and burn- 
ing in throat : Phosphor. 

, with pain in pit of stomach : Bryon. 

, with expectoration, lumpy and easy : 

Carb. veg. 

of thick mucus : Sanguin. 

, scanty and stringy : Kali bichr. 

and tenacious, muco-purulent : Hepar. 

from irritation in pit of stomach : 

Bryon., Laches., Pulsat. 

, excited by laughing: Kali bichr., 

Laches., Rhus tox. 

, by speaking, talking: Arsen., Calc. 

carb., Kali bichr., Laches., Phosphor., Rhus 
tox., Rumex. 

, by hurried or deep inspiration, or in- 
haling colder air than usual: Rumex. 

by motion : Bryon. 

by pressure upon the trachea in pit 

of throat: Rumex. 

by entering a warm room : Bryon. 

is worse in the morning : Iodum. 

in the evening, before and when going 

to bed : Pulsat, Sulphur. 

from evening until midnight: Phos- 
phor., Spongia. 

at night : Chamom. 

during sleep : Calc, carb., Chamom. 

in spells usually far apart: Carb. veg. 

ATTENDING SYMPTOMS. 

Inability for mental and physicial exer- 
tion: Calc. carb. 

Disagreeably impressed by music and 
noise : Calc. carb. 

Irritable: Chamom. 

Impatient: Aeon., Chamom. 

Peevish : Tart. emet. 

Restless: Aeon., Chamom. 

Listless deposition: Calc. carb. 

Headache : Bellad,, Nux vom., Sanguin. 



320 



LARYNX AND TRACHEA. 



Cold in head : Mercur. 
Stoppage of nose: Nux vom. 

with pain across eyebrows: Sanguin. 

Face pale: Tart. emet. 

puffy, particularly eyelids, with dark 

rings around : Calc. carb. 

waxy, li{ s almost white: Calc. carb. 

, fair skin : Bromium. 

Cheeks, one or both flushed : Chamom. 
Teething: Bellad., Calc. carb., Chamom. 
Tongue white; buccal cavity very pale: 

Calc. carb. 
No thirst: Pulsat, Tart. emet. 
Hunger and yet emaciation: Iodum. 
Tightness across the chest : Phosphor. 
Tuberculous disposition: Arsen , Hepar, 

Mangan. 
Palpitation of heart : Arg. nitr. 
and breathlessness caused by exertion : 

Calc. carb. 
Pulse trembling: Tart. emet. 



Drowsiness: Bellad., Tart. emet. 



Chilliness: Pulsat. 

in the commencement : Nux vom. 

during fever, whenever moving the 

feet to a cool place in the bed : Mercur. 
Cold knees even in bed : Carb. veg. 
Cold and moist hands and feet: Calc. carb. 
Fever: Bellad., Chamom., Spongia. 



Fever, with hot and dry skin : Aeon. 
Perspiration about head: Calc. carb. 

hot: Chamom. 

easy without improvement : Mercur. 

sticky : Tart. emet. 

Night-sweats : Calc. carb. 



Pain in all the bones, worse when quiet: 

Rhus tox. 
Weakness, can hardly walk: Calc. carb. 

and tremulousness: Arg. nitr. 

and anaemic: Mangan. 

Torpor of all functions : Carb. veg. 
Vitality reduced : Carb. veg. 
Delicacy of constitution : Arsen. 



Rachitic children: Calc. carb. 
Catarrh of other mucous membranes and 
disposition to skin affections: Sulphur. 



Laryngitis brought on by exposure to 
cold west winds: Aeon., Hepar. 

, draughts, as sitting in cold room : 

Nux vom. 

by any sudden change from warm to 

cold : Bryon , Dulcam. 

from cold to warm : Bryon. 

from mercurial abuse : Nitr. ac. - 

, abuse of nitrate of silver: Natr. mur. 

, suppressed eruptions : Sulphur. 

Feels worse in a warm room : Pulsat. 



Croup. 

Croupous laryngitis produces a fibrinous exudation upon the raucous 
surface, which coagulates and forms a false membrane, loosely attached, but 
frequently regenerated. It is therefore nearly related to diphtheria, which 
in some cases also extends to the larynx, causing all the symptoms of true 
croup. It differs, however, from diphtheria, in that the exudation never 
leaves scars behind. In diphtheria, especially in severe cases, the mucous 
membrane as well as the submucous tissues become destroyed, and cicatrize 
on healing. Croup may commence in the fauces and extend downwards, or 
in the larynx and spread upwards. In almost all cases there is a hypersemic 
state of the whole mucous membrane of the trachea and bronchial tubes, 
which at times augments to a croupous exudation in these parts. 

Ocular inspection reveals the pseudo-membrane in the fauces, if it com- 



croup. 321 

mences or extends, there; laryngoscopy is inmost cases impossible; ausculta- 
tion reveals nothing but what we can hear, even at a distance — labored 
breathing, with a sawing sound. 

Croup generally attacks children in early childhood, — from two to seven 
years, and seldom more than once. 

Its Premonitory Signs consist at times in peevishness, feverishness, 
soreness of the throat, inflammation of the tonsils and fauces, with patches 
of exudation, as in diphtheria. In other cases there are no such forebod- 
ings. The child is aroused suddenly out of a sound sleep, generally about 
midnight, by a hoarse, dry, croupy cough. It exhibits restlessness and 
fright, and frequently puts its hands to the windpipe. Soon, however, it 
falls asleep again, to be again roused by the same dry, hoarse cough, alter- 
nating in this way until morning, when usually a remission takes place, and 
the child seems to be lively and playful. When evening approaches, the 
child becomes worse again, and, in addition to the cough, we observe the 
breathing to be getting impeded between the coughing spells. Not only can 
we see the labored action of the respiratory muscles, but we can also plainly 
hear a sawing noise, which the ingress and egress of the air causes in the 
stuffed-up air-passages. This difficulty increases from hour to hour. The 
child involuntarily bends its head and neck backwards, in order to free the 
windpipe as much as possible from all pressure ; the alse nasi move strongly 
up and down like wings ; the epigastric region does not, as is usual during 
the act of inspiration, bulge out, but is drawn in, in consequence of a defi- 
ciency of air in the lungs on account of the obstruction in the larynx. For 
the same reason we find the xiphoid process and the cartilages of the lower 
ribs during inhalation drawn strongly inwards, instead of gliding gently 
downwards, as is natural. When we find inhalation and exhalation equally 
difficult, there is surely coagulated exudation around the glottis ; when, how- 
ever, as is sometimes the case, only the inspiration is difficult and expiration 
easy, it is probable that the difficulty does not lie in the presence of a pseudo- 
membrane, but in a paralytic state of the muscular structure of the glottis, 
whereby the epiglottis, during inspiration, is not lifted up from the glottis, 
thus hindering the free ingress of air ; while during exhalation the paralyzed 
parts easily give way to the returning stream of air. 

Thus the child struggles terribly for air ; raises up, wants to be carried 
about, until from sheer exhaustion and the carbonized state of the blood, it 
sinks into drowsiness and stupor. The face, being at first red, grows pale, 
finally cyanotic and is covered with cold sweat; the pulse, at first quick, 
hard and strong, grows very frequent, small, irregular, intermitting, until at 
last this fearful scene i3 closed by general paralysis or suffocation. The 
temperature may not exceed 101.3° F. in some cases, while in others, 
2L 



322 LAKYNX AND TRACHEA. 

especially in complications with bronchitis or pneumonia, it may rise from 
104° to 105.8°. 

In those cases in which dissolution of the false membrane, or the tear- 
ing, loosening and ejection of it, permits recovery, we frequently find a long- 
continued hoarseness, caused by catarrh of the larynx, or bronchitis or 
pneumonia, the latter being complications which did already exist during the 
attack, and made it so much the more serious. 

Secondary croup occurs during the course of acute, infective or gene- 
ral constitutional diseases. Of the acute exanthemata, Measles is the one 
most frequently complicated with it, and especially during the stage of 
desquamation, while pseudo-croup occurs usually as a prodromal symptom of 
measles. Scarlatina, too, and Small-pox, when complicated with throat- 
diphtheria, are apt to produce laryngeal croup; the most fatal complication 
is that with Epidemic diphtheria. Some authors have observed secondary 
croup during the height of whooping-cough, and in the course of typhoid 
fever, pneumonia and cholera. 

True croup is most readily confounded with Catarrhal laryngitis or 
Pseudo-croup; the latter, however, is frequently attended with other catar- 
rhal symptoms, such as sneezing, coryza, etc., and apt to occur frequently. 
Diphtheria is thought by some writers (Wagner and others) not to be an 
essentially different affection from croup, and that there is no sharp dividing 
line between the two. But if we take in consideration that in croup the 
exudation takes place upon the free surface of the mucous membrane, and in 
diphtheria also within it, causing necrosis and loss of substance, that diph- 
theria is contagious while croup is not, and that in many cases of diphtheria 
a peculiar penetrating smell from the mouth claims at once our attention, we 
shall hardly find any difficulty in distinguishing between the two, notwith- 
standing the close similarity of symptoms between them. 

The Prognosis of true croup is a great deal more favorable under 
homoeopathic treatment than under allopathic. " While practitioners of the 
old school of known ability and honesty confess to the most dreadful losses" 
(Steiner), we of the Hahnemannian school have a right to boast of brilliant 
cures, if boasting it be when physicians of " known ability and honesty " 
state their successes. 

How a man like Johann Steiner can call these men swindlers and 
ignoramuses, men who at least in therapeutic science stand far above him, is 
explainable only when we understand the beclouding influence of bigotry 
over sound judgment. 

THERAPEUTIC HINTS— Acid, ac, has been used successfully 
by Dr. Krebs. I have found it curative in a case that did not yield to other 
remedies, and which was characterized by a remarkable bright redness of the 






croup. 323 

face. From five to ten drops of acetic acid in half a tumblerful of water 
with some sugar make a pleasant acidulated drink. I gave a teaspoonful of 
it every two or three hours with speedy effect. 

Aeon., high fever, dry skin, restlessness ; the child is in agony, impatient 
and throws itself about. 

Arsen., worse about midnight; great restlessness notwithstanding pros- 
tration ; bloated face, covered with cold perspiration. 

Bellad., sawing, whistling breathing, frequent barking, croupy cough; 
skin dry and hot ; face red ; pulse full and sharp ; very restless ; tonsils red 
and swollen ; patches of exudation on the fauces ; midnight attacks. 

Bromium, when after Spongia aggravation again sets in next evening; 
especially in children with blue eyes and light hair. 

Calc. carb., in a case of marked calcarea constitution. (H.V.Miller.) 

Canthar., in cases where the voice was entirely gone, and there was 
whistling breathing, and tossing about in bed with the greatest agony. 

Caustic, sensation of rawness in the larynx. (E. C. Price.) 

Hepar, cough worse in the morning; mucus rattling and yet no getting 
rid of the phlegm ; hoarseness ; dry, barking cough ; the child cries when 
coughing; after exposure to cold west wind. 

Iodium, as Bromium follows well after Spongia, so does Iodium after 
Hepar ; cough worse in the morning, rattling and no getting loose ; hoarse- 
ness ; especially in children with black eyes and dark hair. 

Kaolin, first recommended by Aegidi; it seems to be especially indicated 
where the croupous inflammation has its seat in the lower portion of the 
larynx or in the upper part of the trachea, which may be recognized by the 
much more laboring and sawing respiration. (I. Landesmann.) 

Kali bichr., worse early in the morning ; inflamed fauces; membranous 
deposition ; hoarseness ; fat, chubby children. 

Laches., the child cannot bear anything touching its throat; aggrava- 
tion in the afternoon, after and during sleep ; patches of exudation in the 
fauces ; commencing paralysis of the lungs. 

Lycop., spasmodic motion of the ake nasi; crossness after sleep; can't 
bear to be covered. 

Phosphor., in combination with bronchitis ; great weakness ; aggrava- 
tion evening up to midnight; lying on back provokes the cough. 

Sanguin., in a case with whistling cough, or of metallic sound, as 
though coughing through a metallic tube. 

Spongia, very dry, crowing sound of cough; always commencing to 
get worse in the evening ; sawing sound of respiration even during remission. 

Tart, emet., face cold, bluish, covered with cold perspiration; pulse 
very frequent; rattling as if the chest and trachea were full of mucus without 
expectoration ; great sinking of strength ; commencing paralysis of the lungs. 



324 LARYNX AND TRACHEA. 

Von Grauvogl advises: 

Cuprum, when spasmodic affections, such as asthma spasmodicum, 
whooping-cough, chorea; or cholerine, etc., are prevalent (epidemic) at the 
time with other people. 

Ipec, Iodium or Bromium, when intermittent affections prevail. 

Hepar, when panaritise, angina?, urticaria, or erysipelas are the pre- 
vailing diseases. 

Schiissler advises : 

Kali mur. at first, or 

Ferr. phosph., when there is violent fever. 

Calc. sulph. later, if required. 

Kali phosph., in cases coming too late under treatment, with great 
weakness, pale bluish face, etc. 

Tracheotomy. — "Out of quite a large number of cases occurring in my 
practice, before I had adopted the operation of tracheotomy, I saw but three 
recoveries; since 1863, however, this discouraging rate has been so much 
improved by the employment of tracheotomy that the mortality has at differ- 
ent times amounted only to sixty, sixty-five and seventy per cent. Bricheteau 
states it at sixty-nine, Franque at sixty-eight, Trousseau at fifty, and Greve 
in Sweden at twenty-three per cent." (Steiner.) "Among the 1,698 cases 
of tracheotomy collected by Ducheck, a favorable result occurred in 428 
of>erations, a proportion of 1 to 3.9 (25.2 per cent.), which is probably the 
correct average." (Steiner.) 

" In fatal cases of croup, where the symptoms consist of great dyspnoea, 
pallid face and lips, cold extremities and very feeble pulse, post-mortem 
examination will disclose fibrous deposits in the heart, and such cases, if 
operated upon, are sure to die ; while if there be turgescence and lividity of 
the face, with blueness of the lips, accompanied with extreme dyspnoea, the 
obstruction is evidently in the trachea, and the case, therefore, offers much 
greater hope of recovery by operation." (Dr. Richardson, of London.) 

" Tracheotomy is no more curative of croup than are emetics ; it cannot 
even arrest the croupous process ; its only office is to establish a new provi- 
sional air-passage, while the danger of death from laryngeal stenosis lasts, 
and to assist Nature in her efforts to cure ; and no other means fulfil these 
indications so certainly and so directly." (Steiner.) 

In short, although tracheotomy is not a sure cure for croup, it may in 
violent cases procure time for the selection and action of the medicine which 
finally will subdue the croupous process and thus be a means of saving the 
child. This is applicable even to Homoeopathic treatment. 



(EDEMA GLOTTIDIS, (EDEMA LARYNGIS. 325 

(Edema Glottidis, (Edema Laryngis 

Consists of a serous or sero-purulent infiltration of the submucosa, following 
either inflammatory or non-inflammatory processes. 

The inflammatory form has been designated as Laryngitis phlegmo- 
nosa, embracing all such inflammations of the larynx which have their seat 
principally in the submucous connective tissue. It is always of a secondary 
nature, and may be the consequence of a catarrhal laryngitis when renewed 
attacks or new injuries spread the inflammation in depth to the submucous 
connective tissue, or it is connected with laryngeal diphtheria, or the conse- 
quence of chemical or thermal irritants or mechanical irritations by foreign 
bodies ; or it is an extension of inflammatory processes from neighboring 
parts, such as wounds of the larynx and its vicinity, or retro-pharyngitis, 
tonsillitis, pharyngeal diphtheria, angina Ludovici and parotitis. The most 
frequent cause is inflammation of the perichondrium of the laryngeal car- 
tilages, in consequence of tuberculous, syphilitic, typhous and carcinomatous 
ulcerations. At last we find it in connection with pyaemia and septicaemia, 
with ulcerative endocarditis, typhus, variola, scarlatina, measles and ery- 
sipelas. 

The inflammatory process may be diffuse, or limited to the aryteno- 
epiglottidean folds, and is then more marked on one side than on the other; 
it affects the submucous tissue of the vocal cords alone only rarely, and 
exists below the cords still more rarely. 

The non-inflammatory form, a simple, serous infiltration of the submu- 
cosa, or dropsy, is either a part of general dropsy, in consequence of nephritis, 
malarial cachexia, amyloid degeneration of the kidneys, etc. ; or a dropsical 
manifestation from diseases of the heart, emphysema and cirrhosis of the 
lungs ; or the result of compression of the superior and inferior thyroid, or 
facial, or internal jugular and the innominate veins by enlargement of the 
thyroid gland, or the swelling of the lymphatic and salivary glands, or by 
new formations about the neck, aneurism of the aorta, etc. The oedema will 
be unilateral or bilateral, according to the site and extent of the hindrances 
to the circulation. The oedematous parts appear pale or pale red, translucent 
and flabby; the mucous membrane is neither injected nor swollen. By 
means of the laryngoscope, we can best decide the nature of the affection. 

The most prominent symptom of either form is Laryngeal dyspnoea, 
which at first is only inspiratory, while the expiratory stream of air passes 
the larynx without any difficulty. The reason of this is, that during inspi- 
ration, the air presses the swollen parts around the introitus laryngis together, 
thus closing its aperture, while during expiration the out-rushing air pushes 
them asunder. However, this difference ceases when the infiltration spreads 
to the aryteno-epiglottidean folds, to the epiglottis and the superior cords. 



326 LARYNX AND TRACHEA. 

There is also hoarseness and barking cough. The intensity of the laryngeal 
stridor depends always on the grade of swelling of the soft parts, and it ter- 
minates in suffocation if the obstruction can not be relieved. The inflam- 
matory form may result in abscesses or ichorization. 

THERAPEUTIC HINTS —In general I must refer to the various 
causes of this affection above detailed. In special compare : 

Aeon. 

Apis, when it occurs in connection with erysipelas or eruptive fevers. 

Arsen., when in connection with general dropsy, following kidney dis- 
eases, etc., with great restlessness and prostration. 

Arum triph., when in combination with diphtheria or scarlet fever. 

Bellad. , sudden attack ; fauces deep purple ; all the parts of the larynx 
cedematously swollen; pain deep in throat; stiff neck; wild expression of 
eyes; great prostration. One drop of tincture in pint of water, by teaspoon- 
ful. (P. J. Valentine.) 

Canthar., when in consequence of burns. 

China, when in connection with dropsy; inspiration short and difficult, 
expiration easy. 

Laches., when in connection with albuminaria; dark, almost black 
urine, like coffee-grounds. 

Phosphor., in connection with heart disease. 

Sanguin., tonsils and pharynx swollen; sawing, rasping respiration; 
expiration easier than inspiration ; cough dry and harsh, relieved by sitting, 
aggravated by eating or lying down; difficult expiration of tough, glairy 
mucus; inflammation of cervical glands. 1st trit. (Th. Nichol.) 

Swallowing of small pieces of ice has been found beneficial by Niemeyer 
in the inflammatory form. 

If in bad cases medicine does not quickly relieve, scarification of the 
swelling must be tried, and if that does not succeed, tracheotomy is the only 
means to prevent suffocation and gain time for further medical treatment. 

Perichondritis Laryngea. 

The inflammation of the perichondrium of the laryngeal cartilages is not 
easily recognized in the beginning, because pain, swelling, cough, hoarseness 
and laryngeal stenosis are symptoms of various laryngeal affections. When, 
however, the inflammation has reached the stage of an abscess which has 
broken, a diagnosis may be more readily formed. The cartilages most liable 
to be affected are the cricoid and the arytenoids. If it be the cricoid, the 
swelling will be found on the posterior wall of the laryngeal opening, or when 
seated in one of its lateral portions, somewhat towards the one or the other 



TUBERCULAR ULCERATION. 327 

side of the posterior wall ; if it be one of the arytenoid the swelling will be 
seen more anteriorly either on the right or the left side in the neighborhood 
of the cartilages of Santorini and Wrisberg. 

Thyroidal perichondritis may exist either on its inner surface, or pene- 
trate to its outer surface and form a laryngeal fistula. Perichondritis of the 
epiglottis is of rare occurrence, usually in connection with the same process 
in the cricoid and thyroid cartilages, or with other ulcerative processes. 

The Causes of laryngeal perichondritis are various. It may arise from 
traumatic influences, for instance from the frequent introduction of the 
oesophageal sound in old persons; from tuberculous, typhous, syphilitic or 
cancerous ulcerations ; from primary laryngeal chondritis. 

THERAPEUTIC HINTS.— All in all the disease being more of a 
secondary nature, the accompanying primary disease will have to be studied 
first ; therefore a number of remedies will offer themselves for consideration. 
As acting especially upon the cartilage, Von Grauvogl designates Silic. 

In cases where the abscess closes the larynx, tracheotomy will have to be 
resorted to. 



Phthisis Laryngis, Tubercular Ulceration. 

As a rule, tubercular ulceration of the larynx is secondary to pulmonary 
tuberculosis and co-existing with it; in exceptional cases it may precede pul- 
monary manifestations, at least palpable ones. Commencing with slight 
hoarseness, lack of ring and easy giving way of the voice on taking a slight 
cold, which, however, gradually subsides, the trouble is often overlooked. The 
laryngoscope shows at this time partial injection and swelling of the vocal 




processes, of the inter-arytenoid region and the cartilages of Santorini. In 
other cases there is a striking anaemia of the mucous membrane and not 
seldom paresis of the muscles. Gradually by renewed colds, ulcers form 
on these places; they may be single, they may spread to the epiglottis and to 
the ventricular bands and vocal cords, and form an extensive ulceration all 
around the glottis. The hoarseness increases, often to total aphonia; the 
cough is generally without tone or power, and there is usually soreness on 



328 



LARYNX AND TRACHEA. 



swallowing, and burning and stinging pain in the region of the larynx. The 
ulcers of phthisical subjects present no characteristic signs by which they 
could be recognized as such, w r e must consider the whole history of the case 
(whether there be any syphilitic taint) and its present state (co-existing pul- 
monary tuberculosis), in order to form our diagnosis. 

The Prognosis is that of tuberculosis in general, a poor one; still, if 
the course of the disease is slow, and the frequency of the pulse does not, for 
any length of time, exceed 96 to 100; if the ulceration is not too extensive 
and the co-existing tubercles in the lungs are not in an extensively softening 
process, and no new infiltrations occur, and also if the patient can and does 
implicitly follow our advice, we surely will be able by a careful study of the 
case to prolong life, at least. 



THERAPEUTIC HINTS.— The treatment of pulmonary tuberculosis 
must be studied. For the prominent laryngeal symptoms, compare Laryn- 
gitis Chronica ; besides consider : 

Arg. nitr., swelling of the parts; ulcers with luxuriant granulations; 
titillation in the larynx ; much hawking, or spasmodic cough, and accumu- 
lation of phlegm. 

Arsen., "dirty red, or anaemic appearance of the laryngeal lining, 
with bluish-red patches, or general discoloration of the tissues; indolent, or 
burning extensive ulceration, with more or less sero-purulent secretion. 
Pulse small and feeble; progressive emaciation and weakness." (Meyhoffer.) 

Bellad., for intercurrent " colds," with difficult and painful deglutition; 
spasmodic or barking coUgh. 

Carb. an., greenish expectoration; lungs affected, especially right side; 
enlarged glands; copper colored spots on face and body; earthy colored 
face; great exhaustion. 

Carb. veg., evening hoarseness; bloatedness; rancid belching; the 
most innocent food disagrees. Great tendency to perspire about the chest 
and to take cold on least change of temperature; knees always cold but 
especially at night in bed. 

Iodium and Kali hydr., in scrofulous subjects; follicular swelling of 
throat; extensive ulceration. 

Laches., ulceration on left side of glottis; bluish inflammation of 
fauces ; voice and cough without tone. 

Merc, jod., after Bellad., "dark red inflammation and swelling of 
the parts with much hawking, coughing and purulent expectorations worse 
in the morning." (Meyhoffer.) 

Nitr. ac, "great irritation; redness and ulceration of the epiglottis 
and larynx, with difficult and painful deglutition, violent dry cough and 
nocturnal perspiration." (Meyhoffer.) 



NEOPLASMS OF THE LARYNX. 329 

Phosphor., Sepia, Silic, Stramon. and Sulphur, ought not to be 
overlooked. 

Syphilis Laryngis 

May consist of a mere Catarrh, scarcely distinguishable from an ordinary 
catarrh; or of Condylomata, which are flat wart-like papules, with a thick, 
whitish-gray, adventitious covering of epithelium ; or of Gummy tumors 
or Syphilomata, consisting of little roundish swellings of the size of a pin- 
head to that of a small pea, usually of the color of the rest of the mucous 
membrane, and frequently found in rows ; or of actual Ulcers of various ex- 
tensions and depth. The diagnosis of all these must be made from the 
history of the case, from the evidence of other syphilitic affections, especially 
in the pharynx, on the skin and in the bones, and by the laryngoscope. 
Ulcers may lead to syphilitic perichondritis, to haemorrhages and papillo- 
mata, which often form in the vicinity of syphilitic cicatrices. 

THERAPEUTIC HINTS.— Aurum, accompanied by ulcers on the 
roof of the mouth ; previous mercurial treatment ; affections of the bones. 
Merc, sol., when ulcers appear also on the tonsils. 
Merc, jo d., painless ulcers. 
Kali, hydr., previous mercurial treatment. 
Kali bichr., ulcers on the soft parts of the fauces. 
Nitr. ac, painful ulcers; abuse of mercury; condylomata. 
Thuja, condylomata. 

Neoplasms of the Larynx. 

Of these, the Papilloma or Fibroma papillare occurs most frequently ; 
it is a proliferation of the connective tissue, commencing by preference on 
the anterior extremities of the vocal cords. The Papillomata are in fact 
hypertrophical papillae, covered with a thick layer of epithelial cells. Their 
size and form varies, representing either little buttons or pegs, or warty 
formations like a cock's comb ; in some cases they attain to huge growths 
similar to a berry, grape, or cauliflower, which may partly or entirely fill 
the upper and middle laryngeal cavity. 

The Fibroma, or Fibrous polypus is also of frequent occurrence, ap- 
pears mostly single, rarely multiple, takes its origin on the vocal cords. It 
presents itself as a little, generally pedunculated, roundish or pear-shaped 
tumor, of a dirty whitish or reddish, or dark red color, sometimes with dis- 
tinctly branching vessels on its surface. Its size may attain to that of a 
hazel-nut, and its consistence is either hard or soft. Fibrous polypi usually 
are of slow growth. 



330 LARYNX AND TRACHEA. 

MUCOUS polypi and Cystic tumors are of not so frequent occurrence. 
They take root in the ventricle of Morgagni by preference, being attached to 
a broad base; they grow slowly and seldom attain any considerable size. 
When incised, they slowly empty their more or less thickened contents. 

Carcinoma or Cancer occurs tolerably often within the larynx, and 
especially in its epithelial form. Its seat is almost invariably the upper and 
middle portion of the laryngeal cavity. Laryngoscopic examination seldom 
shows very characteristic conditions at the beginning, especially in those cases 
in which cancerous infiltration into the submucous tissue produces a uniform 
intumescence of the soft parts, with strong vascular injection of the mucous 
membrane. Later, however, when the intumescence becomes considerable 
and extensive ulceration takes place, with enlargement of the lymphatic 
glands of the neck, and an extension of the morbid process to the pharynx 
or oesophagus, its diagnosis is easy enough. 

THERAPEUTIC HINTS —Usually, that is since the laryngoscope 
has been in use, the neoplasms have been treated surgically either by cauteri- 
zation or by extirpation, or by still more complicated surgical operations. 
We are sadly in want of observations gained by pure homoeopathic treat- 
ment. If it, however, is beyoud doubt that similar morbid growths on other 
parts of the body have been removed by the administration of homoeopathic 
remedies alone, there is no reason why a similar treatment should not succeed 
in these cases. Compare, for instance, polypi in ears, nose, etc. For can- 
cerous disorganization even extirpation is of no avail. 

Neuroses of the Larynx. 

These are either neuroses of sensation (anaesthesia, or hyperesthesia, 
neuralgia of the laryngeal mucous membrane), or of motion (paralyses or 
spasms of certain muscles of the larynx). 

Anaesthesia, or diminution or total extinction of sensibility in the laryn- 
geal mucous membrane, is an ordinary symptom of approaching death ; it 
occurs in diphtheritic paralysis of the organs of the throat, and at times in 
hysteria. Its degree and extent vary, and can only be ascertained by care- 
fully testing the parts by the probe under guidance of the laryngeal mirror. 

THERAPEUTIC HINTS.— Argent., Gelsem., Kali brom. Elec- 
tricity. Strychnine. 

Hyperesthesia and Neuralgia occur most frequently in inflammatory 
and ulcerative conditions of these parts. When it is a symptom of general 
nervousness, as in hysteria, it is frequently attended with a spasmodic cough 
of longer or shorter duration, and at times periodically recurring at a given 



NEUROSES OF THE LARYNX. 331 

hour. Hypochondriasis, too, especially in persons suffering from seminal 
emissions, is at times attended with great sensitiveness of these parts. 

THERAPEUTIC HINTS.— Ignat. meets frequently the hysterical 
cough. Other symptoms must necessarily be taken into consideration. If 
in connection with inflammatory conditions, compare these. 

Paralysis may be bilateral in consequence of a paralysis of the trunk of 
the recurrent of both sides. The recurrent innervates all the muscles con- 
cerned in the locomotion and tension of the vocal cords, except the crico- 
thyroid muscles. Such a paralysis is therefore characterized "by absolute 
loss of voice ; inability to cough or expectorate with force ; undue expendi- 
ture of breath on making attempts at phonation, or at forcible expiration, 
for instance in coughing ; the absence of dyspnoea during quiet breathing, at 
least in adults; laryngoscopically, the cadaveric (widely opened) position of 
both vocal cords, the edges of which still further approximate each other 
on forced inspiration." (Von Ziemssen.) It may be unilateral when the 
trunk of the recurrent of one side only is paralyzed. This causes the voice 
to lose its ring and be(*>me impure (rattling), being rendered so by tremors; 
on straining it in speaking loud, the voice readily breaks into a falsetto, and 
the patient becomes wearied. The vocal cord of the paralyzed side remains 
motionless during phonation, while the healthy cord and arytenoid cartilage 
pass over the median line. When the posterior crico-arytenoid muscles, the 
office of which is that of widening the glottis during respiration, become 
paralyzed, the inspiratory opening of the glottis is extinguished, and true 
stenosis of the glottis of the highest grade, with danger of asphyxia, is es- 
tablished. The mirror shows the glottis transformed into a narroAV slit, 
which is still further narrowed by the external atmospheric pressure during 
inspiration, while during expiration the glottis returns to its original size. 
Inspiration, therefore, causes loud sounding vibrations of the vocal cords, 
which are pushed forward to the middle, while expiration takes place un- 
hindered, is short and noseless. The voice seldom undergoes any change. 

Still other individual muscles may be paralyzed, but they are of less 
importance. 

THERAPEUTIC HINTS.— Compare : Bellad., Bryon., Caustic, 
Coccul., Cuprum, Ignat., Plumbum, Zincum. China and Stramon., 
difficult inspiration and easy expiration. Electricity. 

Paralytic or Paretic Aphonia, may require : 

Amm. caust., when attended with bronchial and asthmatic symptoms, 
great general muscular debility, exhaustion and tremors. 

Ant. crud., loss of voice from getting heated by exertion; return of 
voice by resting. 



332 LARYNX AND TRACHEA. 

Arg. met., hoarseness after singing and preaching; anaesthesia of the 
fauces. 

Arum triph., aphonia after singing or speaking; voice changes in 
tone frequently. 

Bellad., aphonia comes on suddenly. 

Caustic, sudden loss of voice after taking cold, often combined with 
catarrhal symptoms. 

Cina, peculiar twitching of the right hand when coughing; right side 
of chest constricted, with difficult breathing; gurgling noise down along the 
oesophagus. (Kafka.) 

Cupr. met., aphonia from central causes after convulsions. 

Gelsem., after diphtheria; during catamenia. 

Ignat., in hysteria. 

Laches., paralysis of left vocal cord; worse after sleep; tenderness to 
touch. 

Nux mosch., aphonia from walking against the wind; hysterical, 
gastro-intestinal and cardiac derangements. 

Nux vom., coming on suddenly and combined with catarrhal symptoms. 

Opium, loss of voice from fright. 

Phosphor., vocal cords broad and relaxed; tired; pale; chest op- 
pressed ; menses too often. (Welch.) 

Platina, in uterine disturbances. 

Rhus tox., after straining the voice. 

Stramon., from cerebral disease and great mental excitement. 

Sulphur, chronic cases of all kinds. 

Spasm of the Glottis. 

In books this affection has been described under various names : Asthma 
spasmodicum or Laryngeum infantum, asthma periodicum acutum 
infantile, Laryngimus stridulus, Laryngitis* stridulosa. The most 
prevalent, however, and at the same time the most inappropriate names are 
Asthma Millari and Asthma thymicum Koppii. It is quite difficult to 
understand how the description which Millar gives of a certain affection of 
children, and which he himself styles Asthma acutum, could ever have 
been applied to spasmus glottidis, as it portrays quite clearly what we may 
express by the term of Laryngitis. He even recognizes the " white, tough, 
jelly-like stuff," with which the windpipe was found filled after death. The 
term Asthma thymicum Koppii is likewise inadmissible ; for the assump- 
tion which it implies, that these spasmodic fits be caused by a swelling or en- 
largement of the thymus glands has, in consequence of late pathologico- 
anatomical researches, become untenable. 



SPASM OF THE GLOTTIS. 333 

The Symptoms of spasmus glottidis are as follows : It commences with 
slight and short attacks of dyspnoea, attended by a wheezing noise during 
inspiration, whereby the children move uneasily and show an anxious ex- 
pression. Soon all is over; and if the attacks happen during the night they 
may be overlooked altogether. By and by, however, these spells increase in 
number, intensity and duration. The child is suddenly attacked in conse- 
quence of a little fright, or whilst crying, laughing, drinking, or especially 
in the moment of getting awake ; its inspiration becomes whistling, crowing 
and so difficult that it strains all the respiratory muscles to draw the air 
through the spasmodically closed glottis into the lungs. Expiration is quite 
impossible, and thus respiration ceases for a while altogether. The face of 
the child expresses the greatest agony and sense of suffocation, and becomes 
purple ; cold perspiration appears upon the forehead ; the veins of the neck 
become turgescent and the thorax is motionless. The pulse falls at this stage 
and is small and intermitting. This fearful condition lasts in severe cases a 
minute or two at the utmost, generally only a few seconds; then with a loud, 
crowing cry the child again catches its breath, is exhausted, cries and sobs, 
but shows no signs of fever or any catarrhal affection. The number of 
attacks may amount to ten, twenty, even fifty, in the course of a day ; and if 
the complaint be not arrested it may terminate in general convulsions and 
death. 

The age in which children are attacked by this disease lies, in most 
cases, between their fourth and fourteenth month ; as they grow older and 
stronger, the spells grow milder. In adults it is of rare occurrence, and then 
much less severe, on account of the larynx being more developed at that age. 
The female sex during the age of puberty, is the most frequently attacked 
amongst grown persons. Its pathological character is a disturbed action of 
the nervus vagus or recurrens, either from central or peripheral irritation. 
In children rachitis is the principal cause. Post-mortem examination shows 
the larynx entirely free from any morbid changes. 

THERAPEUTIC HINTS — Bellad., congestion to the head; throb- 
bing of carotids; teething process; drinking excites the spasms. 

Bromium, gasping and snuffing for breath. 

Chlorine (the gas in water), crowing inspiration and expiration im- 
possible (Dunham). The respiratory acts consist of a succession of crowing 
inspirations, each one followed by an ineffectual effort at expiration, the 
whole serving to inflate the chest to a most painful extent. (W. S. Searle.) 

Cuprum, bluishness of face and lips; convulsions; after fright of 
mother or child. Cold perspiration at night; cough relieved by a swallow 
of cold water. 



334 LARYNX AND TRACHEA. 

Gelsem., inspirations long, with crowing sound; expirations sudden 
and forcible. 

Ignat., difficult inspiration with easy expiration; hysteria. 

I odium, tightness and constriction about the larynx, with soreness, 
hoarse voice, etc. Enlargement and induration of the glands, cervical and 
mesenteric; absence of appetite; utter indifference to food; scanty, high 
colored urine ; clayey evacuations ; emaciation ; yellow skin ; action of heart 
feeble and much increased by motion. (Dunham.) Rachitic children; 
swelling of bronchial glands; thymus gland (perhaps) enlarged. 

Ipec, blueness of face and coldness of extremities, at the commence- 
ment. 

Laches., sensitiveness of larynx and trachea to the touch. 

Mephit., similar to Chlorine, has suffocating feeling with inability to 
exhale ; bloated face and convulsions. ( W. S. Searle.) 

Moschus, in hysterical women. 

Phytol., "frequent spasmodic closure of the larynx; drawing of the 
thumbs into the palm ; flexion of the toes ; distortion of the face ; muscles of 
the eyes affected so that the motions of one eye were independent of the 
other." (Kapp.) 

Plumbum, spasmodic closure of the rima glottidis; mucus rattling in 
throat, with sudden difficulty of breathing and asphyxia. 

Sambuc, able to inhale but not to exhale; becomes livid in the face; 
gasps in great anguish and very slowly recovers its breath; awakes from 
sleep with suffocation. (C. Wesselhceft.) Burning red, hot face, hot body, 
with cold hands and feet during sleep; on awakening, the face and body 
break out into a profuse perspiration, which continues as long as the patient 
is awake; on falling asleep again, the dry heat returns. 

Veratr., cold perspiration on forehead, and cold extremities. 

The following remedies may also be indicated in individual cases: 
Arsen., Calc. carb. and phosph., Chamom., Coral, rubr. (Mey- 
hoffer), Hydr. ac, Lauroc, Phosphor., Silic, Spongia, Sulphur. 

The rachitic conditions require : Calc. carb., Hepar, Iodium, Silic, 
Sulphur. 



THORAX. 



This is a chapter of great importance, and at the same time of difficulty. 
Its exploration we will have to undertake on different roads. We must 
know what is to be learned by inspection, palpation, percussion, and auscul- 
tation. 

I. Inspection— Ocular Examination. 

If we consider that the thoracic cavity holds within itself the lungs and 
heart, the organs of respiration, and of circulation, we shall understand why 
it is that the first phenomenon which strikes the eye is the continuous motion 
in which we find its walls engaged. 

This Respiratory motion of the chest in men is greatest in the region 
of the lower ribs on each side; in women, on the upper part of the chest; and 
in children, towards the abdomen. 

The number of respirations varies according to age, sex, and individu- 
ality; so that we might put down the normal number of respirations per 
minute in grown people at from twelve to twenty; in young persons, from 
fourteen to twenty-four ; in children, about twenty-six, and in infante about 
forty-four. But there are other conditions which may materially modify the 
frequency of respirations — such as mental excitement, bodily exertions, di- 
gestion, temperature, and other conditions of the air. As a rule, however, if 
compared with the pulsations of the heart, it may be said, that during one 
respiratory act there are three or four beats of the heart ; but these respiratory 
motions of the lungs and pulsations of the heart never correspond in rhythm, 
as you may easily ascertain by counting your pulse, and observing your 
breathing at the same time, the pulse being a little too fast or a little too 
slow to make up an even count between respiration and pulsation. This is 
a very interesting fact, which it is well to bear in mind. "When respiration 
and pulsation become synchronous — that is, when upon each act of respira- 
tion for a length of time fall precisely two, three, four, five, or six pulsa- 
tions — we may be pretty sure that death is near. My attention was first 
drawn to this interesting fact by Dr. Hering. Since then I have found it 

(335) 



336 THORAX. 

verified many times. Its explanation is another matter. We might, per- 
haps, explain it, if we remember that the heart's action is governed mainly 
by the sympathetic nerve, while the lungs are under the control of the vagus, 
though each of them sends branches to the other organ, the sympathetic to 
the lungs, and the vagus to the heart. The sympatheticus is the great nerve 
of organic life, and under its direction all the functions of the body are per- 
formed, which are entirely out of the reach of the will. It arises from a 
series of ganglia, extending along each side of the vertebral column from the 
head to the coccyx. The vagus has its origin in the brain, and its fibres 
may be traced through the fasciculi of the corpus restiforme into the gray 
substance of the floor of the fourth ventricle, and therefore the parts to 
which it is distributed are more or less under the control of the will. When 
death approaches, or, in other words, when the separation of soul and body 
commences, those functions which are more or less under the control of the 
will are most probably the first to cease. The vagus losing its influence 
upon the lungs, their action is now continued under the sole direction of the 
sympatheticus as long as organic or vegetative life still continues; thus 
respiration and pulsation act in full harmony — become perfectly synchronous. 

" The respiratory motion of the chest itself in ordinary health is com- 
paratively slight in consequence of the thoracic cavity being enlarged in 
every direction nearly simultaneously. It resembles the easy ebb and flood 
of a soft wave. When, however, a deep respiration is taken, it is observed 
that the sternum is slightly but steadily projected forward, the abdominal 
parietes gently dilated. The lower ribs are first and most considerably 
raised, and the elevation of each separate rib takes place gradually, evenly, 
and regularly upwards, notwithstanding which, each and all appear to move 
at the same time. Every part acts separately, but each in perfect harmony 
with the other." (H. M. Hughes.) 

Without any deviation in form, a remarkable stillness and want of 
movement may be observed either of a whole side or only a part of it. This 
is a sign of inflammation of the pleura in its early stage. 

The thoracic breathing, when the diaphragm is not moved, is a sign of 
2>eritonitis ; the abdominal breathing, when the ribs are not moved, is a sign 
either of inflammation of the chest, or of paralysis of the respiratory nerves, 
except the phrenic, from injury of the upper part of the spinal cord. 

The Form of the thorax must also be taken into consideration, and this 
must always be done by comparing one side with the other. In this way, if 
we bear in mind the natural motion and the natural shape of the thorax, 
ocular inspection will reveal the following noticeable facts : 

1. The upper ribs sink away from the clavicle, become flattened and 
motionless, while, in many cases, the movement of the lower ones is not inter- 






PALPATION — MANUAL EXAMINATION. 337 

fered with, and, as a general rule, the change is more evident on one side 
than on the other. This is a sign of advanced phthisis. (Barclay.) 

2. The chest is full and rounded ; the ribs stand out, but have a very 
slight range of movement, and the inspiratory effort is marked by powerful 
traction of the muscles of the neck; the movement of the lower part of the 
chest is very often inward in place of outward, during inspiration. (Barclay.) 
These are some of the physical signs of emphysema of the lungs, that morbid 
state in which the volume of the organ is increased in consequence either of 
the dilatation of the air-cells, or, what is of rarer occurrence, of the escape of 
air into the space between the lobules or beneath the pleura ; and also of 
croup. 

3. Only one side bulges, the intercostal spaces are obliterated and the 
respiratory motion is annihilated. This is a sign of a collection of serum — 
hydrothorax, or of pus — pyothorax, or of gas — pneumothorax — into the pleural 
sac. 

"But in many advanced cases of pleuritic effusion, of empyema (collec- 
tion of pus) and of pneumothorax, with effusion, not only, as before stated, 
is the side not enlarged, but it is, on the contrary, contracted ; and not only 
are the intercostal spaces not widened and prominent, but they are actually 
much narrowed. Herein exists a notable example of that which is so necessary 
to bear constantly in mind, that the results of one mode should be carefully 
compared with those deduced from other modes of physical examination, and 
the whole weighed together with the observations derived from the history 
and the constitutional symptoms of the case under examination. Because 
the side is contracted, and the intercostal spaces narrowed, as observed upon 
inspection, it might be hastily assumed that there was no fluid in the chest, 
while in truth the contracted side might be actually filled with pus or serum, 
and the other, supposed from its greater size to be the one diseased, might 
be quite healthy. (H. M. Hughes.) 

4. A general fulness or roundness of the precordial region may be some- 
times observed. This is the case when the heart has been enlarged for a con- 
siderable time, or when fluid effusion has long existed in the pericardium. 
Nota bene : A broken rib may bulge out too ! 

II. Palpation— Manual Examination. 

This is a method of using the hand with its sense of touch, for the elimi- 
nation of certain conditions of the thorax. We may merely tap with one 
finger, or lay the whole hand upon the parts to be examined, press or glide 
gently over the surface, according to the requirements of the case. In this 
way we become cognizant of temperature, form, resistance and motion of these 
parts. 

22 



338 THORAX. 

The Temperature, if raised to calor mordax, fairly burns and stings the 
examining hand, and is found on the chest in far advanced pulmonary com- 
plaints. We feel at the same time the condition of the skin, whether it be 
dry or moist, harsh or soft. 

The Form. When it is convenient to expose the chest of a patient, 
the appressed fingers of one hand placed flatly and pressed firmly upon the 
infraclavicular region of one side, while .the other is similarly placed and 
pressed upon the corresponding region of the other side, are often capable of 
distinctly appreciating a flatness of one side, or a difference in the pliability 
or expansibility of the two sides, even in the early stages of phthisis. 

The Resistance depends upon the character of the parietes and the 
contents of the thorax. The resistance of the parietes is greater, the more 
convex, stiff and strong the thoracic bones, and the narrower the intercostal 
spaces are. It is more yielding where the contrary conditions exist. In the 
acromial region the resistance to pressure increases when the muscles are put 
upon the stretch. The resistance of the contents of the thorax increases in 
the ratio as they are compressed. Whether there be much or little air, water 
or pus collected in the cavity, it has no influence upon its resistance to ex- 
ternal pressure. But when this air, water or pus becomes compressed, and in 
consequence the walls which contain it are put upon the stretch, its resist- 
ance increases in the same ratio, and such swelling within the chest may feel 
as hard as a stone. Hepatization of the lungs gives a considerable resistance, 
but it is greater in exudations under the above-mentioned conditions. 

Palpation lastly reveals different kinds of Motions which originate 
within the cavity of the chest. The most important of them is the Yibration 
Of voice, or the Yocal fremitus, of which we become cognizant by placing 
our hand upon the thorax of a person who is in the act of talking or singing. 
Its force corresponds with the power and depth of the voice, so that we feel it 
much stronger in men of a deep bass voice than in other persons, whose 
voices are of a higher pitch. Singing and screaming causes fremitus even in 
the highest-toned voice. The localities in which it is perceived, arranged ac- 
cording to the strength of the vibration, are as follows : 

1. Larynx and trachea down to the sternum in front and laterally. 

2. The last four cervical and first three dorsal vertebral of the adjacent por- 
tions between the scapulce, especially in thin persons and children. 

3. The acromial and subclavian regions down to the liver and spleen, on 
the right side much stronger than on the left. 

4. The lateral regions, from the axillce down to liver and spleen; to the fifth 
rib stronger on the right side ; below the fifth rib stronger on the left side. 

5. The posterior inferior regions from the edges of the shoulder-blades down- 
wards. 

6. The shoulder-blade region. 



PALPATION — MANUAL EXAMINATION. 339 

7. The manubrium sterni. 

8. Where the liver or the enlarged heart or spleen lie close to the tho- 
racic wall, the fremitus is not felt at all. 

The mamma of women decrease the vibration of the voice, but do not 
suppress it altogether. In thin persons with a long thorax, the fremitus is 
stronger than in persons with a broad but short thorax. It is felt more in 
the horizontal than in the upright position. This is its normal condition in 
health. 

In disease it may be increased or decreased. 

It is Increased when the bronchial walls become thickened by chronic 
inflammation; or when the lungs become hepatized, or infiltrated with tuber- 
cles, or indurated and consolidated. It is also increased by cavities, which 
lie near the periphery, contain air and not much fluid, and which are sur- 
rounded by walls of good conducting quality; in short, its increase depends 
upon good conductors of vibratory motions. 

The Fremitus is decreased by the presence of large abscesses or gan- 
grenous destruction or softening of the substance of the lungs; it is decreased 
or even suppressed when gas or serum fills the pleural sac; and it is de- 
creased when the bronchial tubes are filled with mucus, pus or blood; in 
short, in all cases where the vibratory undulation has to pass through different 
media, air, fluids and solids. 

For here, too, is the 23hysical law of the conduction of sounds applicable; 
the more equal the media in respect to density and elasticity, the better do they 
conduct sounds; the greater their inequality of substance, the less is their con- 
ductive power. 

Another vibratory motion within the cavity of the chest, which mani- 
fests itself to manual examination, is, the Rhoncus vibration, caused by 
tough mucus lodged in the larynx, trachea or bronchial tubes, and brought 
into vibratory motion by the in-going and out-going current of air. This 
vibration very often extends over the whole chest, although only a little tough 
phlegm may be the cause of it, which can be thrown off by a single cough. 

When, however, the cause of this vibration consists of phlegm lodged in 
the bronchial tubes, the rhoncus vibration is not felt in the trachea and 
larynx, but may extend all the way down to the bronchial periphery. For 
this reason we can never judge from the extension of the vibration to the ex- 
tension of its cause; in other words, it does not follow that because we feel 
the rhoncus fremitus all over the chest, that there should be phlegm all 
through the chest. This would be a mistake which could be made onlv by 
those who do not understand the propagation of rhoncus vibration. 

A third vibratory motion, recognizable by manual examination, is the 
Peculiar rubbing or grating feel, which occurs when the surface of the 
pleuro pulmonalis and costalis — which naturally glide smoothly upon each 



340 THORAX. 

other — are roughened by solid effusion between their contiguous surfaces, as 
in pleurisy. It is mostly of short duration, but may last in some cases 
months and even years. The same motion is caused by fibrous deposits 
within the pericardium, in consequence of pericarditis; it resembles very 
much the purring of a cat. 

A fourth motion which the examining hand discovers upon the thoracic 
walls are the Pulsations of the heart. " While the body is erect, the 
heart, when in a natural condition, is constantly felt to strike the parietes 
between the fourth and fifth ribs about an inch below and to the inner side 
of the nipple. While lying upon the back, its impulse is greatly decreased, 
and is usually felt somewhat nearer to the sternum. When the body is 
turned to the left side, the impulse is felt in a direct line with, or often 
nearly an inch to the outer side of a line passing vertically over the nipple ; 
while, on the contrary, when the body is turned to the right side, it is felt 
between the cartilages of the ribs, close to the sternum, or sometimes cannot 
be felt at all. 

"When the parietes of the heart are thickened, or hypertrophied, and 
the force of its impulse is consequently increased, the hand, placed over the 
precordial region, becomes at once sensible of its abnormal force, though the 
pulse at the wrist may at the very same time be small and feeble. In con- 
siderable hypertrophy of the left ventricle the apex of the heart strikes not 
only lower, but also outside, or to the left of the nipple line. 

" When the cavities of the* heart are dilated, with or without any in- 
crease of the thickness of their walls, the impulse is often perceptibly ex- 
tended over a larger space than natural, and may be felt not only above, 
below, and around its ordinary site, but also in the scrobiculus cordis; and 
sometimes even on the right of the sternum. It must, however, be recol- 
lected, that in nervous and excitable persons of spare habit, the impulse of 
the heart is often very extensively diffused, even when no disease of the 
heart exists ; and, therefore, that a widely extended or diffused impulse is by 
no means a proof of the existence of disease in the heart, or in any other 
organ. 

" When the heart is removed from its natural situation by gaseous or 
fluid effusions into the pleura, by tumors, abscesses, etc., it is by manual ex- 
amination that the fact can generally be best determined. 

" When obstruction exists in the valves, a trembling motion or 'purring 
tremor' is frequently communicated to the hand, and the tumultuous action, 
or trembling motion, existing in the more advanced stages of disease in the 
heart, can often be best appreciated by palpation." (H. M. Hughes.) 

III. Percussion. 

A casual examination of the different works on this subject is amply 



PERCUSSION. 341 

sufficient to cause total confusion in the mind of the beginner, and a loathing 
of the task of wading through such contradictory assertions of the different 
authors. For whilst the one pretends to hear the grass grow, and to find 
out every little nook and hook in the lungs, if wrong, by knocking, another 
asserts coolly, that such talk is a mere flatulent phraseology, referring simply 
to the fact that the most skilled and experienced in this knocking art them- 
selves confess of having made the most glorious mistakes. 

What are we to do then in such perplexity? Shall we throw the whole 
overboard, as a fashionable craziuess of the profession? It would be a short 
process of getting rid of the trouble. But then, that is not the thing. There 
has been so much labor and ingenuity bestowed upon this subject, that there 
must be some guiding truths in this heap of collected experiments and re- 
searches, no matter how badly mixed with contradictory assertions. 

In the following pages I shall try to state the fundamental principles, 
by which we must be guided in the application of this kind of examination. 

There is an immediate and a mediate mode of percussion. It is immedi- 
ate when the finger of the examiner strikes directly upon the parietes of the 
chest. It is mediate when some solid material, such as a disc of wood or 
ivory, a piece of leather, or the finger of the left hand, is interposed between 
the parietes and the striking body. 

The striking body may be one or more fingers pressed together and bent 
slightly, or a little steel hammer, whose head or striking surface is covered 
with leather or caoutchouc. 

In regard to the merits of these different modes I have to say that much 
depends upon what we may have got accustomed to ; still the one or the 
other may be preferable under certain circumstances, which practice will 
soon teach. 

What does percussion reveal f 

If we strike different things we receive different sounds. There is, 
however, a marked difference between those bodies which contain air and 
such as do not. As extreme examples of this difference we may cite the 
sounds which we obtain when we percuss the chest or stomach, and when we 
percuss the thigh. In the first case we obtain a sound which reverberates — 
has resonance; whilst in the other case we hear a mere noise, a clap, without 
any resonance or tone whatever. This latter, which we may call the dull, 
dead or fleshy sound, is everywhere the same, where we strike upon an organ 
not containing air; such as the liver, the spleen, the kidneys, hepatized lung, 
or lung completely deprived of air by compression and fluids ; a hard liver 
yields the same sound as a soft liver, a hard spleen as a soft spleen. 

But it is different with such organs and bodies as contain air; there the 
sound varies quite considerably. Take for example an open jar or bottle, 
and percuss it at its mouth, you will hear a sound similar to that of a drum ; 



342 THORAX. 

this is the sound which Skoda has called the Tympanitic Sound, and which 
we also might call drum sound. Its variations are as follows : 

1. If w r e percuss an open jar or bottle, this drum sound will be deeper, 
t*he higher or longer the bottle or the column of air which it contains ; it will 
be higher, the shorter the column of air is within. 

2. If we percuss an open jar or bottle, we find that the wider the inouth 
of the vessel, the higher is its tympanitic tone ; and, the more we contract the 
mouth of the vessel, the deeper becomes this tone. In short, it depends on 
the volume of air which is set into vibration ; a larger volume gives a deeper, 
a smaller gives a higher tone. 

3. If we, however, percuss closed cavities, there comes into consideration 
another momentum. A drum or jar, w r hose mouth is closed tightly w T ith a 
piece of bladder, can exemplify it. We perceive at once that the tenser the 
skin is drawn over the drum or the bladder over the jar, the higher becomes 
its tympanitic tone, and vice versa, the looser, the deeper. Here, however, it 
must be remarked, that this comes to pass only when the surrounding air 
and the air within, is of equal density and expansion. As soon as either is 
set out of that equilibrium, just as soon the tympanitic sound is lost, because 
this diversity hinders the regular vibrations of the membrane, w 7 hich are 
necessary for the tympanitic sound. 

Thus we find that the tympanitic sound varies in height and depth of 
its tone. It becomes higher in the ratio — 

1. That the column of the percussed air is shorter; 

2. That the mouth or aperture by which the percussed air stands in 
connection with the external air is wider; and 

3. That the enclosing membrane is drawn tensely over the cavity. 
It becomes deeper in the same ratio — 

1. That the column of the percussed air is longer; 

2. That the mouth or aperture by which the percussed air is in con- 
tact with the external air is narrower ; and 

3. That the membrane which closes the vessel is looser. 

Applying these physical rules to the living organism, we come to the 
following results : 

1. The tympanitic sound is heard at the larynx. The wider the person 
under examination opens his mouth, the higher is its tone; in closing the 
mouth it becomes deeper and weaker, and when closing the nostrils also, it 
becomes still deeper and weaker. 

2. The tympanitic sound is heard where there exist superficial cavities in the 
Jungs, which contain air. If it happens that such cavities are in immediate 
connection with the trachea, larynx and mouth, by means of large bronchial 
tubes, then we have the same phenomena in opening and shutting the mouth, 
as above detailed. In opening the mouth the tympanitic sound has a higher, 






PERCUSSION. 343 

and, when shutting it, a deeper tone. If the cavity is in no such connection, 
then opening or shutting the mouth does not alter the tympanitic sound. 

3. It is heard on the thorax in all those conditions of the lungs in ivhich 
the external air presses equally strong within upon the substance of the lungs, 
by means of its air-cells and bronchial tubes, as it does from the outside upon 
the thorax; that is, where there is a perfect equilibrium between the pressure of 
the internal and external air. This, however, in a normal state is never the 
case. The inner pressure of the air is like the external, minus the contractility 
of the pulmonary tissue. But disease may deprive the lung tissue of this 
elasticity and contractility by compressing it, whereby this equilibrium be- 
comes established. This we find, for example, in partial emphysema, in the 
neighborhood of infiltration, as happens in pneumonia, where, not unfre- 
quently, the tissue around the hepatized portion, and especially at the borders 
of the lung, is emphysematous, and also during pneumonia, as long as the 
air-cells are not infiltrated, but have lost their natural elasticity. In these 
conditions we hear a decided tympanitic sound, whilst in pneumothorax — 
a collection of air or gas in the pleural sac — we hear none. Especially is this 
the case when the thorax is much distended ; although we might be inclined 
to expect it more then, than under other conditions. We hear it again dis- 
tinctly and invariably at the upper portion of the chest, when the lower portion 
of a lung is entirely compressed by a pleuritic effusion and its upper portion is 
reduced in volume. 

4. The tympanitic sound is heard lastly in those parts of the chest in whose 
neighborhood the stomach lies, namely, in the lower part of the left mammary, 
left lateral, and left infrascapular regions, provided the stomach be not too 
much distended with air ; because otherwise a regular vibration of its walls, 
and hence the tympanitic sound, would be impossible. 

The same is true of the abdomen; and thus we come directly to the 
following result: The tympanitic sound on percussion is heard at the larynx; 
at the collapsed or compressed lungs; at the relaxed stomach, and at the com- 
pressible abdominal walls. 

Quite different from this tympanitic sound is another sound elicited by 
the percussion of bodies containing air: the Non-tvmpamtic sound of 
Skoda, which we might perhaps more intelligibly call the resonant sound of 
the lungs, or, by abbreviation, the lung-sound. The best example of this 
sound is obtained by percussing a healthy thorax ; and, in doing this, we 
perceive at once that there are different degrees of resonance in it. It varies 
in clearness from a very resonant to a muffled sound ; and, in duration, from 
a long resonance to a short snap. 

In the normal state of the lungs we find this sound very resonant in the 
superior sternal, the axillary, and the upper part of the infrascapular re- 
gions; resonant in the subclavian, the upper part of the mammary, and 



344 THORAX. 

lateral, and interscapular regions; muffled in the acromial, and the lower 
part of the right mammary, and lateral, infrascapular regions ; dull, dead, 
fleshy in the inner edge of the left mammary (where the heart lies), and in 
the regions of the liver, spleen, and kidneys. 

Pathological altered states of the lungs alter also this natural resonance 
of the percussion sound. 

It is Muffled, dull— 

1. On any portion of the lung which is deprived of air, if it is, at least, 
the size of a half-dollar, and about half an inch in thickness. 

2. In the subclavian regions from tubercular infiltration. 

3. In the inferior posterior regions, as the favorite seat of pneumonic 
hepatization ; other parts not excluded from the same cause. 

4. Diffused over a considerable portion of the chest in haemorrhages 
and destructive processes within the substance of the lungs. 

5. In malignant diseases of the lungs, where the pulmonary tissue is 
pushed aside and the air is excluded from the parts affected by cancerous or 
fungous growth. 

Diseases of the pleura cause a dull percussion sound — 

1. "In pleuritic effusion,- no matter whether the fluid be blood, serum 
or pus. The dulness in either case may, and generally does, primarily, 
affect only the lower part of the serous cavity, gradually extending upwards 
as the fluid increases, and by its increment displacing the lung. But it may 
also, on the contrary, in either case, extend over only a limited space, to 
which it is confined by previously existing pleuritic adhesions. 

"When the pleura is free from such adhesions, the fluid, from whatever 
part of the membrane it proceeds, may in each case gravitate to the lowest 
part of the cavity, and its site may be changed according to the varying 
position of the patient's body. In each case, therefore, the part in which the 
dulness is observed may also vary with the change of position. This change 
in the situation of the fluid and of the consequent dulness, according to the 
position of the body, is, however, far more common in hydrothorax than in 
either simple pleuritic effusion or empyema, in which diseases the fluid is 
much more frequently confined to a limited space by surrounding adhesions, 
or gravitates with less facility." (H. M. Hughes.) 

2. " In malignant disease of the pleura, as in that of the lung, the pul- 
monary tissue is pushed aside, and the dulness and resistance exist on per- 
cussion commensurate with the extent of the solid deposit." (H. M. Hughes.) 

The Metallic ringing percussion sound. This is the same sound 
which we elicit by striking empty or nearly empty vessels. The presence of 
water is not required, but does not hinder its production. According to 
Wintrich it originates in smooth cavities, where the vibrations of the sound 
are reflected from wail to wall in a regular manner. It is heard in pneu- 



AUSCULTATION. 345 

mothorax, over large cavities, and such cavities as are connected with each 
other, whose walls must be fit for the reflection of sound ; that is, they must 
be smooth and curved. 

The Cracked pot SOUlld is similar to the metallic ringing sound, only 
not so perfect — a spoiled metallic ringing. It may be produced on any 
healthy chest by knocking forcibly with the fist during loud speaking or 
singing. It is said to be found where cavities exist, but Wintrich says: "It 
is rather a feeling of disappointment for the physician, when he stands by 
the deceased body of a patient during whose illness he many a time observed 
this sign and diagnosticated a cavity in his lungs, and yet does not find now 
any thing the like." For this reason we cannot attach a pathognomic mean- 
ing to this sound, as it expresses only general physical conditions. 

IV. Auscultation. 

You may auscultate a patient either by applying your ear immediately 
to his chest, or by interposing a stethoscope between it and your ear. The 
first is called immediate and the latter mediate auscultation. 

Much has been said in books about the superiority of each method over 
the other; but there is no need of such long disquisitions. I hear best with 
the naked ear, and so w T ill any one else who faithfully tries both methods. 
But I prefer the stethoscope decidedly, if I have to examine an unclean per- 
son, or a person with skin disease, or in any case where great delicacy must 
be observed, or when I cannot easily apply my ear to the parts to be ex- 
amined. 

There has also been a great talk in books about the form and material 
of the stethoscope. It is all the same, whether it be made a little shorter or 
longer, straight or bent, out of one piece or of several pieces of wood or 
metal, if only its bore be smooth and adapted to conduct and reflect the 
sound perfectly. That is all that is required. 

In order to know anything about abnormal sounds in the respiratory 
organs, we must first become acquainted with those sounds which we can 
hear in a normal state of these organs. 

The Normal Sounds of Respiration. 

They must be distinctly considered as inspiratory and expiratory sounds. 

The Inspiratory sound heard at the larynx, trachea and large bronchial 
tubes may be imitated by forcing air against the hard palate, as is done in- 
voluntarily in hard breathing, or in pronouncing the guttural consonant ch. 
The height or depth of this sound (its pitch) depends upon the width of the 
cpening through which the air passes. This sound is called Bronchial 
respiration or Tubular breathing, and is found in a normal state at the 



346 THORAX. 

larynx, trachea, large bronchial tubes under the upper part of the sternum, 
the inner side of the subclavian, the interscapular regions, and occasionally, 
though less distinctly, in the axillary regions, especially the right one. It is 
loudest in the larynx, less loud at the trachea, and still less loud at the super- 
ficial bronchial tubes, sounding as if coming from a distance. If this bron- 
chial or tubular breathing be heard in other localities than the above named, 
it may, with tolerable certainty, be regarded as morbid. 

An altogether different sound is heard during inspiration, when we put 
the stethoscope upon any other part of the chest than those previously speci- 
fied. It may be imitated by narrowing the opening of the mouth and then 
drawing in the air. The consonant of this murmur is v or b, and it is called 
the Respiratory or Tesicular murmur of the air-cells and finer bronchial 
tubes. 

" It varies considerably in intensity in different regions of the chest. It 
is most distinct in the acromial, the central and lower part of the superior 
sternal, the subclavian, the axillary and the subscapular regions. It is less 
distinct in the lateral, the right mammary, the scapular regions, still less in 
the hypochondriac, and least of all in the inferior sternal and the inner part 
of the left mammary region. 

" Independently of the variation of the intensity of the sound in the dif- 
ferent regions of the chest, whether the variation arise from the position of 
the organs, the amount of pulmonary tissue beneath the ear, or the facility 
or difficulty with which the inspired air reaches the pulmonary cells, the two 
sides of the chest frequently vary a little in respect to the loudness of the 
respiratory murmur. Thus it is rather louder in the acromial, scapular and 
infraclavicular regions of the right side, but in so slight a degree as to be 
scarcely worthy of consideration in a practical point of view. 

"The respiratory murmur may, both locally and generally, be more or 
less loud than natural in persons who are quite free from any appreciable 
disease. It may also be harsh or rough, scarcely audible, or altogether ab- 
sent. Thus in childhood and in youth, the respiratory murmur is louder 
than in adult life, and especially than in old age. From this circumstance 
a loud inspiratory murmur is called (whether normal as in childhood, or 
youth, or abnormal, from any cause, in age) puerile or supplementary respira- 
tion: puerile, because it is the normal state of respiration in children, and 
supplementary, because it is thought that when one lung or a part of a lung 
is disabled, the increased activity of the other lung, or another part of the 
same lung, supplies the defective action of the diseased organ or part. 

" It is always heard when the healthy respiration is more than ordina- 
rily active, as in persons ' out of breath/ as it is called, from strong exertion, 
as running, dancing, etc., or after the respiration has been voluntarily sus- 
pended for a time, and the individual breathes quickly to restore the normal 



AUSCULTATION. 347 

balance of the circulation through the pulmonary organs ; we hear it, there- 
fore, also after the sudden termination of an asthmatic paroxysm. The 
strength of the inspiratory murmur, instead of being increased, may be 
diminished, though no disease exist in the chest. This imperfection of the 
respiratory murmur is usually observed either in parts of the lungs which 
have been little used, as in the lower regions of the chest of females accus- 
tomed to tight lacing, or in persons suffering from deformity, whether con- 
genital or acquired ; or in the chest of persons considerably advanced in 
life, also after long illness when the patient for a long time has been obliged 
to lie on his back. In the first two and last instances the defect results from 
ivant of use aud consequent imperfect expansion of the lung. In the case of 
deformity it proceeds from atrophy and consequent defective functional activity 
of the pulmonary tissue. It may, indeed, be regarded as the natural char- 
acter of the respiratory sound in old people, and may therefore be called 
1 senile,' as that existing in children is termed ''puerile respiration.' 

" Occasionally the inspiratory murmur is entirely absent from one or a 
part of one lung, though no disease be present in the organ itself. This 
condition, however, probably never exists without some mechanical obstruc- 
tion to the ingress of air, either in the air tubes or upon the exterior of the 
organ (spasm, foreign body, apparent death)." (H. M. Hughes.) 

The murmur of expiration in the normal state of the respiratory 
organ causes little or no sound in the air-cells and finer bronchial tubes ; 
whatever sound is heard differs from the murmur of inspiration, and resem- 
bles rather a gentle aspiration or blowing. It can be imitated only by the 
mouth during expiration ; the consonant which represents it falls between / 
and h. In the larynx, however, it is louder than in inspiratory murmur. 

Laennec and Skoda attribute the sound of the vesicular breathing to 
the friction of the air against the walls of the finer bronchial tubes and the 
air-cells, the contractile power of which it has to overcome. The reason 
why the inspiratory murmur of the air-cells is much louder than the expira- 
tory is, that the air, when it enters into them, meets with resistance from 
their contractility, but does not meet with any in its passage out of them. 
It is otherwise, however, with the large bronchial tubes, and particularly 
with the trachea and larynx; here the air, during inspiration, meets with no 
opposition; it has, indeed, rather a tendency to expansion; but during 
expiration the stream of air coming from all parts of the lung out of the 
air-cells, collecting in the trachea and larynx, becomes compressed and 
causes friction on the walls of this tube, and especially in the narrow glottis; 
hence, the expiratory murmur of the larynx, trachea and large bronchi is, as a 
rule, louder than the inspiratory. 



348 THORAX. 

Pathological Deviations from the Normal Vesicular Respiration. 

1. The inspiratory murmur. The presence of the vesicular murmur 
at any part of the thorax indicates the entrance of air into the air cells of 
that part of the lung which lies beneath the spot auscultated. Its absence, 
therefore, indicates those abnormal conditions which prevent the passage of 
air into the air-cells; such are compression of the air-cells by exudations or 
tumors in the pleura; by enlargement of the heart and other diseases; 
infiltration of the lung tissue by plastic or tuberculous matter, by blood, 
serum, pus, etc.; atrophy of the air-cells and obstruction of the bronchial tubes 
by mucus, blood, or by swelling of the mucous membrane. 

The vesicular murmur becomes harsher, when the lining membrane of 
the air-cells and finer bronchial tubes is roughened, swollen and thickened. 
The presence of a harsh vesicular respiration, which may amount sometimes 
even to a hissing sound, indicates, therefore, a swelling of the mucous mem- 
brane of the finer bronchial tubes and air-cells, as exists in catarrh ; or soli- 
tary tubercles thickly scattered through the tissue of the lungs; and oedema oj 
the lungs. 

2. The expiratory murmur. In a healthy condition of the lungs 
it is very soft and somewhat shorter than the inspiratory murmur, sometimes 
scarcely audible. Its abnormal conditions are, therefore, harshness and pro- 
longation. The causes hereof must be sought in a roughened and narrowed 
condition of the finer bronchial tubes and air-cells, by which greater friction 
of the egressing air is produced. 

This prolongated and harsh expiratory murmur is rarely heard extending 
all over the lungs in a uniform manner, but is mostly confined to portions of 
the lungs, and then is of the highest diagnostical importance. 

If it extends over a large surface of the lungs, it indicates a more gene- 
rally swollen and uneven surface of the bronchial mucous membrane ; as we 
find in acute and bronchial catarrh, with or without emphysema. If it, how- 
ever, is confined to the apex of the lungs, between the first and third ribs, and 
more in front than behind, and more on one side than on the other, it indi- 
cates tuberculosis. 

Dr. Jackson, of Philadelphia, was the first who, in the year 1832, drew 
attention to this prolonged, harsh, and partial expiratory murmur, as a sign 
of tubercular infiltration, and it has been confirmed by a number of authors 
since. 

This prolonged, expiratory murmur is sometimes broken into two or 
three jerks, and is observed in tuberculosis ; also in old people and children 
when frightened; also during the chilly stage of fevers. The inspiratory 
murmur also exhibits such interruptions. It is necessary to listen in such 
cases to the larynx, whether the interruption is heard there too, otherwise it 
might easily be mistaken for a friction-sound of the pleura. 






AUSCULTATION. 349 

3. Broiichial respiration. When we auscultate the larynx or trachea, 
the respiratory sound is louder than in any other part of the chest, if it be in 
a healthy condition. It may be imitated, as said before, by forcing the air 
against the hard palate, so as to produce the consonant ch, guttural. This 
respiratory sound has been termed bronchial respiration. If heard in any 
other part than that above specified, it denotes a change in structure, which 
subdues the vesicular breathing, and serves as a good conductor of sound 
from the larger bronchial tubes. Such conditions are : hepatization and tu- 
bercular infiltration (the most frequent) ; next in frequency, thickening of the 
bronchial tubes, with atrophy of the lung tissue; pulmonary oedema and pleu- 
ritic effusions; and hydrothorax. 

4. Rhonchi or rattling noises in the respiratory organs. When 
the bronchial tubes are partly constricted, or when tough mucus exists 
therein, which is set into a vibratory motion by the rush of air during respi- 
ration, or, if sticking tightly to the walls, is suddenly torn, then we have all 
sorts of noises within the thorax. Such noises may sound high, deep, clear, 
husky, harsh, or hollow ; may be short like a snap, and return at intervals ; 
or be continuous for a longer time, like the purring of a cat. 

"These noises," says Dr. Wintrich, "have been called, funny enough, 
dry rattle noises, and have been divided into rhonchi sicci, graves, sonori, 
sibilantes and canori. The poetical talent of some authors has had ample 
opportunity to force them by comparison into the most singular and fanciful 
classes, by which a cool reflection has mighty little to think," and, I may 
add, by which the beginner is thrown into utter confusion. They originate 
within the respiratory tubes, exactly in the same manner as sounds originate 
in any other kind of tubes. The sound is high, shrill, when the tube is nar- 
row or constricted in one or more places; it is deep, when the vibrating 
column of air is long, or when the vibratory undulation is slow ; it is loud, 
strong, when the stream of air is of great force ; and vice versa, it is iveak, 
faint when the stream of air is weak. 

These ronchi often extend over a large portion of the chest ; if deep, they 
occasion a vibration of the thoracic walls, perceptible to the touch; if high, 
not. Still we cannot, as has been mentioned already under the head of vocal 
fremitus, from its extension, draw any conclusion as to the extension of its 
cause, because this sound may be propagated, like the fremitus, from a single 
point where it originates to all parts of the chest. 

These rattling noises generally have their origin in catarrhal affections, 
and change constantly according to the location and the different nature of 
phlegm, which is shifted from one place to another by breathing and cough- 
ing. Exceptions to the above are hissing sounds, which sometimes exist con- 
tinuously for weeks, and even months. These hissing sounds, or rhonchi sibi- 
lantes, must have, therefore, a more persistent cause, the nature of which 



350 THORAX. 

seems to be a constriction in some of the finer bronchi ; and we find them in 
such a persistent manner only in tuberculosis of the apices of the lungs. 

The so-called moist sounds are thought to originate in the presence of a 
fluid, which, by the rush of air, is stirred up into large and small bubbles, 
which burst. We may distinguish the following varieties : 

1. RhoncllUS crepitans, vesicular crepitation, or crepitant rattle. It is 
quite similar to the noise which is produced when a lock of hair is rubbed 
between the fingers. It is heard only during inspiration. Laennec and all 
his followers, even Skoda, explain it in this way : that the rush of air during 
inspiration into the finest bronchial tubes and air-cells, if they contain a fluid, 
stirs this fluid into bubbles, which burst and thus cause the crepitant rattle. 
Already Walshe, an English author, was not satisfied with this explanation, 
and according to his opinion it originates through the sudden expansion of 
the interstitial spaces around the air-cells by a full inspiratory action. He 
thought these interstitial spaces glued together by the exudation of a tough 
matter in pneumonia, so that a sudden expansion would tear them asunder 
and cause this crepitation. This opinion of Walshe has already been refuted 
by Davies in his lectures, who says, that in pneumonia the exudation does 
not take place outside but inside of the air-cells, as the tough sputa sufficiently 
show, and that the same crepitating sound is also found in oedema of the lungs. 
Dr. Wintrich gives, no doubt, the best explanation of this sound. He says : 
" This crepitating sound is nothing else but the noise which is caused by the 
sudden inspiratory expansion of the air-cells and finest bronchial tubes when 
their walls have become glued together by means of a sticky exudation." It 
is therefore not heard in a sound lung, because here the air-cells, even during 
the fullest expiration, never contract to such an extent that their walls touch 
each other and stick together. Wherever it exists, there is a morbid swelling 
and tough secretion within these air-cells and finest bronchial tubes, which 
bring their walls during expiration in such near contact that, by means of a 
sticky secretion within, they are glued together and torn asunder by the 
following inspiratory action. 

The intensity of this crepitation depends upon the toughness of the 
secretion and upon the force with which inspiration tears the adhering walls 
asunder. It does not cease after coughing and expectoration, because it de- 
pends upon a swelling and secretion of the air-cells and finest bronchial tubes, 
which no cough can remove. It is heard at the commencement of pneumonia, 
just when exudation takes place, and at its resolution; in capillary bronchitis, 
and in cedema and sometimes in emphysema of the lungs. In oedema the crepi- 
tant rattle is much softer and distant, because the transudation is of a much 
less sticky nature than in pneumonia or bronchitis. 

It is heard, lastly, in sound lung under the following condition, as Walshe 
describes it : " If individuals whose lungs are healthy, or diseased only at the 



AUSCULTATION. 351 

apices, and whose breathing is habitually calm, are made suddenly to respire 
deeply, a peculiar, fine, dry crepitation, accompanying inspiration only, may 
often be detected at the basis posteriorly. But after two or three, or, at most, 
five or six acts of respiration, it totally disappears. This pseudo-rhonchal 
sound seems to depend on the sudden and forced unfolding of air-cells, which 
are unaffected by the calm breathing habitual to the individual; and its 
only importance arises from the possibility of confounding it with crepitant 
rhonchus." 

It is frequently heard in patients who have lain long on their backs, 
especially after typhoid fevers, and may be explained in the same manner. 
The pulmonary secretion collects mostly in those places which lie deepest and 
are used least. By these means the air-cells gradually collapse and stick 
together. A few deep inspirations tear them asunder and at the same time 
remove the secretion, so that, as there is no morbid swelling iu these parts, 
the crepitant sound ceases after two, three, or, at most, after five or six acts 
of respiration. 

2. The subcrepitailt rattle. This is a sound which appears to arise 
from the bursting of very small bubbles in the air-passages. It is heard most 
distinctly during the act of inspiration, weaker during expiratiou. It denotes 
a fluid secretion in the finer bronchial tubes. 

3. The mucous rattle. There is sometimes a great deal of mucus in 
the respiratory organs; and yet, on auscultation, no rattling sound is per- 
ceptible. It seems, then, that certain conditions must exist in order to render 
the bursting of large and small bubbles in the air-passages audible. These 
conditions are : that the walls, wherein the sound originates, must be good 
reflectors of sound, like the larynx, the trachea, cavities, and bronchi, if they 
are surrounded by walls which do not contain air ; and also, that fluid (mucus, 
pus, blood, serum) be contained in them, which, by respiration, is set into 
bubbling motion. This mucous rattle varies very much in character ; is a 
sound of large or small bubbles, high or deep in pitch; confined to a small 
spot, or extended over the whole lung. By the extension of the sound we 
can never judge of the extent of the fluid which gives rise to it; because this 
sound is propagated quite a distance from its origin, if there exists good re- 
flecting media. It therefore does not indicate any particular disease, but only 
certain conditions, like consolidation of the lung tissue, either by infiltration 
or hepatization, compression or atrophy. 

4. The metallic tinkling. "When, in consequence of a communi- 
cation with a bronchial tube, or a portion of the lung, the pleural sac con- 
tains a considerable portion of air, and also a small quantity of fluid, or 
when a phthisical cavity of large size is similarly circumstanced, there is 
every now and then heard a very peculiar sort of tinkling noise upon ex- 
amining the chest. It resembles very nearly the sound caused by shaking a 



352 THORAX. 

pin in a decanter. This is the metallic tinkling. It is, most commonly, heard 
only at intervals ; that is, it may occur once in three, four, or forty respi- 
rations. It rarely, if ever, attends the expiration. It may cease altogether 
and reappear after a considerable time. In this respect it seems to be in- 
fluenced by the position of the patient's body. It is most probably produced 
by the continued and rapid reverberation of a delicate sound against the 
firm and vibrating walls of a large cavity. It is in fact an echo in a small 
space. The original sound from which the echo proceeds appears most com- 
monly to arise from the bursting of a bubble of air, or from a drop of liquid 
falling upon the surface of fluid in the bottom of the cavity. But it some- 
times seems to be likewise produced by the passage of air over a loose portion 
of membrane or thick secretion situated in a tube at or near the entrance of 
the cavity. The physical conditions necessary for its production appear to 
be a large cavity with resonating walls, and containing a large portion of air, 
with a small quantity of fluid." (H. M. Hughes.) 

In pneumothorax much depends upon the position of the patient. Often, 
when nothing can be heard while the patient is lying down, the metallic 
tinkling appears at once on assuming the sitting posture. In those cases in 
which tubercular infiltration extends to the diaphragm in the left lung, it not 
unfrequently happens that sounds within the lungs are conducted into the 
cavity of the stomach, where they cause exactly the same metallic tinkling. 
Any one, w T ho is not aware of this fact, might easily diagnosticate pneumo- 
thorax where, upon post-mortem examination, none could be found. 

Another practical and interesting sound is 

5. A sort of click, w T hich is heard occasionally, perhaps not oftener 
than once in four or six inspirations, resembling the sticky noise produced 
by the removal of the tongue from the roof of the mouth. It is generally 
observed at the apex of the lungs, when there is a deposition of tubercles, 
and, according to Wiutrich, especially when these tubercles commence to 
dissolve. Cough sometimes breaks it up; but often it is of a very persistent 
nature. 

6. Friction sound. This sound originates when both pleural surfaces 
(pleura pulmonalis and costalis) become roughened and, in the absence of 
gas, fluids, or adhesions between them, rub upon each other. It generally 
accompanies both inspiration and expiration ; being at one time most distinct 
during inspiration, at another during expiration. It may be heard during 
inspiration only, or the reverse. It resembles the creaking of leather ; ap- 
pears at intervals, and in most cases it is recognizable by the finger as well 
as by the ear, and the patient generally experiences the sensation of some- 
thing rubbing within his thorax. This sound is most commonly caused by 
2)leurisy and pericarditis. It is sometimes heard at the commencement of this 
disease, when fibrous deposits have settled on the surfaces of the pleura, and ■ 



AUSCULTATION. 353 

the contact of the surfaces is not prevented by serous effusions. It is also 
heard, and sometimes more distinctly, at a later period of the disease, when 
absorption of the serous effusion has taken place, and the surfaces, covered 
by a firm plastic exudation, have once more come in contact. In this case 
the friction sound continues until either the pleura has formed adhesions to 
the thoracic walls, or its surfaces have become perfectly smooth. It is also 
heard in tuberculosis; especially in the left infraclavicular region, where it 
continues to be sometimes for months, even years; because tuberculosis is 
more or less always attended by partial pleuritic inflammations. Here, how- 
ever, it must not be confounded with the above-mentioned interrupted or jerk- 
like expiration. Both may easily be distinguished, as already stated, by 
listening to the larynx. If heard there too, it is no friction sound, but inter- 
rupted expiration. 

Ausculation of Voice. 

The voice, as heard in a normal condition of the respiratory organs. If 
the stethoscope be placed upon the larynx of a healthy person, and we listen 
through it whilst the person is talking, his voice sounds nearly as loud as 
though he were talking immediately into our ear ; but the words are not so 
clearly articulated. The same is true if we place the stethoscope upon the 
trachea. This normal sound, heard at the larynx and trachea during talk- 
ing, has been called Laryngophony and Tracheophony — laryngeal voice 
and tracheal voice. 

If the stethoscope be placed upon the upper part of the sternum, or 
upon the cartilages of the second and third ribs, or upon the interscapular 
regions, we may still hear his voice when he speaks, but much less loud, and 
the words will be still less clearly articulated than on the larynx and trachea. 
This normal sound of the voice, as we perceive it over the larger bronchial 
tubes, is called Bronchophony — bronchial voice. 

If, lastly, the stethoscope be put upon any part of a healthy person's 
thorax, the voice of the person is heard simply as a buzzing or humming, or 
is not heard at all. 

Such then are laryngophony, tracheophony, bronchophony and the 
distant humming or buzzing of the voice, when heard over the respiratory 
organs in a normal condition. It must not, however, be supposed that there 
exists any defined line of demarcation between each, so that it could be said, 
here ends laryngophony, and here begins bronchophony. They all gradually 
merge into each other ; they are not distinct species of sounds, but merely 
variations of intensity of the same sound. We may convince ourselves of 
this gradual lessening of intensity and clearness of articulation, if we gradu- 
23 



354 THORAX. 

ally move the stethoscope from above downwards, and listen at the same 
time, whilst the person is talking. 

Further, it must be remarked and borne in mind, that the thoracic 
voice is very generally more distinct upon the right side, and particularly 
below the right clavicle and over the right scapula, than in the correspond- 
ing situations upon the left side ; also, that a shrill or acute, high-toned voice, 
generally sounds clearer and more distinctly modulated than a deep base 
voice, though not so loud and strong as this ; and that the thoracic voice is 
usually more audible in thin persons than in those whose thoracic walls are 
loaded with fat; and in persons with contracted chests, than in those in 
whom the thoracic cavity is largely developed; and, other things being 
equal, it is also more distinct in females than in males. 

The voice as heard in abnormal conditions of the respiratory organs. 
Pathological changes and conditions multiply these variations in intensity 
and articulation of the voice still more. We will frequently have to make 
nice distinctions, and this is only possible, if we compare constantly both 
sides and different parts with each other, for it rarely ever happens that both 
lungs should be alike affected. Thus, in listening to the sound portion we 
obtain a standard by which we are enabled to judge of the corresponding 
portion. There is a threefold alteration of the thoracic voice from its normal 
condition possible: it is either — 1. Decreased in its intensity or suspended 
altogether; or, 2. Its intensity and clearness of articulation is augmented; or, 
3. It is changed altogether in its character. 

1. Its decrease is caused by any and all such solid, fluid or gaseous 
substances as may form between the lungs and thoracic walls, and which 
interfere with the transmission of the natural humming or buzzing of -the 
voice on those parts of the thorax mentioned above. This is the case in 
moderate effusion of lymph or pus into the pleural sac, and in moderate 
pneumothorax, as far as it separates the lungs from the thoracic walls. It 
is the case in widely-extended emphysema, if the bronchial tubes are not 
widened and thus made good conductors of sound. It is the case, where 
large cavities, as it were, swallow up the sound. It is quite important that 
all this be borne in mind, lest we might make mistakes. 

The natural thoracic voice is entirely subdued, when massive exudations 
and transudations in the pleural sac cause a separation of the thoracic organs 
from the thoracic walls. The same is produced by pneumothorax, if it does 
not cause metallic tinkling. The most total suppression, however, of the 
thoracic voice is caused by the closure of the bronchial tubes, either by 
foreign bodies, tough mucus, large quantities of pus, phlegm, or serum, etc. 
The higher up towards the larger bronchi such stoppage exists, the larger is 
the circumference in which the natural thoracic voice is wanting. 

2. Its increase in intensity as well as in clearness of articulation. At 



AUSCULTATION. dOO 

first I have to remark, that in no case of morbid affection, and on no part of 
the thoracic cavity, does the voice sound so loud as at its origin, the mouth. 
But it may sound as loud, or nearly as loud, as we hear it in a normal con- 
dition at the larynx. This increase of the thoracic voice we may call 
Laryngophony. French authors have called it Pectoriloquy, which 
means a speaking ont of the chest. If it exists in a degree, as on those 
places where the larger bronchial tubes lie, near the thoracic walls, it is 
called Bronchophony. Neither pectoriloquy nor bronchophony are always 
of the same strength or loudness, and therefore the authors speak of a perfect 
and an imperfect pectorilquy, and of a loud and a weak bronchophony. 

The question arises, what causes this increase of the thoracic voice to 
bronchophony and pectoriloquy in places where there should naturally 
exist only a humming or buzzing of the voice ! 

The answer is : This increase of the thoracic voice depends entirely upon 
a greater or lesser degree of aptness of the bronchial tubes to reflect and conduct 
sounds, or, as we remarked of vocal fremitus, its increase depends upon good 
conductors of vibratory motion. This aptness of the bronchial tubes grows 
in the same degree as their walls become tenser and more solidified, ap- 
proaching the walls of the trachea and larynx; and further, when these 
tubes are surrounded by fluids or semi-solid exudations (as in pneumonia) ; 
or even by solid masses (as in tuberculous infiltrations) ; or when the sub- 
stance of the lungs around them has become compressed, and thus deprived 
of air. All these requirements for an increase of the thoracic voice we find 
more or less realized in the following pathological conditions : In tubercular 
infiltration, if it surround several bronchial tubes up to their last extremities 
(this is of the most frequent occurrence) ; in pneumonic infiltration, where 
the semi-fluid or coagulable exudation causes hepatization of the substance 
of the lungs ; in strongly developed cedema, especially of interstitial lung 
tissue, and this only in rare cases ; in dilatation of the bronchial tubes, if sur- 
rounded by indurated and shrinking, airless lung tissue; in tumors of all 
kinds, if they compress the lung tissue, or by their own nature and situation 
around the bronchial tubes become good conductors of sound ; in all kinds of 
fluid exudations into the plural sac, pleuritic exudation, hemothorax, em- 
pyema, etc., when they compress the lung to such a degree that the periphe- 
ric portions of it become deprived of air — in such cases, however, the lung 
must not be pushed too far from the parietes of the thorax, as, for example, 
during the period of dilatation in pleuritis, in which, in the majority of 
cases, no sound is heard at the corresponding wall of the thorax ; in cavities, 
which stand in unbroken connection with the larynx, trachea, and larger 
bronchial tubes, which have smooth walls that are good reflectors, which are 
neither too large nor too small, and which are situated so near to the 
periphery that but little previous lung tissue intervenes between them and 



dob THORAX. 

the thoracic walls — the nearer they are to the periphery and the tenser and 
harder their walls, the greater is the intensity of the thoracic voice heard 
over them. 

This increase of the thoracic voice, in consequence of these pathological 
conditions over parts which, in a normal state, afford only a humming or 
buzzing of the voice, has been called, as already stated, according to its 
degree, weak or loud bronchophony, and imperfect or perfect pectoriloquy. 
Bronchophony has always a kind of nasal twang, is never so clearly modu- 
lated as sounds or words which come immediately from the mouth. 

3. The thoracic voice is changed in its character. Such a peculiar 
deviation from bronchophony is the so-called cegophony, a tremulous sound, 
which resembles the bleating of a goat, and which is nothing but a modified 
bronchophony, with the nasal twang of quick, successive, tremulous interrup- 
tions. (Wintrich.) It is heard sometimes without any pathological change, 
in old people, if their voice has become of a trembling character. Otherwise 
it is found under conditions similar to those which produce bronchophony, and 
does not designate any particular condition or disease. It corresponds to the 
cracked-pot sound. 

Another deviation from bronchophony is the cavernous voice, which is 
well modulated, without nasal twang or goat-bleating. It originates in 
moderately large cavities, which are situated near the thoracic wall and 
adhere to it ; which have thin, smooth walls, capable of good reflection ; 
which are, by the larger bronchial tubes, in uninterrupted connection with 
the larynx and trachea, and which do not contain too much fluid. 

If these cavities are large, another deviation from mere bronchophony 
is occasioned, which is spoken of in books under the name of emphoric echo 
and metallic tinkling. These phenomena may be imitated by a person 
speaking and directing his voice into a jug. When he does so, a peculiar 
humming is heard in addition to the voice. Besides this humming, there is 
also occasionally heard a metallic after-tone, both of which represent what 
Laennec describes under emphoric echo and metallic tinkling. It is pro- 
duced in tolerable large cavities, and also sometimes in pneumothorax. 

Auscultation of Cough. 

As cough is nothing else than a loud and forced expiration, it is clear 
that all which has been said about respiration and voice is likewise applica- 
ble to the cough. It is heard weaker or louder under the same conditions 
which decrease or increase the sound of respiration and of voice. In some 
cases it may make some of the auscultatory signs clearer and more distinct, 
and thus far it may be a help to a more accurate diagnosis. 



BRONCHIAL CATARRH. So i 

Special Diseases of the Respiratory Organs 

Having thus far explained, step by step, the phenomena which respira- 
tory action, in normal as well as abnormal conditions, offers to the senses of 
sight (inspection), touch (palpitation), and hearing (percussion and ausculta- 
tion), we now come to consider certain forms of abnormal conditions of the 
respiratory organs which occur again and again ; and although varying con- 
stantly as individual cases, present, nevertheless, some common, persistent 
features by which they may be arranged, considered and recognized, as definite 
and marked forms of pathological alterations and conditions in these organs. 
What we have learned concerning the respiratory action in normal and 
abnormal conditions, we shall now have occasion to apply to certain diseases, 
and in this way demonstrate its practical use. 

a. AFFECTIONS OF THE BRONCHIAL TUBES. 

Bronchitis, Bronchial Catarrh. 

This, like all other catarrhal inflammations, is characterized by a hyper- 
semic state of the mucous membrane in the bronchial tubes, causing abnormal 
secretions, and if long continued, gradual changes in their texture. The 
membrane appears injected, ecchymosed, infiltrated, opaque, swollen and 
covered with secretion. In this way the finest tubes may become entirely 
closed, preventing the renewal of air in the air-cells, and causing a poisoning 
of the blood by uneliminated carbon. This generally, however, happens 
only with infants, who are not strong enough to free themselves of the 
secreted phlegm. In such cases, during post-mortem examination, the lungs 
swell out of the thorax, not having room enough inside without being com- 
pressed by the parietes of the thorax, because their alveoli remain filled with 
the inhaled air. In chronic cases the mucous membrane grows hyper- 
trophic, the muscular fibres lose their elasticity, and the tubes enlarge 
in width, either evenly throughout, or only in short tracks, sac-like, — 
Broucliiectasia. 

The inflammation may be confined to the trachea and the larger 
bronchi, or to the smaller ones, or be diffused all over. In the first case it 
is accompanied more or less by a troublesome tickling under the sternum, or 
a sore feeling or burning; while in the second no such sensations exist, as 
the finer bronchi are less liberally supplied with sensible nerves than the 
larynx and trachea. The cough is usually much more violent in the case of 
inflammation of the larger bronchi ; it is most readily excited at the point of 
bifurcation. If the catarrhal inflammation is located iu the smaller bronchi, 
it is always attended with more or less dyspnoea, which, in an affection of the 



358 AFFECTIONS OF THE BRONCHIAL TUBES. 

larger bronchi alone, is never found, and for obvious reasons : the swelling 
and phlegm, if ever so great, cannot easily occlude these large tubes, while 
in the smallest a little swelling and a small quantity of phlegm may easily 
prevent the undisturbed ingress and egress of air. 

The sputum is at first viscid, mucous, transparent, poor in cells, often 
frothy, because mixed with air from the severe efforts of coughing required 
for its detachment ; often it is mixed with small quantities of blood for the 
same reason ; in the spit-cup it is readily confluent and corresponds to the 
sputum crudum of older writers. As the catarrh progresses, more and more 
cellular elements become freed, and this is a sign that the culmination of the 
process is passed ; the sputum now is richly cellular, non-translucent, and 
consists chiefly of mucus and pus cells — it is the " sputum coctum " of older 
writers. If the disease enters the chronic stage, the sputa become more 
puriform, and appear either in greenish or yellowish clumps of muco-pus in 
a sero-mucous fluid, of which, when poured into water, one portion remains 
floating on account of the admixture of air, while the rest sinks to the 
bottom ; or the purulent masses run together in -the spit-cup of which the 
heavy portion settles to bottom, the sero-mucous part floats upon it, and 
the whole is covered by considerable froth ; this sort of expectoration is often 
fetid in a high degree ; or the sputa consist of roundish, coin-like masses, 
which lie separate beside each other in the spit-cup ; this sort of expectoration 
is often the product of a cavity in the lungs, but is also observed in chronic 
bronchitis. At still other times the sputum is sero-mucous, being character- 
ized by its thin, thready consistence, frequently copiously mixed with air- 
bubbles which cover the entire surface of the expectorated mass. Its 
quantity is often very considerable, amounting to actual bronchorrhoea, and 
is principally observed in the chronic forms of bronchitis. The ashes of 
these various kinds of sputa have been found to contain : Chlorine, sul- 
phuric acid, phosphoric acid, potassa, soda, lime and magnesia, oxide of iron 
and silicic acid. The same constituents are found in the ashes of the lungs, 
but their quantitative composition differs greatly. Phosphoric acid, for 
instance, and oxide of iron are found of much less amount in the sputa than 
in the ashes of the lungs, whereas potassa exceeds greatly in amount in the 
ashes of the sputa. 

Bronchitis, whether confined to the larger or smaller tubes, is most 
always attended with fever. It generally sets in with chilliness, alternating 
with a feeling of burning heat, without a corresponding rising of the mercury 
when the thermometer is applied. Thus we may already in the commence- 
ment of a fever be able to distinguish a catarrhal from an inflammatory 
fever; the latter, generally commencing with only one chill, is followed by a 
fever-heat that indicates a much higher degree on the thermometer. 

Catarrhal fevers are sometimes epidemic, when they are called Influ- 



BRONCHITIS, BRONCHIAL CATARRH. 359 

enza or Grippe; involving the whole system and especially the mucous 
membranes, even those of the bowels. 

In old people, or otherwise exhausted persons, catarrhal fevers take at 
times a bad turn, and assume a typhoid character. The patient becomes 
delirious and comatose, his tongue dry, pulse small and frequent, and his 
person covered with exhausting perspiration. To the comatose, state is 
added at last, a rattling in the trachea from the bursting of big bubbles, 
which is caused by the inability to throw off the phlegm, in consequence of 
paralysis of the muscular fibres of the bronchi. This is the so-called death- 
rattle; after the setting in of which the scene soon closes. This form of 
bronchitis is termed by older writers Pneumonia 110 til a. 

Another form is the so-called Catarrh on the chest of infants, espe- 
cially during dentition. It involves the smallest branches of the bronchi, 
whence it is also called Bronchitis capillaris. Its character is the same 
with any other form of catarrh ; but as the swelling attacks the finest tubes, 
it soon makes them impervious to air, and consequently prevents the expul- 
sion of carbon, and the inhalation of oxygen. Such children are in great 
distress, breathing heavily, with hissing and rattling noises in the chest. The 
coughing spells are painful and violent, driving the blood to the face, and 
when still further progressing, the epigastric region and lower ribs are 
drawn in during inhalation, as in croup, a sign that the air-cells are no 
longer filled by the inspiratory act ; so also do we find the supra and infra- 
clavicular region bulging out, protruding, as the air contained therein is not 
removed by expiration, and there is consequently a noticeable stillness of the 
upper part of the chest during expiration. 

When such an attack befalls newborn children from their having been 
exposed to cold by washing, bathing, etc., it soon develops itself into a higher 
stage, as the child is too young and too weak to clear away the accumulating 
secretion by its own efforts. The child turns bluish and grayish ; the nose 
becomes pointed; the eyes dull; the respiration quite superficial. It is 
nothing more nor less than a clogging up of the finest bronchial tubes, and, 
in consequence of that, an overcharge of the whole system with carbon. A 
superficial observer might confound it with cyanosis from some organic lesion 
of the heart. 

The chronic forms of bronchitis differ but little from the acute forms. A 
chronic bronchial catarrh aggravates usually in spring and fall, and leaves 
the patient comparatively free through the summer. In some cases where 
the sputa are very tough, it is attended with painful straining fits of cough- 
ing, in others the cough is much lighter, as the secretion consists of a more 
fluid and yellowish substance. Very frequently bronchial catarrh is attended 
with dyspnoea on account of constrictions which, by the chronic inflamma- 
tion, have been formed within the air-tubes. So also originate by the 



360 AFFECTIONS OF THE BRONCHIAL TUBES. 

gradual change of texture of the bronchi, dilatations here and there 
(Bronclliectasias), which in most cases contain masses of puriform sputa of 
a very fetid odor. In other cases, especially where the catarrhal inflamma- 
tion is located in the larger bronchi, the expectoration is of great abundance, 
and consists of a thin, sero-mucous substance, mixed largely with air-bubbles. 
Such abundant discharge from the air-tubes is called Blennorrhea of the 
Bronchi, or Bronchorrhoea. In some cases there is no great dyspnoea, 
in others w T here the inflammation infests the finer tubes, dyspnoea will not be 
wanting. 

A long continuance of chronic catarrh often becomes associated with 
hypertrophy and dilatation of the right ventricle of the heart. A particular 
form, the so-called " Dry Catarrh " of Laennec, which is associated by 
severe paroxysms of cough with but a trifling amount of expectoration, is 
often combined with emphysema. 

Physical Signs. — Percussion reveals nothing in these affections; its 
sound is everywhere the same as in a healthy condition. 

Auscultatory signs depend upon the condition of the bronchial tubes. 
As soon as their mucous lining becomes inflamed and swollen, the vesicular 
murmur is loud, harsh, and coarse; the expiratory murmur, usually scarcely 
audible, also partakes of this character, and may be even louder than the in- 
spiratory murmur. When, however, the inflammation invests the larger 
bronchial tubes, the vesicular murmur is frequently oversounded by the loud 
bronchial breathing which originates there; but, when the breathiDg is slow 
and weak, there may be, at the commencement of the disease, no sound at all 
perceptible. 

As soon as the mucous membrane becomes covered with secretion, w T e hear 
all sorts of mucous rattling, fine bubbling, large bubbling, hissing, and 
whistling sounds, according to the nature and location of the secretion. 
When the secretion is located in the larynx, trachea, or larger bronchi, the 
rattling noise originating here maybe heard all over the chest; hence we 
cannot, from the extent of the noise, judge of the extent of the secretion. On 
the contrary, the finer bronchi may be filled with mucus, and no rattling 
noise be perceptible when the breathing is weak and feeble. When, during 
vigorous respiration, the vesicular murmur is absent, it denotes the presence 
of -a large quantity of mucus, or the closure of the finest bronchial tubes by 
swelling, which prevents the air from entering into the air-cells. We may 
also hear the crepitant sound, when the inflammation invades the finest 
bronchi. 

In regard to differential diagnosis, bronchial catarrh differs from other 
acute lung diseases by the absence of acute pain — it produces only a sore, 
raw, and burning sensation ; by the absence of all abnormal percussion signs; 
and by its commencing with frequently repeated chills. 



BRONCHITIS, BRONCHIAL CATARRH. 361 

THERAPEUTIC HINTS.— Catarrh on the chest of infants, Aeon., 
Bellad., Bryon., Calc. carb., Ferr. phosph., Ipec, Laches., Opium, Phosphor., 
Sulphur, Tart, euiet. 

Catarrh of old people or exhausted persons, Bar. carb., Bryon., Carb. 
veg., Hydrast., Laches., Phosphor., Khus tox., Sepia, Tart, emet., Veratr. 

Compare Catarrh of Nose and Larynx. 

Acute Forms. — Aeon., in the commencement, especially if brought 
about by exposure to cold west winds, or sudden suppression of perspiration, 
with high fever, dry skin, restlessness and irascibility. 

Act. rac, cough excited by every attempt to speak, so that one is 
obliged to desist. (Guernsey.) 

Ant. crud., especially if caused by bathing. The cough seems to 
start from the abdomen ; gastric derangement. 

JEsc. hipp., when complicated with gouty diathesis, and a tendency 
to piles with constipation. 

Arnica, cough excited in children from crying; sputa difficult to loosen, 
or bloody. f 

Arsen., cough attended with dyspnoea; worse about and after mid- 
night ; from drinking cold water ; from lying down ; from mental excitement ; 
sometimes attended with cold in head, diarrhoea, rheumatic pains in the 
limbs, palpitation of the heart, restless anxiety in the night. When cough- 
ing a pain extends from the small of back down into the thighs. The cough 
is excited by an intense tickling in trachea and under sternum, from cold 
air; it is whizzing with difficult expectoration of frothy, tough sputa. 
Lively exercise brings on the cough. 

Badiaga, spasmodic cough, with sneezing and lachrymation ; during 
the paroxysms, crying and pressing hands upon head ; sometimes strangling, 
face turning dark, and thick, yellow viscid mucus flying out of mouth and 
nostrils. Cough loose a.m., tight p.m. (H. V. Miller.) 

Bellad., barking cough; crying when coughing; hot skin, inclined to 
be moist; drowsy; sleepy, but cannot sleep; starting in sleep. 

Bryon., crying when being moved, and when coughing; cough tight, 
sometimes with blood-streaked expectoration ; worse through day, at times 
worse in the night, compelling to sit up; worse from motion; when entering 
a warm room ; from sudden changes of the atmosphere, either to warm or to 
cold; from eating and smoking. Pain in the pit of stomach, and in the 
muscles under the short ribs, or in the sides of the chest, or in the head when 
coughing; spurting of urine when coughing. The cough is at times excited 
by a tickling in the pit of the stomach. 

Calc. carb., teething children; loose cough; rattling of mucus; bowels 
moved more frequent towards evening ; profuse head sweat, especially during 
sleep. 



362 AFFECTIONS OF THE BRONCHIAL TUBES. 

Carb. veg., evening hoarseness; burning under sternum; soreness of 
chest, and heat of body when coughing; itching from throat down to centre 
of chest when coughing. The cough comes mostly in spells far apart ; is ex- 
cited by going into the cold air out of a warm room. Cold knees in the warm 
bed. Pyrosis with great flow of water from the mouth during the day. 

Caustic, morning hoarseness; cough worse on getting warm in bed; 
also better in bed and from a swallow of cold water; is attended with pain 
over the left hip ; involuntary discharge of urine. Heartburn and acidity 
after fat, saccharine and farinaceous food ; sudden cramps in heel-cords in 
the night; stiffness and lameness of jaws. 

Chamom., during teething; cough during sleep without waking; child 
wants to be carried and is very cross. Suffocative constriction of the chest 
as if the throat were throttled, with constant desire to cough. 

Cina, dry hacking cough, especially at night, followed by swallowing, 
as if something were rising in the throat ; the child becomes stiff during the 
cough, and afterwards there is a clucking noise in the throat down to the 
stomach. 

Cinchona, tickling cough worse from talking or laughing. 

Conium, cough worse from horizontal position, speaking or laughing. 

Cuprum, cough better from taking a sip of cold water; trembling 
after coughing ; suffocating spells. 

Drosera, the cough seems to come from the abdomen and convulses 
the muscles of the chest and abdomen ; the patient tries to relieve the pain in 
chest and hypochondriacal regions by holding them tightly ; perspires im- 
mediately on waking from sleep. 

Eupat. perf., rough, scraping cough; violent cough with soreness in 
the chest ; the patient supports the chest with his hands ; cough before and 
after meals; pain in all the limbs and back; palpitation of the, heart. 

Euphras., dry, tickling cough only in daytime, better from eating and 
drinking small quantities of beer or water. After the cessation of hemor- 
rhoidal flow. 

Ferr. met., cough better while eating, especially during supper. 

Ferr. phosph., often relieves the catarrh on the chest of children; sim- 
ilar to Aeon. 

Hepar, cough tight or loose, worse in the morning; from uncovering 
any part of the body ; better from wrapping up and keeping warm. Re- 
pelled eruptions. 

Hyosc, nightly, dry, spasmodic titillating cough, worse in lying. 

Ipec, titillating cough with dyspnoea, nausea and vomiting, diarrhoea; 
face pale, even bluish during cough. 

Iodium, tickling, dry cough; young persons subject to spitting blood; 



BRONCHITIS, BRONCHIAL CATARRH. 363 

palpitation of the heart ; swelling of cervical and bronchial glands ; progres- 
sive emaciation by good appetite. 

Kreos., during dentition, when the child is extremely fretful, irrit- 
able, much agitated, and screaming in the night. Dry cough excited by a 
crawling sensation below the larynx. 

Laches., cough is worse during and after sleep; in afternoon and even- 
ing; there is tickling in the pit of the throat and great sensitiveness of the 
throat to any touch ; during cough, stitch pains in the hemorrhoidal tumors ; 
the stools are fetid even if formed. 

Mangan., spasmodic cough from afternoon till bedtime, ceasing on 
lying down, worse from motion; expectoration scanty and difficult, causing 
long efforts of coughing for its expulsion ; in the morning easy. Sore and 
bruised feeling through the chest. 

Merc, sol., catarrh of the whole mucous membrane from the nose 
down ; chilliness and heat alternately ; feels hot in bed and chilly when mov- 
ing his feet to a cooler place ; sweats without relief; cannot bear either warm 
or cold air ; cough worse when lying on the right side ; tongue coated thick, 
yellowish; great thirst for ice water, although it aggravates the cough. 

Nux mosch., cough worse on getting warm in bed; excited by a creep- 
ing sensation from the chest to the throat ; especially during pregnancy. 

Nux vom., always after previous use of cough mixtures; cough worse 
in the morning ; excited by beer, relieved by warm drinks. Nose stopped 
up in the evening; headache; fever with chilliness from slightest motion; 
irritableness ; oversensitiveness to light, noise and smells. Involuntary mic- 
turition w T hen coughing, laughing or sneezing. 

Opium, convulsive, dry tickling cough in paroxysms, worse at night, 
with bluish redness and sweat in the face, and yawning after the cough. 
Drowsiness, and inability to go to sleep. 

Phosphor., tight cough, worse from evening till midnight; tightness 
across the chest; pain in the head, larynx and chest when coughing. Cough 
worse from speaking, laughing, eating, motion and on going into the cold 
air. Useful after onion syrup. 

Pulsat., chilliness; thirstlessness ; loose cough with yellow or greenish 
expectoration ; tight in the evening on retiring to bed, often causing vomiting. 
After measles. 

Rhus tox., cough excited by a tickling under the middle of the ster- 
num, worse from uncovering any part of the body; from laughing, talking, 
singing, and cold drinks; better from warm drinks. Pain in the limbs 
during rest, which feel stiff and lame on first moving, but get better during 
exercise ; restlessness. 

Rumex, dry cough in long paroxysms, brought on by any irregularity 
in breathing, taking a deeper breath than usual, talking ; or from external 



364 AFFECTIONS OF THE BRONCHIAL TUBES. 

pressure upon the throat-pit; worse in the evening after retiring; the patient 
covers his head all over, because the slightest draft of cold air at once 
brings on a distressing tickling in the throat-pit and behind the sternum, 
more towards the left side ; in walking he covers mouth and nose. (Dun- 
ham.) 

Senega, tough mucus causes the greatest, often ineffectual efforts of 
coughing and hawking for its expulsion. 

Sepia, cough seems to come from stomach or abdomen; nausea during 
and after cough. Tickling cough before midnight in bed, coming in rapid 
concussions until breath is exhausted, followed by expectoration of mucus 
with temporary relief. Worse in cold, wet weather. Eruption of »hard 
papulae on a red base with burning and itching ; herpetic eruptions and pas- 
sive congestion of the womb. 

Spongia, cough wheezing and asthmatic, relieved by eating or drink- 
ing ; oppression and breathing worse from lying with the head low. 

Sticta, dry, racking cough, with splitting frontal headache, from 
tickling in right side of trachea, below larynx ; cough excited by inspira- 
tion. 

Sulphur, cough worse in evening on lying down, with itching in the 
bronchi, accompanied with retching. Hot flushes ; cold feet ; or hot palms 
and soles, hot vertex. Rheumatic pains in knees and hips at night, with 
coldness and soreness ; itching of skin on retiring. 

Tart, emet., rattliug mucus; cough is followed by yawning; cough 
worse when lying; child wants to be carried about; worse after eating, with 
vomiting. Drowsiness; sticky perspiration; dyspnoea; cyanosis. 

Ver. alb., capillary bronchitis, with livid face, blue nails, cold extremi- 
ties and tumultuous, irregular contractions of the heart; cold perspiration 
on forehead when coughing ; eyes half open during sleep. 

Zincum, child grasps the genitals when coughing. 

The Chronic forms may require any of the remedies above detailed ; 
they may require one or the other of the following : 

Alum., cough worse about 6 o'clock in the morning, on and after 
getting up; raises but little after considerable coughing; sometimes the 
cough is troublesome at night ; it often recurs with the cold season and lasts 
until the warm season sets in again ; the cough is relieved by lying flat on 
the face. Irritable persons and women who easily laugh or cry. Follows 
well after Bryon. 

Ambra gris., cough dry in the evening, gray sputa in the morning; 
excited by exertion and music. Aged people. 

Amm. carb., cough dry, tickling, with a sensation of heat and burn- 
ing in windpipe under sternum, as of having swallowed alcohol; rough 



BRONCHITIS, BRONCHIAL CATARRH. 365 

voice ; from taking cold in rough, rather dry air. Aged people ; adynamic 
state. 

Amm. mur., cough with profuse, thick, whitish expectoration, some- 
times in lumps, with heaving ; mucous rattling in the chest, worse when lying, 
either with or without difficult expectoration ; burning in the chest ; dyspnoea 
on moving and when lying; rawness and soreness in fauces; coldness between 
the shoulders. Old age ; bronchiectasias ; emphysema. 

Arg. nitr., rattling cough; hoarse voice; marasmus, the legs are 
especially emaciated; child cries much, unless carried about; craving for 
sugar. 

Arsen., dry, spasmodic cough, with dyspnoea, asthma, suffocating 
spells, cardiac troubles; exhaustion, nervous irritability, hydrsemia. Worse 
at night ; from lying down, drinking and change of weather. 

Calc. carb., expectoration yellow, lumpy, sweetish, sometimes fetid; 
when thrown into water, a lump is seen shooting to the bottom, with a 
mucous trail behind, like a falling star. (Fellger.) For scrofulous indi- 
viduals and such who have to talk a great deal, who are subject to hoarse- 
ness, to perspiration from any exertion, and palpitation of the heart after 
eating. 

Carb. an., cough with hoarseness or night-sweats, very fetid and debili- 
tating, following chill and fever in the evening; coldness and aching in 
lumbar region and lower extremities. 

Carb. veg., burning in chest, heat and perspiration; great weakness; 
oppression ; want to be fanned. Coldness of skin ; pointed nose ; rattling of 
large bubbles ; cold knees in bed. Exhausted and aged persons. 

Cinchona, black, difficult expectoration ; cough worse with head lying 
low, or when lying on left side, or when moving., talking, etc. ; better with 
head lying high. 

Coral, rubr., cold expectoration. 

Hepar, dirty yellowish expectoration, badly smelling; cough worse in 
the morning and when uncovering any part of the body; bronchiectasia. 

Iodium, compare Acute Forms. 

Kali bichr., ropy expectoration ; cough excited from eating or drinking. 

Kali carb., dry cough, as if excited by a dry membrane in the trachea, 
which cannot be detached ; slimy, salty expectoration ; cough worse about 3 
o'clock, a.m., also from eating and drinking, with pain in lower part of the 
chest. Dry skin ; dry stool ; eyelids red and swollen, especially between the 
brows and upper lids. After measles. 

Laches, compare Acute Forms. 

Lauroc, short, titillating cough from cardiac affections. 

Lobel. infl., "spasmodic contraction of the diaphragm in emphysema, 



366 AFFECTIONS OF THE BRONCHIAL TUBES. 

accompanied by pain in epigastrium, tympanitis of the abdomen, impossi- 
bility of deep inspirations; extreme dyspnoea and cyanosis." (Meyhoffer.) 

Lycop., "chronic pneumonia; bronchitis, with copious muco-serous, or 
muco-purulent secretion; emphysema; dilatation of the air-tubes; senile 
catarrh. Congestion of the liver, flatulency, constipation, cachectic com- 
plexion, red gravel, acid dyspepsia." (Meyhoffer.) " Cough dry day and 
night in feeble, emaciated boys." (C. Wesselhoeft.) The cough ends with a 
loud belch ; salty expectoration. 

Natr. carb., cough is excited by coming into a warm room (Bryon.). 

Natr. mur., transparent, viscid sputa; weak voice; fluttering of the 
heart; worse on the seashore; cutting pain in the urethra after urination. 

Natr. sulph., when coughing at night has to sit up and hold his chest 
with both hands; asthmatic spells worse towards morning. Aggravation 
always from cold, damp and rainy weather. 

Nitr. ac, cough with thirst in the morning. 

Phosphor., besides a dry cough, there.is in chronic cases often a free 
expectoration of abundant, tough mucus, especially in the morning. At 
times the expectoration is cool. Tremor when coughing. 

Phosph. ac, cough in overgrown youths. 

Platina, chronic cough dependent on uterine diseases with mental dis- 
turbances. 

Plumbum, copious muco-purulent, or purulent expectoration. 

Sanguin., cough worse at night; circumscribed redness of the cheeks; 
burning dryness of the mouth and throat, not relieved by drinking. 

Secale, concussive cough; profuse perspiration; sleepless nights ; colic, 
diarrhoea and bloatedness of the abdomen. Emphysema. 

Sepia, compare Acute Forms. 

Silic, expectoration of pus, which when thrown into water, falls to the 
bottom and spreads like a heavy sediment. (Fellger.) Cough worse from 
cold, and better from warm drinks. 

Spongia, compare Acute Forms. 

Stannum, bronchial dilatations with purulent expectoration; exces- 
sive muco-purulent expectoration ; weak feeling in the chest. 

Staphis. , cough is excited by eating meat, or cleaning the teeth. Very 
sensitive, feeling easily hurt when being reproached. Cervical and axillary 
glands swollen. 

Sulphur, often indicated in rheumatic, gouty, herpetic and scrofulous 
individuals, also when seemingly well indicated remedies refuse to act. 
Sensation as of ice in the chest whenever chilled, or perspiration is checked. 
Compare Acute Forms. 

Tart, emet., compare Acute Forms. 



DIGEST TO BRONCHITIS. 



367 



Digest to Bronchitis. 



COUGH, CHARACTER OF: 

Barking : Bellad. 

Concussive : Secale, Sepia. 

Convulsive : Opium. 

Dry in evening, gray sputa in morning: 

Ambra. 
} with heat and burning in windpipe 

under sternum, as of having swallowed 

alcohol: Amm. carb. 
, spasmodic, with dyspnoea, asthma, 

suffocating spells : Arsen. 

, hacking, especially at night: Cina. 

, tickling, only in daytime : Euphras. 

, spasmodic, titillating, nightly : Hyosc. 

, as if excited by a membrane in the 

trachea, which cannot be detached : Kali 

carb. 
, day and night, in feeble, emaciated 

boys: Lycop. 
, convulsive, tickling, in paroxysms: 

Opium. 
, or with free expectoration of tough 

mucus, especially in the morning: 

Phosphor. 

, in long paroxysms : Bumex. 

, before midnight, in rapid concussions, 

followed by expectoration : Sepia. 

, racking : Sticta. 

Loose, a.m., tight p.m. : Badiaga. 

, or tight : Hepar. 

, from evening till midnight : Phosphor. 

and rattling of mucus: Calc. carb., 

Tart. emet. 
Rattling : Arg. nitr. 
Rough, scraping: Eupat. perf. 
Spasmodic : Badiaga, Hyosc. 

, from afternoon till bedtime: Mangan. 

In spells, far apart : Carb. veg. 

Tight: Phosphor. 

— — , or loose : Hepar. 

in evening on retiring to bed, causing 

vomiting: Pukat. 
Titillating or tickling: Amm. carb., 

Chamom., Euphras., Ignat., Ipec, Iodum, 

Lauroc, Sepia. 

, worse in lying: Hyosc. 

, with dyspnoea: Ipec. 



Titillating, from cardiac affections: Lauroc. 

before midnight, followed by expecto- 
ration : Sepia. 

Wheezing and asthmatic : Spongia. 

Whizzing with difficult expectoration: 
Arsen. 

Expectoration, badly smelling: Calc. 
carb., Hepar. 

, black and difficult: Cinchona. 

blood-streaked sometimes : Bryon. 

, bloody : Arnica. 

, cold : Coral, rubr. 

, cool at times : Phosphor. 

, difficult: Alum., Arnica, Arsen., Cin- 
chona, Mangan. 

, easy : Mangan. 

, frothy and tough : Arsen. 

, gray in the morning : Ambra gris. 

, mucous : Kali carb., Sepia. 

, muco-purulent : Calc. carb., Lycop., 

Plumbum, Stannum. 

, when thrown into water, a lump is 

seen shooting to the bottom, with a 
mucous trail behind, like a falling star : 
Calc. carb. 

, profuse: Amm. mur., Lycop., Stannum. 

, purulent : Lycop., Silic , Stannum. 

, when thrown into water, it falls to 

the bottom and spreads like a heavy 
sediment: Silic. 

, ropy : Kali bichr. 

, salty : Kali carb., Lycop. 

, scanty : Mangan. 

, sweetish : Calc. carb., Phosphor., Stan- 
num. 

, thick, lumpy : Amm. mur., Calc. carb. 

, transparent, viscid : Natr. mur. 

, yellow: Calc. carb. 

, or greenish : Pulsat., Sulphur. 

, dirty yellowish : Hepar. 

COUGH, EXCITED BY: 

Crawling sensation below larynx: Kreos. 
Creeping sensation from chest to throat : 

Nux mosch. 
Suffocating constriction of throat, as if 

throat were throttled : Chamom. 



368 



AFFECTIONS OF THE BRONCHIAL TUBES. 



Tickling in pit of throat: Laches., Rumex. 

in right side of trachea below larynx : 

Sticta. 

in trachea and under middle of ster- 
num: Arsen. 

under middle of sternum : Rhus tox., 

Rumex. 

in pit of stomach : Bryon. 

in abdomen : Ant. crud., Drosera, Sepia. 

Itching in bronchi: Sulphur. 

Tough mucus in throat : 



Cold air: Phosphor., Silic. 
Uncovering any part of the body: Hepar, 

Rhus tox. 
Going into cold air: Carb.veg., Phosphor. 
Slightest draught, covers his head all 

over: Rumex. 
On seashore : Natr. mur. 
Entering a warm room: Bryon., Natr. 

carb. 
Getting warm in bed: Caustic., Nux 



Drinking : Arsen., Kali bichr., Kali carb. 
Hepar. 

cold water : Arsen. 

cold drinks : Rhus tox. 

ice water: Merc. sol. 

cold beer : Nux vom. 

Eating : Bryon., Kali bichr., Kali carb. 

meat: Staphis. 

, after: Kali carb. 

before and after meals : Eupat. perf. 

Smoking: Bryon. 



Motion : Bryon., Mangan., Phosphor. 
Crying in children : Arnica. 
Laughing, singing, talking : Act. rac, 

Cinchona, Conium, Laches., Phosphor., 

Rhus tox., Rumex. 
Inspiration : Sticta. 
Any irregularity in breathing, taking a 

deep breath : Rumex. 
Exertion and music: Ambra. 
Lying : Conium, Hyosc, Tart. emet. 

down : Arsen. 

in evening, with retching : Sulphur. 

with head low : Cinchona. 



Lying on right side : Merc. sol. 
on left side : Cinchona. 



During sleep without waking: Arnica, 

Bellad., Calc. carb., Chamom. 
and after : Laches. 



Mental excitement : Arsen. 
Cleaning the teeth : Staphis. 
External pressure upon the pit of the 
throat: Rumex. 



Cough, < in the morning: Bellad., Hepar 

Nux vom., Pulsat. 

, < about 6 o'clock A m. : Alum. 

, < through day: Bryon., Euphras. 

, < day and night in feeble, emaciated 

boys: Lycop. 

, <^ in afternoon and evening: Laches. 

, < till bedtime: Mangan. 

, <^ in evening till midnight : Phosphor. 

, <^ after retiring: Arsen., Pulsat, 

Rumex, Sulphur. 
, < in night: Alum., Arsen., Cina, 

Hyosc, Natr. sulph., Opium, Sanguin. 
, < in night, compelling to sit up: 

Bryon. 

, < after midnight : Arsen. 

, < after 3 o'clock a.m. : Kali carb. 

, <^ in paroxysms: Opium, Rumex. 

, < in spells far apart : Carb. veg. 

, > from wrapping up and keeping 

warm: Hepar. 
, ^> from covering mouth and nose 

when walking : Rumex. 
, > in bed : Caustic. 



— , >> while eating, especially during 
supper: Ferr. met. 

— , ^> from eating or drinking : Spongia. 
— , > from drinking small quantities 
of beer or water : Euphras. 
— , > from drinking sips of cold water 
Caustic., Cuprum. 

— , > from drinking warm drinks : Nux 
vom., Rhus tox., Silic. 



, > from lying down : Mangan. 

, > from lying flat on the face : Alum. 



DIGEST TO BRONCHITIS. 



369 



Cough > from lying with head high: 
Cinchona. 

COUGH ATTENDED 'WITH : 

Crying : Bellad., Bryon. 

and pressing hands upon head: 

Badiaga. 

Pain in head: Badiaga, Bryon., Nux vom., 

Phosphor. 

in forehead, splitting: Sticta. 

in chest, which he supports with his 

hands : Drosera, Eup. per/., Natr. sulph. 

in sides of chest : Bryon. 

in lower part of chest : Kali carb. 

in chest, head and larynx : Phosphor. 

over left hip : Caustic. 

in pit of stomach and under short 

ribs: Bryon. 

in epigastrium: Lobel. infl. 

from small of back down into thighs: 

Arsen. 
Stitch pain in hemorrhoidal tumors: 

Laches. 
Soreness in chest : Eup. perf. 

and bruised in chest : Mangan. 

Heat and burning in windpipe under 

sternum : Amm. carb. 
Itching from throat down to centre of 

chest : Carb. veg. 
Convulsing the muscles of chest and ab- 
domen : Drosera. 
Dyspnoea: Arsen. 
Spurting of urine : Bryon., Caustic., Nux 

vara. 
Child grasps the genitals : Zincum. 
Strangling, face turning dark, and yellow, 
viscid mucus flying out of mouth and 
nostrils: Badiaga. 
Face pale, even bluish : Ipec. 
Bluish redness and sweat in the face: 

Opium. 
Cold perspiration on forehead: Ver.alb. 
Heat of body : Carb. veg. 
Tremor: Phosphor. 
Becoming stiff: Cina. 

COUGH FOLLOWED BY: 
Swallowing as if something were rising 
in the throat : Cina. 
24 



Clucking noise in throat down to stom- 
ach : Cina. 
Belching : Lycop. 
Nausea: Sepia. 
Vomiting: Pulsat. 
Yawning : Opium, Tart. emet. 
Trembling: Cuprum. 

GENERAL SYMPTOMS. 

Wants to be fanned : Carb. veg. 

carried about: Arg. nitr., Chamom., 

Tart. emet. 

Screams in the night : Kreos. 

Restless anxiety in the night : Arsen. 

Irritable : Arsen., Chamom., Kreos., Nux 
vom. 

persons and women who easily laugh 

or cry : Alum. 

Fretful: Kreos. 

Sensitive, feeling easily hurt, when be- 
ing reproached : Staphis. 

Irascibility and restlessness : Aeon. 

Oversensitive to light, noise and smells : 
Nux vom. 

Mental disturbances: Platina. 

Much agitated : Kreos. 



Headache : Nux vom. 

Eyelids red, and swollen between eye- 
brows and upper lids : Kali carb. 

Lachrymation and sneezing : Badiaga. 

Nose stopped in evening: Nux vom. 

Cold in head and diarrhoea: Arsen. 

Circumscribed redness of cheeks: 
Sanguin. 

Livid face : Ver. alb. 

Cyanosis : Lobel. infl., Tart. emet. 

Cachectic complexion : Lycop. 

Pointed nose: Carb. veg. 

Stiffness and lameness of jaws: Caustic. 

Tongue coated thick, yellowish : Merc. sol. 

Burning dryness of mouth and throat not 
relieved by drinking : Sanguin. 

Rawness and soreness in fauces: Amm. 
mur. 

Cough with thirst in the morning : Nitr ac. 

Thirst for ice water : Merc. sol. 

Thirstlessness : Pulsat. 

During teething : Calc. carb., Chamom. 



370 



AFFECTIONS OF THE BRONCHIAL TUBES. 



Cervical and axillary glands swollen: 

Staphis. 

and bronchial glands swollen : Iodum. 

Sensitiveness of throat to any touch: 

Laches. 



Hoarseness : Arg. nitr., Carb. an. 

in the morning : Caustic. 

in the evening: Carb. veg. 

Rough voice : Amm. carb. 
Weak voice : Natr. mur. 



Burning in chest: Amm. mur., Carb. veg. 

under sternum : Carb. veg. 

Soreness of chest: Carb. veg. 
Tightness across the chest : Phosphor. 
Asthma : Arsen., Natr. sulph., Spongia. 
Dyspnoea: Ipec, Tart. emet. 

with cyanosis : Lobel. infl. 

when moving and lying : Amm. mur. 

Oppression : Carb. veg. 

, worse from lying with head low: 

Spongia. 
Impossibility of deep inspirations: Lobel. 

infl. 
Rattling in chest : Tart. emet. 

, worse when lying, without or with 

difficult expectoration: Amm. mur. 

of large bubbles : Carb. veg. 

Catarrh on the chest of children : Aeon., 
Ferr. phosph. 

of the aged : Lycop. 

Capillary bronchitis : Ver. alb. 
Chronic pneumonia: Lycop. 
Bronchiectasia or bronchial dilatation : 

Amm. mur., Hepar, Lycop., Stannum. 
Emphysema : Amm. mur., Lycop., Secede. 
with spasmodic contraction of dia- 
phragm: Lobel. infl. 



Palpitation of the heart: Arsen., Eup. 

perf., Iodum. 

after eating: Calc. carb. 

Fluttering of the heart: Natr. mur. 
Tumultuous, irregular contractions : Ver. 

alb. 
Cardiac affections: Arsen., Lauroc. 



Pyrosis with great flow of water from 

mouth during day : Carb. veg. 
Heartburn and acidity after fat, saccharine 

and farinaceous food : Caustic. 
Nausea and vomiting : Ipec. 
Gastric derangement: Ant. crud. 
Acid dyspepsia : Lycop. 



Congestion of liver: Lycop. 

Flatulence: Lycop. 

Tympanitis : Lobel. infl. 

Colic, diarrhoea and bloatedness : Secale. 

Diarrhoea : Arsen., Ipec. 

Bowels moved more frequently towards 

evening: Calc. carb. 
Dry stool : Kali carb. 
Stools fetid even if formed : Laches. 
Tendency to piles with constipation: 

JEsc. hipp. 
Cutting in urethra after micturition: 

Natr. mur. 
Red gravel: Lycop. 



Passive congestion of womb : Sepia. 

Uterine diseases with mental disturbances : 
Platina. 

During pregnancy : Nux mosch. 

Rheumatic pains in limbs: Arsen. 

during rest and on first moving, better 

from continued exercise: Rhus tox. 

in knees and hips at night, with cold- 
ness and soreness: Sulphur. 

in limbs and back : Eup. perf. 

Aching in lumbar region and lower ex- 
tremities, and coldness : Carb. an. 

Gouty diathesis : JEsc. hipp. 

Sudden cramps in the heel-cords in the 
night : Caustic. 



Craving for sugar: Arg. nitr. 



Drowsiness : Tart. emet. 

with inability to go to sleep : Bellad. 

Opium. 
Sleepless nights: Secale. 
Restlessness : Rhus tox. 
Starting in sleep: Bellad. 
Eyes half open during sleep : Ver. alb. 



Chilliness: Pulsat. 

in bed when moving the feet to a 

cooler place : Merc. sol. 



DIGEST TO BRONCHITIS. 



371 



Chilliness and heat alternately : Mere. sol. 
Coldness of skin: Carb. veg. 

in bed : Carb. veg. 

Cold feet: Sulphur. 

knees in warm bed : Carb. veg. 

extremities with blue nails: Ver. 

alb. 

Sensation as of ice in chest whenever 
chilled or perspiration is cheeked : Sul- 
phur. 

Coldness between the shoulders: Amm. 
mur. 

and aching in lumbar region and 

lower extremities: Carb. an. 

High fever: Aeon. 

with chilliness from slightest motion : 

NUX BOOT. 

Fever followed by perspiration: Carb. an. 
Heat and perspiration : Carb. veg. 
Hot flushes: Sulphur. 

skin, inclined to be moist: Bellad. 

in bed and chilly when moving feet 

to a cooler place : Merc. sol. 

palms, soles and vertex: Sulphur. 

Perspiration, profuse: Secede. 

, sticky: Tart. emet. 

, without relief: Merc. sol. 

, immediately on waking from sleep : 

Drosera. 

, on head during sleep : Calc. carb. 

, fetid and debilitating, after chill and 

fever in the evening : Carb. an. 
from any exertion : Calc. carb. 



' Adynamic : Amm. carb. 
Hydreemia: Arsen. 
Marasmus, especially legs emaciated: 

Arg. nitr. 
Progressive emaciation by good appetite : 

Iodum. 
Catarrh of the whole mucous membrane 

from nose down : Merc sol. 
Cannot bear either warm or cold air: 

Merc. sol. 



Dry skin : Kali carb. 
Itching of skin on retiring: Sulphur. 
Hard papulae on a red base with burning 
and itching: Sepia. 



Exhaustion: Arsen. 
Weakness : Carb. veg. 



During dentition : Bellad , Cede, carb., 
Chamom., Kreos. 

Persons subject to hoarseness and who 
have to talk a great deal: Calc. carb. 

Young persons subject to blood-spitting : 
Iodum. 

Too fast growing youths: Phosph. ac. 

Aged people: Ambra, Amm. carb., and 
mur., Carb. veg , Tart. emet. 

Scrofulous individuals: Calc. carb. 

Rheumatic, gouty, herpetic and scrofu- 
lous persons: Sulphur. 

Repelled eruptions: Hepar. 

herpetic eruptions : Sepia. 

perspiration : Aeon. 

After measles : Kali carb., Pulsat. 

cessation of hemorrhoidal flow: 

Euphras. 

Taking cold in rough, dry weather : Aeon., 
Amm. carb., Hepar. 

in cold, wet weather: Natr. sutyh., 

Sepia. 

Recurs with the cold season, lasting till 

warm season : Alum. 
Change of weather: Arsen., Bryon. 
Caused by bathing: Ant. crud. 
After the use of cough-mixtures: Nux 

vom. 

onion syrup: Phosphor. 

Alumina follows well after Bryon. 



Tussis Convulsiva, Pertussis, Whooping-Cough. 

This affection is, in its nature, a species of bronchitis of an infectious 
and mostly epidemic nature, and not a mere nervous complaint. For al- 
though in some cases the nervus vagus has been found softened, and the 
medulla oblongata and its membranes hypersemic, these changes are not of a 



372 AFFECTIONS OF THE BRONCHIAL TUBES. 

uniform occurrence and must be considered as mere accidental complications; 
of constant presence on post-mortem examinations are the symptoms of 
catarrhal inflammation; hyperemia, swelling and secretion of the mucous 
membrane of the larynx, trachea and bronchial tubes. In the beginning, 
whooping-cough cannot be distinguished from an ordinary bronchial catarrh ; 
later, however, the fits of coughing assume that characteristic whoop, which 
consists in a long, crowing inspiration on account of a spasmodic closure of 
the glottis, and which is followed by several short expirations in quick suc- 
cession, ending most frequently with vomiting of ingesta and large masses of 
tough, gelatinous phlegm from the bronchi. Such paroxysms come as often 
as the collection of phlegm is sufficiently abundant to excite them. The 
child feels their coming and dreads them ; therefore it almost always strives 
to get hold of something whereby to support itself. During the paroxysm 
regular respiration and the action of the heart are very much interfered 
with, and it explains those cyanotic symptoms, which we so frequently ob- 
serve in the face and on the neck, (bluishness and swelling of veins) and also 
the general convulsions, in consequence of congestion to the brain. Hard 
paroxysms, by their violent convulsive straining, not unfrequently cause 
bleeding from mouth, nose and even ears. In rare cases children are seen to 
succumb suddenly and unexpectedly during a coughing fit, either from 
severe and persistent spasm of the glottis, causing suffocation, or from effusion 
of blood, or transudation of serum into the brain and its ventricles, or from 
paralysis of the heart, or a rapid development of a diffuse pneumothorax. 

Whooping-cough has been divided into three stages: the catarrhal, con- 
vulsive, and the critical. The first is like any other catarrh ; the second is 
sui generis, characterized by its peculiar paroxysms, and in a majority of 
cases attended by an ulcer on one or both sides of the frsenulum linguse, less 
often on the upper surface of the tongue, said to be the consequence of wounds 
received by thrusting the tongue between the teeth during the paroxysms at 
a spot where they are either much inclined or very prominent; the third, 
like the first, is similar to an ordinary catarrhal affection, and gradually 
wears off. The popular belief in regard to whooping-cough is, "that it is six 
weeks coming, six weeks standing and six weeks going;" but, like all popular 
observations, this ought to be taken with some discrimination. For, although 
obstinate cases last a long while, under careful homoeopathic treatment they 
never last that length of time. Its Physical Signs are precisely those of 
bronchitis. Whooping-cough may, when the inflammatory process spreads 
into the finest bronchial tubes and further combine with bronchitis capillaris, 
cause pneumonia and emphysema; or, by its disturbance of circulation, 
bring about hyperemia and even oedema of the brain and its membranes. 
It is also not unfrequently complicated with measles, scarlatina and small- 
pox. In these complications lies its danger. Ordinary, simple cases pass 
over without any difficulty, even without fever. 



TUSSIS CONVULSIVA. 6(6 

"Whooping-cough prevails mostly epidemically among children up to the 
eighth year of age, and, as a rule, attacks them only once in their life, and is 
said to be broken off at once by vaccination. It is of rare occurrence in ad- 
vanced years, although it does occasionally occur. 

THERAPEUTIC HINTS.— For first stage compare Bronchitis. 

Ambra gris., severe paroxysms of hollow-sounding cough; oppression 
and rapid respiration ; expectoration of large quantities of tough, grayish or 
yellow mucus, especially after waking in the morning. (M. Preston.) The 
paroxysm ends with belching. 

Ambrosia artem., cough worse from 8-12 p.m., or about midnight 
wheezy, asthmatic with pain in the left chest; nosebleed; stuffed up feeling 
in nose, head and chest ; eyes red, dry, smarting, or watery with profuse 
lachrymation. Given in the tincture. (E. E. Holman.) 

Anac, fits of vexation excite the paroxysms; dyspnoea during and 
after the coughing spells; for children who are ill-natured and of an uncon- 
trollable temper. (Preston.) 

Arnica, the child cries before the paroxysms; eyes are bloodshot; there 
is bleeding at the nose. 

Bellad., congestion to the head with red face and eyes; crying when 
coughing ; sneezing after coughing. 

Bry on., worse after eating and drinking with vomiting; involuntary 
loose stools during the coughing fits, involuntary discharge of urine. 

Calc. carb., teething infants; convulsions. 

Capsic, pain in the ears when coughing; ears and tip of nose hot; 
bloody mucus from nose when coughing; eyes protrude with burning and 
lachrymation. 

Carb. veg., vomiting of food; bleeding at the nose; cough worse in the 
evening and in the open air. 

Cina, spasms of the extensor muscles; the child becomes suddenly stiff; 
clucking noise, as though water were poured out of a bottle, from the throat 
down to the abdomen ; frequent sneezing after a paroxysm ; bleeding from 
nose and mouth. For children who are inclined to frequently wet the bed, 
and pick at the nose, and who are obstinate and irascible. Fretting excites 
the cough. 

Cocc. cact., expectoration of ropy mucus, causing gagging and vomit- 
ing of food. Feel better in the open air. 

Cor. rubr., spasms of cough so violent that children lose their breath 
and grow purple and black in the face. 

Cuprum, convulsive, long-continuing paroxysms of coughing, worse 
from eating solid food, better from drinking cold water; during the parox- 
ysms loss of breath and convulsive throwing up of tough, gelatinous mucus 



D/4 AFFECTIONS OF THE BRONCHIAL TUBES. 

and afterwards constant rattling on the chest ; bluish face and lips ; convul- 
sions of the flexor muscles. 

Drosera, worse after midnight; attended by gagging and frequent 
vomiting of ingesta ; feeling of constriction in chest and hypochondria, so 
that the patient tries to support these parts by the hands ; worse from tobacco 
smoke, and drinking; bloody urine. 

He par, for third stage. 

Hyosc, cough dry and worse at night in a recumbent position. 

Ipec, spasm of the glottis before the paroxysm; bleeding from nose 
and mouth during the coughing fits; vomiting of mucus or food; convulsions 
and stiffening of the body backwards ; vomiting of food without coughing ; 
rattling of mucus in the bronchial tubes ; rash-eruption. 

Iodium, "patients are weak, sallow, short of breath, emaciated and 
have enormous appetite." (M. Preston.) 

Kali car b., paroxysms worse after midnight, about 3 o'clock a.m.; 
bloated face, especially between upper eyelids and brows ; dry skin, dry hair, 
and dry stools. 

Laches., coughing spells always worse after sleep. 

Ledum, dizziness and staggering after paroxysm; moaniug and groan- 
ing during sleep; spasmodic contractions of the diaphragm after the spell, so 
that inspiration becomes double, sobbing-like, as we observe after hard crying 
spells. 

Mephit., spells day and night; the child must be raised, gets blue in 
the face and can't exhale. Convulsions ; fetid diarrhoea. 

Natr. mur., "when the tears stream down the face whenever he coughs." 
(Burnett.) 

Niccol., the cough is a dry hack, like the tick of a clock in its regular- 
ity, continuing for a long time. The child must be held straight up during 
the continuance of the cough, otherwise it is seized with spasms. The greatest 
possible degree of dyspnoea, but no expectoration. (M. Preston.) 

Naphthal., recommended by Von Grauvogl. 

Nux vom., cough worse in the morning and after eating; attended by 
vomiting, gagging, constipation, choking spells with bluish face, and pain in 
the abdomen. After previous quackery with cough-mixtures, drops, etc. 

Phosphor., third stage. 

Pulsat., first and third stage; disordered stomach. 

Sepia, cough in rapid successions till breath is exhausted, then gagging 
and vomiting of mucus; cough worse in the night. (C. Wesselhoeft.) 

Squilla, cough excited by drinking cold water; involuntary discharge 
of urine during the spell. 

Stramon., barking, croup-like cough with suffocative contraction of the 
chest, rattling, palpitation of the heart; anxiety, congestion, blood-spitting; 



ASTHMA. 375 

coiivulsioDs. When coughing while sitting, the lower extremities are 
jerked up. 

Sulphur, frequent relapses; third stage. 

Tart, emet., coughing and gaping consecutively; coughing excited by 
getting angry, and by eating; vomiting of food and mucus after coughing. 
Signs of carbonized blood. 

Veratr., vomiting of tough thin mucus, with cold perspiration on the 
forehead, involuntary discharge of urine and great exhaustion; face pale and 
sunken; restlessness and anxiety. Spells brought on from entering a warm 
room or drinking cold water; cough better when lying, worse when rising 
from bed. Lingering fever with lassitude, weakness, constant chilliness and 
great thirst. Fall and spring epidemics. 

Bronchial Asthma, Asthma Bronchiale Nervosum seu 

Convulsivum. 

Bronchial asthma is characterized by attacks of sudden dyspnoea, coming 
on after longer or shorter intervals, increasing rapidly in severity, and lasting 
for a few hours or for several days. Its nature is thought to be a spasm of 
the bronchial muscles (Biermer and others) ; a tonic spasm of the diaphragm 
(Wintrich) ; a tumefaction of the bronchial mucous membrane in consequence 
of dilatation of its blood-vessels through vasomotor nervous influence (Weber) ; 
a presence of fine-pointed crystals found in the sputa of asthmatic expectora- 
tion, which irritate the peripheral termination of the vagus nerve in the 
bronchial mucous membrane, and cause a reflex spasm of the musculature of 
the smaller bronchi (Leyden). It is quite likely that in individual cases, 
these various conditions may exist singly or conjointly, or may be produced 
either by a direct irritation of the vagus nerve, or in a reflex manner by irrita- 
tion of various organs. For the first speak cases in which asthmatic and epi- 
leptic paroxysms, or asthmatic attacks with hemicrania and with angina 
pectoris alternated. The reflex manner by which the bronchial branches of 
the vagus may be excited, is by far more frequent. We see it originate in 
the sexual organs (uterine asthma), in the sensitive nerves of the intestinal 
tract, as in disorders of digestion, irritation from worms (dyspeptic, verminous 
asthma), in the sensitive nerves of the skin (asthma from taking cold), in the 
sensitive nerves of the mucous membrane of the respiratory tract (asthma 
from nasal polypi) ; after measles and whooping-cough ; from the smell (in- 
halation) of different drugs (ipecacuanha, yellow oak, fresh coffee, violets, 
lamp-black, etc.); of the pollen of certain grasses (hay asthma). 

Essential anatomical alterations on post-mortem examination are not 
found. But Stork has demonstrated by tracheoscopic examinations that the 
mucous membrane of the trachea and main bronchi is intensely reddened 



376 AFFECTIONS OF THE BRONCHIAL TUBES. 

during the attack. It is, therefore, scarcely to be doubted, that the mucous 
membrane of the smaller ones must be in a like condition, if not more so. 
It is also clear that long-continued and frequently recurring attacks will lead 
to changes which are characteristic of chronic bronchial catarrh, or to em- 
physema. 

Like all neuroses, bronchial asthma generally attacks in paroxysms, 
the intervals between which may amount to weeks, months and even years. 
It not unfrequently commences during sleep; then the patient gets restless; 
the gradual increasing difficulty of breathing causes terrible dreams and 
awakens him. On getting awake, the patient has a desire to draw a long 
breath, but feels that the inhaled air does not reach and satisfactorily fill his 
lungs. We hear, and so does the patient, all sorts of hissing, whistling, and 
rattling noises during inspiration and especially during expiration. The 
dyspnoea increases; the respiratory and especially the expiratory muscles 
labor; the alse nasi move up and down; the sterno-cleido-mastoid muscles 
are put upon the stretch ; the head is drawn backwards* the arms are 
pressed firmly upon the chair to widen the chest ; or the patient leans for- 
ward, resting with head and arms upon a chair or table; but all in vain. 
The vesicular murmur ceases, and in place of it we observe here and there a 
hissing noise, coming aud going suddenly; the inspiratory noise in the larynx 
and trachea, however, continues even stronger than normal. There is an 
anxious expression of countenance ; the eyes are wide open ; cold perspiration 
covers the forehead. The color of the face is pale ; the impulse of the heart 
is violent, uneven, irregular ; the pulse at the wrist is weak and small ; the 
hands and cheeks are cold. After some time, varying from an hour to 
several hours, with short intervals, the paroxysm ceases, either suddenly, 
when the air rushes into the bronchial tubes, which are suddenly relieved 
from spasm, causing puerile respiration, or the relief is only gradual, attended 
with belching, yawning, or increased secretion within the bronchial tubes, 
which excites cough and rattling of mucus for some time afterwards. 

On percussion, we will find the clear lung-sound extending on the right 
anterior side of the chest, some two inches or more below the sixth rib, show- 
ing that the inflated lung has pressed the liver down into the abdominal 
cavity ; while on the left side the cardiac dulness is sometimes diminished in 
consequence of the distention of the edges of the lung. There is also only a 
very slight change of the limits of the lower edges of the lung during in- 
spiration and expiration, for the reason that during expiration the lung 
cannot rid itself of the air within on account of the spasmodic closure of the 
finer bronchi. So also shows the percussion sound a tympanitic quality, 
usually in the lower portions of the thorax, especially posteriorly and on the 
sides, which is due to the greater distention of the alveolar tissue. 

Its Diagnostic difference from spasm of the glottis lies in the difficulty 






ASTHMA. 377 

of its expiration, similar to that of bronchial catarrh and emphysema, while 
the dyspnoea in croup, in oedema of the larynx, in stenosis of the trachea, in 
spasms of the glottis, and in paralysis of the dilators of the glottis is an in- 
spiratory one. 

Its Prognosis is favorable. Asthma alone does not cause a fatal issue, 
but when complicated it may. It has its own remedy within itself. The 
accumulation of carbon relaxes all the muscles of the body, and, of course, 
the contracted bronchial muscles. As soon, however, as they relax, respira- 
tion is free, and the paroxysm ceases. (Niemeyer.) 

THERAPEUTIC HINTS— Apis, chest feels bruised; worse from 
heat; nettle-rash disappears. 

Arg. nitr., must rise and walk about; an effort to breathe deeply takes 
away the breath; cannot talk; drinkiug suffocates; agony, thinks of killing 
himself. 

Aral., dry, whistling respiration; cannot lie down, must sit up; gradual 
loosening and discharging of acrid mucus from nose and throat. (Hay 
asthma.) 

Arsen., paroxysms from midnight till daybreak; has to leave the bed, 
sit up bent forward ; great restlessness and anxiety, with feeling hot and cold 
in turns ; fear that he will be compelled to destroy his own life ; sweat of 
whole body; burning pain in chest; prostration; attacks from cellar-air, 
stormy w T eather, heavy atmosphere, change of temperature, rapid walking. 

Bellad., paroxysms in the afternoon and evening, with sensation of 
dust in the lungs ; w T orse in hot, damp weather, and after sleep. 

Bromium, asthma of sailors as soon as they go ashore. 

Cist, can., feeling as if the windpipe were too narrow, must open 
the window and breathe fresh air, which relieves; worse again on lying 
down. 

Carb. veg., attacks come during sleep, always after midnight; must 
sit up by a table; is full of wind, but cannot raise it; for old people; weak- 
ness, with trembling; look as if dying. 

Cuprum, attacks come on suddenly and after some hours cease 
suddenly; worse at night, when coughing, laughing, leaning backwards 
and after drinking; also before and during menses, after fright, chagrin, or 
a cold. 

Ferrum, attacks after midnight, driving out of bed; better from mov- 
ing slowly about and talking, from uncovering the chest. 

Graphit., paroxysm every night, wakes him out of sleep, usually 
after midnight; he has to jump out of bed quickly, must hold himself 
fast at something and quickly eat a piece of bread, after which the par- 
oxysm passes of. 



378 AFFECTIONS OF THE BRONCHIAL TUBES. 

Hyper., attacks return with changes of the weather, from clear to 
damp, or before storms; after lesion of the spine by a fall. 

Ipec, constriction of throat and chest; gasps for air at the open 
window; worse from least motion; constant cough, no phlegm yielding, 
although the chest seems full of it ; cough causes gagging, vomiting, followed 
by relief; stiffness of the body ; pale face ; cold extremities and cold perspi- 
ration. 

Kali carb., must lean forward, with head on table; worse from 
motion and drinking; pressure and tension in pit of stomach, after eating 
the least; belching, nausea, vomiting; puffy around the eyes; dry stools; 
dry skin. 

Laches., feeling of constriction in the throat and chest, as though a 
cord were tight around it, necessitating the loosening of the covering of the 
neck and epigastrium. Heart feels as if it turned over and ceased beating 
for a while, after which the pulsations increase. Dyspnoea worse after sleep, 
after eating, from moving the arms,, and touching the throat; cannot lie, 
must sit up, bent forward, with head thrown back. 

Lobel. infl., worse from exertion; disordered stomach, especially a 
feeling of weakness in the pit of the stomach ; asthmatic attack, often pre- 
ceded by prickling all over, even to fingers and toes. 

Mephit., inspiration difficult, expiration almost impossible; asthma as 
from inhaling vapor of sulphur ; in sleep ; of drunkards. 

Natr. sulph., in the morning, about 4 or 5 o'clock, with cough, and 
raising of glairy slime, and vomiting after eating; always worse in damp and 
rainy weather. 

Nux vom., for persons who drink much coffee or liquor, and who are 
very irritable; they feel full in the pit of the stomach, belch a good deal, 
and feel better after it. Asthma worse in the morning, after eating, from 
cold air or exercise. Spasms of the chest from vapor of copper or arsenic. 

Opium, short inspiration, long, slow expiration with a marked drawing 
in of the epigastric region; fine rales, constant cough, soporous condition, 
bluish face ; extreme anguish, with dread of suffocation ; looks as if dying ; 
slight relief from cold air and bending forward ; worse from eating, drinking 
wine and smoking. 

Pulsat., worse in the evening; constant chilliness; dizziness when 
rising from a seat ; nausea and vomiting ; palpitation of the heart ; deranged 
menstruation ; suppressed rash. 

Sanguin., asthma with hay fever. 

Sepia, long, difficult, noisy expirations. 

Silic, breathing so difficult that eyes protrude from their sockets; 
doors and windows must be opened ; always during thunder-storm. 

Stannum, attacks increase and decrease gradually. 



PNEUMONIA. 379 

Sulphur, attacks come on every eight days. Stooping posture; hunger 
and weakness every forenoon about 10 or 11 o'clock. 

Tart, emet., great difficulty in expiration; must be supported in a 
sitting posture; great rattling of mucus. Children and old people. 

Thuja, little cough, but sensation as if something were grown fast in 
the region of the left lower rib. 

Pulmo vulpis, has been recommended by Von Grauvogl in asthma 
humidum of old people when other remedies failed. 

b. AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Pneumonia. 

Catarrhal pneumonia never originates primarily in the alveoli, unless 
it be brought on by an irritant, such as chlorine, for instance, when an in- 
flammation may arise in the alveoli and the bronchi simultaneously; other- 
wise it is always a secondary morbid process to bronchitis, which compare. 
For this reason it has received the name of Broncho-pneumonia; and as 
the inflammatory process presents itself at first in isolated nodules, from the 
size of a pea to that of a hazel-nut within the collapsed portions of the lung 
tissue which still contains isolated portions accessible to air, it has also been 
named Lobular pneumonia. This morbid process may diffuse all over the 
lungs in the form of isolated infiltrations, and usually progresses from behind 
and below, forwards and upwards. 

According to all observations its most frequent occurrence is found in 
the first three years of life, and those of old age, and as indirect causes we 
may set down all disturbances that favor the development of bronchial ca- 
tarrh — such as measles, whooping-cough, diphtheria, influenza, rotheln; some- 
times typhus, variola and scarlatina; also foreign bodies in the bronchi and 
inhalation of gases. 

It presents no regular type of fever; the physical diagnosis is of great 
difficulty; we must mainly rely on the presence of a capillary bronchitis; on 
the consolidation of the lung, beginning at its base, arising slowly, at first 
without any prominent signs and mostly bilateral ; on the retraction of the 
lower ribs seen during inspiration; on the indefinite limitation of the disease, 
the absence of all critical periods and the fluctuations which occur in general 
and local symptoms. 

THERAPEUTIC HINTS.— Compare Bronchitis and Croupous Pneu- 
monia. 

Serous pneumonia, see (Edema of the lungs. 

Pneumonia from embolism happens only in otherwise diseased per- 



380 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

sons. The emboli are formed either from clots which have originated in the 
cavities of the right side of the heart, or in the veins of the systemic circula- 
tion. In the first place there is disease of the heart, and in the latter their 
sources are either large external wounds, venous thrombi of the uterus in 
puerperal women, or bed-sores, ulcerations and suppurations of various 
kinds. When these plugs are non-infectious, they produce mere hemor- 
rhagic infarction ; when they are of an infectious nature, they result in em- 
bolic or metastatic abscesses, which may perforate into the bronchi, or into 
the pleural cavity, or even break through the chest walls. Simple infarc- 
tions are often accompanied with an effusion into the pleural sac, and are 
much oftener found in the right lung than in the left. 

Croupous pneumonia, is that form which is commonly meant by the 
term "pneumonia," and consists of "an acute inflammation of the alveoli and 
bronchioles in which a fibrinous exudation is poured out upon the free sur- 
face of the mucous membrane, and there coagulates." (Juergensen.) It 
attacks in preference the inferior lobes of the lungs, especially on the right 
side; very rarely both lungs at the same time. It very rarely pervades one 
whole lung, being much oftener confined to limited portions, which may 
even be too small to be detected by percussion. It is also of rare occur- 
rence that the inflammation remains confined to a central portion of a lobe 
only (central pneumonia), but generally spreads to the surface of the lobe 
which joins the pleura. In aged persons and cachectic individuals the pos- 
terior parts of the lungs are most frequently attacked. When normally pro- 
gressing, pneumonia offers three distinct stages for consideration: 1. The in- 
flammatory stage, or hyperemia of the capillaries in the lung tissue with exuda- 
tion of coagulable lymph. 2. Hepatization, or infiltration of the lung tissue 
with coagulable lymph. 3. Its resolution, or purulent infiltration. 
The characteristic signs of these different stages are as follows : 
First stage. As a general thing the disease sets in with a violent chill, 
often attended with vomiting and followed by an intense fever, with a tem- 
perature of 104 to 105 in the evening and from 0.9° to 2.7° less in the morn- 
ing; the pulse rises to 100 or 110 and the respiration to 40 or 50 per minute. 
In other cases the disease sets in with several light chills or chilliness, or the 
chill is entirely absent and the scene opens with convulsions and complete 
loss of consciousness. The skin is at first very dry, but becomes moist usu- 
ally about the third day, though only temporarily. The face is purplish-red, 
and frequently only on that side which corresponds to the diseased side of 
the lungs. The lips become covered with hydroa (fever blisters) and also 
very often only on the affected side, or, at least, more marked on that side. 
The alae nasi make corresponding movements with respiration ; the voice of 
the patient is low and he speaks in broken sentences. Cough is, in almost all 
cases, present, although in some less marked than in others; the patient 



PNEUMONIA. 381 

generally tries to suppress it, on account of the pain which it gives. At first 
it is dry, but after a time it yields a tough, jelly-like, viscid sputum, difficult 
to expectorate, and adhering to the lips, from which it has to be wiped off; 
it soon changes to the characteristic color of rust, from an admixture of 
blood. 

"When the patient complains during the coughing spells of stitch-pain in 
the chest, it is more or less a sign that the pleura participates in the morbid 
process; when he complains of dull, heavy pains, they probably originate in 
the bronchial tubes. 

In consequence of the disturbed circulation through the lungs, the blood 
being either not sufficiently oxygenized, or being prevented or retarded 
in its return from the brain, different brain symptoms originate, such as 
delirium, stupor, etc., so that the case may take the appearance of typhoid 
fever, from which, however, it is easily distinguished by the hydroa on the 
lips, which are scarcely ever found in typhoid fever. 

In rare cases we observe jaundice combining with pneumonia. In such 
cases the liver appears enlarged on account of the engorgement which is 
brought about by the impeded circulation. As the hepatic veins cross the 
gall-ducts the latter become compressed and the gall retained. In other 
cases it seems that pneumonia is complicated with a parenchymatous inflam- 
mation of the liver, or a catarrh of the duodenum, causing in either case, 
icterus. 

The urine is scanty and concentrated, ,and deposits, on cooling, a sedi- 
ment of brick-dust urates. The bowels are usually constipated. 

The Physical Signs at this stage are the following : 

Inspection discovers decreased mobility of the diseased side of the thorax. 
In cases where both the lower lobes are engorged, the patient moves only the 
upper part of the thorax in breathing, whilst the abdomen remains quiet on 
account of the impossibility to retract the diaphragm. 

Palpation shows an increased vocal fremitus, unless the bronchial 
tubes should be stopped up by mucus. The impulse of the heart is also 
increased, but felt in its normal position. 

Percussion yields generally a short, tympanitic sound over the parts in- 
volved, as long as they still contain air. 

Auscultation reveals the crepitant sound which, according to Wintrich, 
arises in consequence of the sticking together of the walls of the air-cells, and 
their separation by inspiration. 

Second stage, hepatization. The above-mentioned symptoms — fever heat, 
dyspnoea, cough, pain, and brain symptoms — continue. The thorax appears, 
on inspection, still less movable during respiration; the vocal fremitus is 
strong, provided there does not intervene a pleuritic effusion between the 
hepatized lung and the thoracic wall. 



382 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Percussion gives forth a dull sound, and the resistance of the thoracic 
walls to the percussing finger is increased, provided the hepatized portion of 
the lung have the thickness of about one inch, and a superficial extent of 
several inches. A central location of the hepatization alters the percussion 
sound very little, if any, on account of the intervening portion of lung con- 
taining air. 

Auscultation yields neither the natural vesicular breathing, nor the 
crepitant sound of the first stage, but bronchial breathing, bronchophony, and 
even pectoriloquy, provided the bronchial tubes, which are contained in the 
hepatized portion of the lung, be not stopped up by mucus, blood-coagula, 
etc. There are also heard all sorts of rattling noises, if mucus exists in the 
bronchial tubes. 

Third stage, resolution. This sets in sometimes with a sudden relaxation 
of all the violent symptoms — the temperature falls in from 12 to 36 hours to 
the normal, and at times even below the normal ; the congested, even purplish 
face becomes pale, the skin moist, the dyspnoea ceases, the sputa becomes 
copious, frothy, yellowish, easily expectorated; the urine increases and be- 
comes natural again. 

On inspection, we observe that the thoracic walls regain their natural 
mobility ; the percussion sound again becomes tympanitic, and by means of 
auscultation we observe the bronchial breathing and bronchophony becoming 
weaker ; the crepitation sound re-appears, until, at length, the natural vesic- 
ular respiration is re-established.* 

This is the regular progress of simple pneumonia, lasting, on an average, 
from fourteen to twenty-five days, of which two, three, or five clays are con- 
sumed by its first development, five to eight days by exudation progressing 
to perfect hepatization, and seven to fourteen days by the resorption of the 
exudation and convalescence. 

But, to the first invasion of inflammation, new invasions often follow, so 
that it is not uncommon to find in one lung all three stages united. 

Or, the adjoining portion of the healthy lung becomes cedematous ; that 
is, infiltrated by a serous exudation, in which case the dyspnoea increases to 
suffocation. There is, at the same time, a frothy expectoration and fine 
rattling noises in the lung not affected with croupous pneumonia. The im- 
possibility of breathing, on account of the serous infiltration, causes an ac- 
cumulation of carbon in the blood, and, in consequence, death by suffocation. 

Or, the disease takes an asthenic form when the symptoms of the central 
nervous system assume great prominence from the beginning, so that the 
whole process might be mistaken for meningitis or typhus ; still the infiltration 
of the lung progresses slowly, and in severe cases is often attended with pleu- 
ritis, jaundice, albuminuria, and considerable enlargement of the spleen. 
This form is called Typhoid pneumonia. 



PNEUMONIA. 383 

Or, the morbid process combines with diseases of the heart, such as 
endocarditis, pericarditis or valvular affections, all of which lessen a favor- 
able prognosis considerably. 

Or, abscesses form in the third stage of the disease, which, if small or 
deeply seated, offer no physical signs, and may discharge and heal. When 
large, and forming large cavities, we may hear pectoriloquy, and, in some 
cases, metallic tinkling. 

Or, the hepatization changes into tubercular infiltration, which is especially 
the case when the seat of inflammation is in the upper regions of the lungs. 
In such cases the fever does not leave altogether, but shows some aggravation 
every night ; cough, dyspnoea and the dull percussion sound of hepatization 
continue, while auscultation reveals bronchial breathing and bronchophony. 
Or, the inflammation assumes a chronic form, and the hepatized lung 
becomes indurated or cirrhosed, the interstitial tissue growing tense and 
rendering the air-cells impervious to air. The patient is almost free from 
fever, but recovers very slowly in strength, and we observe, for a long time, 
the dull percussion sound and the bronchial breathing ; whilst, the thorax, in 
these places, gradually sinks in. 

Or, the whole morbid process ends in gangrene, which happens very 
seldom, and which may be diagnosticated by the sudden general collapse and 
the cadaverous smell of the breath and expectoration, which is dark-blackish 
and copious. 

The mean or average time which it takes for pneumonia to run its course, 
if it is not interfered with by medicines, is, as above stated, twenty-five days. 
But this average may, by judicious treatment, be considerably shortened; for 
pneumonia can be arrested in each of its stages. The most interesting data 
in this respect have been brought forth by Dr. Eidherr, of Vienna, who has 
collected all cases of pneumonia out of a large hospital practice, which had 
been recorded there for ten years. From these data it appears that under the 
application of the sixth decimal attenuation of the appropriate remedies the 
average came down to nineteen, under the application of the fifteenth potency 
to fourteen, and under the application of the thirtieth potency to eleven days. 
The Diagnosis must be based on the above detailed physical signs ; but 
one of the most constant and characteristic signs is the great frequency of 
respirations compared with the pulse, which in very severe cases may approach 
that of the pulse, usually, however, amounts to one respiration for two or 
three beats of the heart, while in health the ratio is about 2 to 9, that is 1 
respiration to 4£ pulsations. 

The most fatal days of pneumonia are those between the fifth and eighth 
days. 

THERAPEUTIC HINTS.— Sulphur, according to Eidherr, when 
exudation sets in, that is, when auscultation reveals the crepitation sound. 



384 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

Iodium or Kali hydr., according to Kafka, at the beginning, when 
the disease localizes itself. 

Bromium, in extensive hepatization of the lower lobes. 

Phosphor., in capillary bronchitis, or catarrhal pneumonia. 

Tart, emet., in pleuro-pneumonia. 

Schiissler recommends Ferr. phosph. for the first, Kali mur. for the 
second, and Calc. sulph. for the third stage* 

All this is very well, but will not suffice for all cases ; we will still have 
to consider the following: 

Aeon., first stage, high fever; must lie quietly upon the back; cannot 
lie on the right side, by stitching pains in the left. "Raising is difficult, the 
expectoration being tenacious, falling in a round lump and of a dark cherry- 
red color." (C. Pearson.) 

Arnica, traumatic cases. 

Arsen., great anxiety and restlessness with tossing about; great thirst, 
but drinking little at a time; burning and heat in the chest; pale face; cold 
extremities ; prostration. 

B apt is., "if I could only get my cough together; it seems to be in 
pieces, all scattered about, and I want to get it together." Typhoid form. 

Bellad., nervousness, delirium, threatening convulsions; drowsiness; 
inability to go to sleep ; starting from sleep. Face flushed, eyes congested ; 
congestion towards the brain. Dry, tickling cough, worse in the night. 

Bryon., expiration shorter than inspiration; inclination to lie perfectly 
still ; the slightest motion increases all the symptoms ; great thirst, wanting 
large draughts of water ; desire for acid drinks ; or little or no thirst with 
dryness of the mouth. Better on lying on the painful side ; sometimes the 
reverse. "Expectoration falling in round, jelly-like lumps, and of a yellow 
or soft brick shade." (C. Pearson.) 

Calc. carb., gray hepatization with sputa, which fall in water to the 
bottom, leaving a trail of mucus behind, like a shooting star. (Fellger.) 
Perspiration about the head. 

Capsic, "when coughing, the air from the lungs causes a strange, 
offensive taste in the mouth, and a badly-smelling breath rushes out of the 
mouth." (A. E. Wright.) 

Carb. veg., third stage; cough by spells, or no cough; hippocratic 
face, eyes half open, nose pinched and cold, lips blue, pupils insensible, no 
complaining or crying; pulse small, quick, difficult to count; body emaciated 
and marbled ; feet and hands blue and cold ; abdomen distended with gas ; 
respiration frequent and superficial; breath cold — a perfect picture of collapse. 

Chelid., right side; bilious symptoms; pain under right shoulder- 
blade; great and quite irregular palpitation of the heart. 

Cuprum, after a previous catarrh in the chest or in the bowels; sudden 



PNEUMONIA. 385 

attacks of dyspnoea to suffocation; face earthy, dirty, bluish, seldom red; 
roof of mouth always red ; sweat not profuse, sometimes sour-smelling, with- 
out relief; diarrhoea. 

Ferr. met., no ailments previous to the chill; dyspnoea increases 
slowly ; face pale, and in adults it becomes collapsed, hippocratic or expres- 
sionless, stiff and stupid ; the roof of the mouth always white ; skin neither 
cold nor burning hot; pulse neither full nor hard; stool consistent, brown. 

Ferr. phosph., the expectoration is clear blood. 

Gelsem., after a sudden check of perspiration with pain under the 
scapulae of both sides. (A. E. Small.) 

Hyosc, typhoid pneumonia; sees persons in the room who are not 
there. 

Kali carb., cough worse towards 3 o'clock a.m., almost choking; pain 
in lower part of chest with dull percussion sound ; pulse small and somewhat 
irregular ; face pale ; skin and stool dry. 

Kali hydr., after shaking chill, fell in a deep sleep, out of which he 
could not be roused; snoring loudly with closed eyes, injected conjunctiva, 
hot head, dry tongue, bluish lips, sunken lower jaw, bluish finger-nails; 
irregular and intermitting pulse ; lies upon his back ; the extremities, when 
raised, fall back as if paralyzed ; has not voided urine nor asked for any 
drink. Both upper portions of the lungs hepatized. (Kafka.) 

Laches., great dyspnoea, worse in the afternoon or after sleep; left 
side; badly-smelling stools, even if formed. 

Lycop., circumscribed redness of the cheeks; lips and tongue ulcerated, 
red and dry ; fan-like motion of the alee nasi ; cannot bear to be covered ; 
sweat without relief; cross on getting awake. " The patient raises a whole 
mouthful of mucus at a time, of a light rusty color, stringy and easily 
separated." (Pearson.) 

Merc, sol., right side; bilious symptoms; jaundice; diarrhoea. 

Nitrum, annoying feeling of heaviness in the chest, as though some 
great load were pressing the thorax together; can drink only in little sips 
for want of breath ; dyspnoea to suffocation. 

Nitr. ac, in protracted cases ; in weak, cachectic individuals, where 
there is a sudden abatement of pain, and yet an increase of the pulse in 
smallness and quickness. 

Opium, Mr. H. F., aged 40 years, of a phlegmatic temperament; 
double pneumonia. At times feels as though he were not in his house, which 
he expresses by saying: "I wish I could be in the house with my family." 
Although in a desperate condition, he is not much alarmed and wants to sit 
up a great part of the time, because the bed feels too hot. His whole body, 
except the lower extremities, perspire profusely, the sweat is very hot The 
perspiring parts are covered by a heavy crop of sudamina. He gropes with 
25 



386 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

his hands about the bed as though he were hunting something. Inasmuch as 
Opium is not one of the routine remedies in pneumonia, I wasted time in 
giving Bryon., Phosphor., etc. About the eleventh day Opium 6 was 
given, which was followed by a sudden change and a most satisfactory re- 
covery, without the aid of any other remedy. If it is objected that pneu- 
monia gets well without treatment, I reply that the time when resolution 
generally takes place had passed when Opium was given, and that in all 
likelihood nature was inadequate to the task in this case, where not only the 
whole left but a considerable part of the right lung was hepatized. I have 
treated another very similar case where the same remedy yielded the same 
results. (C. Bernreuter.) 

Phosphor., "stupor with burning, hot head; red, hot cheeks, red ears, 
contracted pupils, closed mouth. Murmuring and gesticulating in delirium. 
Takes water when offered greedily, but cannot swallow more than one sip, 
on account of shortness of breath. Wing-like motion of alse nasi. The 
carotids pulsate violently ; the heart beats strong ; the pulse is very quick ; 
the skin dry and hot. The lower portion of the posterior right lung is 
hepatized." (Kafka.) Great tightness across the chest; diarrhoea. "The 
expectoration, when falling on paper, will break and fly like thin batter." 
(Pearson.) 

Pulsat., lies on the back, can't lie on the sides; semilateral perspiration 
(left side of the chest) ; can scarcely speak above a whisper ; respiration 50 
per minute. 

Rhus tox., restless moving, because lying still increases pain and 
dyspnoea ; tongue red at tip. Typhoid pneumonia. 

Sanguin., second and third stage; extreme dyspnoea; tough, rust- 
colored sputa; the patient lies upon his back; there is not much pain in his 
chest, and that of a burning, stitching character; pulse quick and small; 
face and extremities inclined to be cold, or hands and feet burning, with 
circumscribed redness and burning heat of the cheeks, especially in the 
afternoon. 

Senega, right side; violent stitches; sinking of strength; small, 
scarcely perceptible pulse; rare cough, without expectoration, but great 
rattling of mucus in the chest; somnolence; dejected features. 

Sulphur, may be indicated in any stage ; sometimes also when other 
remedies fail. Its indications may be found in : hot palms and soles ; hot 
vertex ; faint, weak spells, especially in the forenoon ; diarrhoea, especially 
early in the morning ; suffocating spells, wants doors and windows open ; 
restless and sleepless nights ; cutaneous eruptions. 

Tart, emet., great rattling of mucus; much coughing, with copious, 
frothy expectoration, or else no expectoration; oedema of the lungs; impend- 



DIGEST TO PNEUMONIA. 



387 



ing paralysis of the lungs ; greatest dyspnoea and fits of suffocation ; cyanosis. 
Pleuro-pneumonia. 

Ver. vir., face flushed; red streak through the centre of the tongue; 
sinking, faint feeling in pit of stomach ; regularly intermitting pulse ; expec- 
toration of pus and florid blood. 



DIGEST TO PNEUMONIA. 



First stage: Aeon., Ferr. phosph., Kali 

hydr., Sulphur. 
Second stage: Kali mur., Sanguin. 
Hepatization, gray: Oakar. 

, lower lobes : JBromium. 

, posterior lower lobes, right side: 

Phosphor. 

both upper portions : Kali hydr. 

Pneumonia, right side : Chelid,, Merc, sol., 

Phosphor., Senega. 

, left side : Laches., Rhus tox. 

Double pneumonia: Lycop., Opium. 
Catarrhal pneumonia: Phosphor. 
Third stage : Calc. sulph., Carb. veg., San- 
guin., Sulphur. 
Pleuro-pneumonia : Tart, emet. 
Typhoid pneumonia: Baptis., Hyosc, 

Bhus tox. 
CEdema of lungs: Tart. emet. 
Cough, dry, tickling, worse in night: 

Bellad. 
, almost choking, worse towards 3 A.M. : 

Kali carb. 

in spells, or no cough : Carb. veg. 

rare, without expectoration, but great 

rattling in chest : Senega. 
, much, with copious, frothy expecto- 
ration, or none : Tart. emet. 
Expectoration when falling on paper 

will break and fly like thin batter: 

Phosphor. 
, difficult, tenacious, falling in a round 

lump, of a dark cherry-red color: Aeon. 
, falling in round, jelly-like lumps, 

and of a yellow, or soft brick shade: 

Bryan. 
falling in water to the bottom, and 

leaving a trail of mucus behind like a 

shooting star: Cede. carb. 
rust colored : Sanguin. 



Expectoration rust colored, whole mouth- 
ful at a time, stringy and easily separated : 
Lycop. 

, pus and florid blood : Ver. vir. 

, clear blood : Ferr. phosph. 



Stitches, violent: Senega. 
Stitching, burning, or little pain: San- 
guin. 
Burning and heat : Arsen. 
Fain in lower chest with dull percussion 

sound: Kali carb. 
Respiration frequent and superficial: 

Carb. veg. 

50 per minute : Pulsat. 

Can scarcely speak above a whisper: 

Pulsat. 
Expiration shorter than inspiration 

Bryon. 
Great rattling of mucus : Tart. emet. 
Heaviness, as though a great load were 

pressing the thorax together : Nitr. ac. 
Great tightness : Phosphor. 
Dyspnoea, great, extreme: Senega, Tart, 

emet. 

, increases slowly : Ferr. met. 

, worse in afternoon or after sleep: 

Laches. 

unto suffocation: Nitr. ac. 

, sudden attacks : Cuprum, Tart, emet. 

Suffocating spells, wants doors and 

windows open : Sidphur. 
Impending paralysis of lungs : Tart. emet. 



Heart beats strong: Phosphor. 
Palpitation great and irregular: Chelid. 
Carotids pulsate violently: Phosphor. 
Pulse quick : Phosphor. 

and small: Sanguin. 

small, scarcely perceptible: Senega. 



388 



AFFECTIONS OF THE PULMONARY PARENCHYMA. 



Pulse quick, difficult to count : Carb. veg. 

irregular: Kali carb. 

irregular and intermitting : Kali hydr. 

regularly intermitting : Ver. vir. 

every third beat : Nitr. ac. 

neither full nor hard : Ferr. met. 



ATTENDING SYMPTOMS. 

Stupor with burning hot head, red, hot 
cheeks, red ears, contracted pupils, closed 
mouth: Phosphor. 

Delirium, nervousness: Bellad. 

, with murmuring and gesticulating: 

Phosphor. 

, "if I could only get my cough to- 
gether ; it seems to be in pieces, all scat- 
tered about, I want to get it together : " 
Baptis. 

, " I wish I could be in the house with 

my family : " Opium. 

, he gropes with his hands about the 

bed as though he were hunting some- 
thing: Opium. 

, he sees persons in the room who are 

not there: Hyosc. 

Although in a desperate condition, he is 
not much alarmed : Opium. 

No complaining or crying : Carb. veg. 

Dejected features: Senega. 

Great anxiety and restlessness with toss- 
ing about : Arsen. 

Congestion towards the brain : Bellad. 

Hot head : Kali hydr. 

Hot vertex : Sulphur. 



Eyes congested : Bellad., Kali hydr. 

half open : Carb. veg. 

Pupils contracted: Phosphor. 

insensible : Carb. veg. 

Face flashed: Bellad., Ver. vir. 

Cheeks red and hot : Phosphor., Sanguin. 

circumscribed redness: 

, especially in afternoon : 

Face pale : Arsen., Ferr. met 

earthy, dirty, bluish, 

Cuprum. 
expression stiff and stupid : 



Sanguin. 
, Kali carb. 
seldom red ; 



Ferr. met. 



Face pale, hippocratic : Carb. veg., Ferr. 

met. 
Cyanosis : Tart. emet. 
Nose cold and pinched: Carb. veg. 
Fan-like or wing-like motion of alse nasi : 

Lycop., Phosphor. 
Lips bluish : Carb. veg., Cuprum, Kali hydr. 
and tongue ulcerated, red and dry : 

Lycop. 
Lower jaw sunken : Kali hydr. 
Roof of mouth red : Cuprum. 

white: Ferrum. 

Tongue dry : Kali hydr. 

red at tip : Rhus tox. 

red streak down the centre : 

Thirst, drinking little at a time : 

, wanting large draughts : Bryon. 

Takes water greedily when offered : Phos- 
phor., Sulphur. 
Cannot swallow more than a sip for want 

of breath : Phosphor., Nitr. ac. 
Little or no thirst with dryness of tongue : 

Bryon., Pulsat. 
Does not ask for drink: Kali hydr. 
Desire for acid drinks : Bryon. 



Ver. vir 
Arsen. 



When coughing, the air from the lungs 
causes a strange, offensive taste in the 
mouth ; the breath smells badly : Capsic. 

Breath cold : Carb. veg. 



Bilious symptoms : Chelid., Merc. sol. 
Jaundice : Merc. sol. 
Diarrhoea : Merc, sol., Phosphor. 

worse in the morning : Sulphur. 

Stool brown, consistent: Ferrum. 

dry : Kali carb. 

badly smelling, even if formed : Laches. 

Abdomen distended with gas : Carb. veg. 
Pain under right shoulder-blade : Chelid. 



Drowsiness and inability to go to sleep 

Bellad. 
Somnolence : Kali hydr., Senega. 
Sleepless and restless : Rhus tox., Sulphur 
Starting in sleep : Bellad. 
Snoring loudly : Kali hydr. 



DIGEST TO PNEUMONIA, 



389 



Lying upon his back : Kali hydr. 
Cross on getting awake : Lycop. 



Cold extremities : Arsen. 

and face : Sanguin. 

feet and hands blue : Carb. veg. 

Bluish under nails : Kali hydr. 

Chill, previous to, no ailments : Ferr. met. 

, often, deep sleep, can't be roused: 

Kali hydr. 

High fever, first stage : Aeon. 

Hot palms, soles and vertex: Sulphur. 

and dry skin : Phosphor. 

Skin neither cold nor burning hot: 
Ferrum.' 

Sweat, whole body except lower extremi- 
ties: Opium. 

, very hot : Opium. 

, not profuse, sometimes sour smelling: 

Cuprum. 

, semilateral (left side of chest) : Pulsat. 

, without relief: Cuprum, Laches., Merc. 

sol., Lycop. 

, with sudamina: Opium. 



Cutaneous eruptions : Sulphur. 
Skin dry : Kali carb. 



Faint, weak spells, worse in forenoon: 

Sulphur. 
Prostration: Arsen. 



Sinking of strength: Sanguin. 

The extremities, when raised, fall back 

as if paralyzed : Kali hydr. 
Body emaciated and marbled: Carb. veg. 
Threatening convulsions: Bellad. 



Inclination to lie still : Bryon. 

Better on lying on the painful side ; some- 
times the reverse : Bryon. 

Lies upon his back : Sanguin, Kali hydr. 

, can't lie on the sides: Pulsat. 

Must lie quietly upon the back : Aeon. 

Cannot lie on the right side by stitching 
pains in the left : Aeon. 

Slightest motion increases all symptoms : 
Bryon. 

Lying still increases pain and dyspnoea : 
Rhus tox. 

Cannot bear to be covered : Lycop. 

Wants to sit up, because the bed feels too 
hot: Opium. 



In traumatic cases: Arnica. 

After a sudden check of perspiration with 

pain under the scapulae (both sides) : 

Gelsem. 
After previous catarrh in the chest or 

bowels: Cuprum. 
In protracted cases of weak cachectic 

individuals, where there is a sudden 

abatement of pain, and yet an increase 

of the pulse : Nitr. ac. 



Pulmonary Consumption, Phthisis, 

Is the general expression for the common result of a variety of pulmonary 
affections, among which may be mentioned chronic pneumonia of the apex, 
broncho-pneumonias, bronchial chronic catarrh, aud tuberculous infiltration, all 
of which begin in the upper lobes, or apices of the lungs, and extend down- 
wards. Inflammatory processes yield as products caseous matter, while " a 
cellular infiltration of the pulmonary connective tissue, composed of small 
nodules, absolutely bloodless, not capable of suppuration, nor of resorption, 
nor of organization, but only of degeneration," (Rindfleish) constitutes tuber- 
culous matter. The principal reasons why pulmonary consumption almost 
always begins in the apices of the luugs, are: a shortening and ossification of 



390 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

the cartilages of the first ribs of scrofulous children during the early years 
of life, or even congenital, and a want of power of the respiratory muscles, 
constituting a paralytic thorax, laying the main burden of respiration 
upon the diaphragm ; both conditions cause a diminished respiration in the 
upper parts of the lungs, and in consequence a non-removal of the secretions 
which form in these parts and become inspissated. 

Although consumption is the result of various morbid processes in the 
lungs, its characteristic symptoms nevertheless may be summed up as fol- 
lows: 

Cough, may not always be present, or at least not in a marked degree 
in the beginning, but once present it continues to the end. Its severity is 
proportioned to the extent of the disease, and increases and decreases with 
the phases of the disease. Its character varies in different individuals, but 
towards the last it assumes a peculiar toneless sound, owing to the ulcerated 
state of the vocal cords and great muscular weakness. 

Expectoration is at first usually absent, and when it makes its appear- 
ance it is of no distinctive character; later with the increase of pneumonic 
infiltration it becomes glassy, glutinous and at times tinged with blood. 
Still later, and in some cases earlier, the sputa contain opaque grayish-white 
strise and granules, mixed with the rest of the yellow viscid mass. On pour- 
ing the whole into water, the granules sink to the bottom, while the strise 
remain suspended; there appear also about this time elastic fibres of the 
lung tissue in the sputa, which sink to the bottom, if the sputa be mixed 
with an equal quantity of caustic soda, and be boiled in distilled water 
(18 : 100), to which, under frequent stirring, water three or four times its 
bulk is added, and the w T hole allowed to stand and settle in a conical glass. 

Still later, and by degrees, the sputa become globular and compact ; they 
sink in water or hang attached to a thread of mucus ; they come from cavi- 
ties formed by bronchiectases, and as the destructive process still further pro- 
gresses and cavities form, the sputa changes to purulent matter, which is 
often expectorated in large quantities. 

Hcemoptysis may occur at any period of the disease, and is due either to 
a degeneration of the blood-vessels or to hard, straining spells of coughing. 
It may amount to a very small quantity of blood, merely staining the expec- 
toration, and it may be so profuse that it kills the patient instantaneously. 
Large haemorrhages take their origin from a rupture of larger vessels, mostly 
in cavities. 

Phthisis is rarely accompanied with any particular pain in the chest, 
unless accompanied with pleurisy, which causes a sharp stitch-pain ; so also 
is the dyspnaza of little account, unless induced by supervening pleuritic exu- 
dation or pneumothorax ; but the breathing is in all cases greatly accelerated 
and especially from any exertion. 



PULMONAEY CONSUMPTION, PHTHISIS. 



391 



Inspection. The subclavicular region of the thorax sinks in, and the 
clavicles become prominent; the whole thorax is flat and elongated, and the 
shoulder-blades stick out; the respiratory motion decreases or ceases alto- 
gether in those places, and in far advanced cases the respiratory motion takes 
place only at the lower portion of the thorax. The whole body of the pa- 
tient is emaciated, pale, and covered by a loose, thin skin. But there are 
cases where the thorax shows no such aspect, but appears finely developed. 

Palpation reveals stronger fremitus in one or the other subclavicular re- 
gion, and in the commencement an increased impulse of the heart. 

Percussion affords, at the beginning of the disease, no results whatever, 
because minute infiltrations cannot alter the sound, as they are surrounded 
by healthy, air-containing lung tissue. Only when they increase in size, and 
thus deprive the lung of air, the percussion sound will grow duller accord- 
ingly, and this is observable most apparently in the infraclavicular, acromial 
and suprascapular region. If at a still later period cavities have formed, 
with tense, smooth walls, well adapted for reflecting sound, and if they are 
near enough to the thoracic walls, percussion may yield a tympanitic sound, 
or a metallic tinkling, or even a cracked-pot sound (if the cavity be con- 
nected with large bronchi), so that through percussion the air is forced out 
of the cavity into the bronchial tubes. 





TCBERCCLOC3 INFILTRATION. (After Bock.) 

a. Fleshy percussion sound. 
&. and d. Short dull sound. 
c. Lung sound, 
e. Heart. 
/. Liver. 



Tuberculous Infiltration. (After Bock.) 

a. Fleshy and dull sound. 

c. Cavity with tympanitic sound, or metallic 

tinkling, etc. 
6 and e. Lung sound. 



Auscultation at first yields an increased and prolongated expiratory mur- 
mur ( Jackson \ which is often heard in two distinct jerks; also fine rattling 
noises, which, from coughing, disappear only for a little while (Niemeyer), 
and a systolic murmur in the subclavian artery on the affected side during 
expiration. (Ruehle. ) 



392 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

When the tubercles commence to dissolve, we often hear the "click 
sound. 1 ' 

After the lung tissue has become infiltrated by tubercular masses, we 
hear, on auscultation, bronchial breathing and bronchophony, and all kinds of 
rattling noises. 

When cavities exist, which, with their smooth and tense walls, are well 
adapted for the reflection of sound, we hear the emphoric echo and metallic 
tinkling, also the cavernous noise. 

The pulsation of the heart is generally heard, even on the right side, 
quite distinctly. 

Phthisis is almost always attended with laryngeal symptoms, such as 
hoarseness, difficulty of swallowing (food or drink go the wrong way), in 
consequence of tuberculous ulceration and inflammation. 

The circulation is accelerated ; the pulse is rapid, soft and empty, the 
action of the heart is increased, causing palpitation, and all this at first with- 
out any corresponding elevation of temperature. In short, the signs are 
those of any form of ansemia, which ultimately developes hydrsemia ; amen- 
orrhea. 

In the digestive organs we frequently meet with loss of appetite, and in 
some cases even at the beginning; with nausea, occasional vomiting, especially 
after coughing, with pain or oppression in the pit of the stomach, in the 
bowels, with diarrhoea. The latter is of very frequent occurrence, at times 
showing itself at the commencement of the disease, at other times during its 
whole course in recurring spells; most commonly, however, it belongs to a 
later period, quickly exhausting the vital forces, or ending with a rapidly 
fatal peritonitis when the tuberculous ulceration terminates in perforation. 

Phthisis is at times complicated with fatty liver and amyloid liver, with 
amyloid degeneration of the spleen and of the kidneys. 

The skin is conspicuous by its transparency and paleness, and by the 
distinctness of the veins; by its great sensitiveness to the slightest changes 
of temperature ; by the easily flushing of the face on the slightest excitement, 
and the profuse perspiration with even moderate fever. The nails grow 
curved like claws, and there is a bulbous enlargement of the third phalanx. 
This symptom, however, is also found in other chronic diseases of the respira- 
tory organs, such as emphysema, etc. The pink-red line on the lower gums 
occurs often at a very early period, though it is not found exclusively in 
phthisical persons. Pityriasis versicolor appears often at the very beginning. 

One of the most constant signs of phthisis is emaciation, noticeable from 
the very beginning and advancing steadily with the progress of the disease. 
During the periods of remission the loss is made up again, but if loss of weight 
should set in again without assignable cause, a renewed attack may be ex- 
pected. The total loss produced by the disease is generally from one-fourth 






393 

to one-third part of the initial weight, and it involves not merely the fat, but 
also the tissues and the blood. On account of this wasting away the disease 
has appropriately been called consumption. 

The fever also is a conspicuous feature of phthisis. In acute cases — 
florid phthisis — it is of a continuous type, the morning temperature falls but 
little below 102°, and the evening temperature rises above 104°. In chronic 
cases it is intermitting, its minima are generally normal, or a little below the 
normal, while the maxima average from 101.3° to 102.2° F. 

At last, must be mentioned the brilliant eyes of the phthisical patient 
and his unchangeable hopefulness even to the last. 

Its Predisposing Cause is a scrofulous diathesis, therefore phthisis is so 
frequently inherited. Still it may be acquired from lack of pure air, light, 
warmth and exercise and from a deficiency and poor quality of food, in short 
by anything that impairs the nourishment of the body, induces poverty of 
blood or depresses the nervous system. In scrofulous subjects these con- 
ditions of course will hasten the outbreak of the disease. The maximum of 
its occurrence lies between the fifteenth and twenty-fifth years. 

Within the last year or two the attention of the profession and the public 
has been drawn to the investigations of Dr. Koch, who detected the tubercle- 
bacillus in the sputa of consumptives. This microscopical fungus is of a 
rod-like shape, and is distinguished from other bacterise by the blue color 
which it retains after staining in methylene-blue, along with caustic potash, 
and subsequent treatment with vesuvin. Such bacilli have been found in 
sputum even before any physical signs of consumption were present, and they 
are said to be carried by the air and inhaled when the sputa of tubercular 
patients are allowed to dry and to be converted into dust-form. However 
that may be, the decision has not yet been rendered, whether the bacillus is 
the cause of consumption, or whether it is simply a result or a part of the 
histological changes that constitute the disease. 

Elevated p>ositions are known to protect against phthisis. A height of at 
least 1,000 or 2,000 feet above the sea seems to be requisite for this purpose. 

So also are goitre, emphysema, valvular diseases of the heart and consider- 
able contractions of the chest by spinal curvatures said to be antagonistic to 
the development of phthisis, although exceptions to this rule surely occur. 

As regards the contagiousness of consumption opinions have been at 
variance. Of late, however, experiments on animals seem to leave no doubt, 
that the disease is communicable, and cases are met where through the in- 
timate relations existing between husband and wife the disease has been 
communicated ; it is certainly good advice to be cautious in attending of, and 
associating with those who are far advanced in the disease. 

Consumption furnishes the largest percentage of deaths amongst all 
other diseases; nevertheless many cases are cured, and the disease cannot be 



394 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

called incurable, though favorable conditions necessarily are required for a 
successful treatment. 

THERAPEUTIC HINTS —General rules, which may serve rather 
as preventatives: Fresh air, and plenty of it; exercise in the open air, and 
gymnastic exercises, which tend to widen and strengthen the chest ; method- 
ical breathing exercises for the same purpose, which consist in regular, slow, 
and full inspirations and expirations; singing; a good and nourishing diet, 
and a careful attention to the skin by rubbing and washing, in order to keep 
up its activity, and to harden it against atmospheric changes; rubbing the 
skin with olive oil has also been recommended, and a change of climate has 
certainly proved beneficial in many cases. 

About the time of puberty, all efforts should be made to prevent the 
excitement of sexual desires, such as reading loose literature. Masturbation 
is in the highest degree hurtful; mental exertions, and depressions of all 
kinds, are also injurious. 

When catarrhal affections set in they must be treated according to their 
special symptoms, and so also all other features, changes and processes of the 
disease. 

When a well-selected remedy is allowed to act, it manifests itself — 
according to Nusser's observations — generally in one of the following symp- 
toms, which are favorable : 

1. Swelling of the glands in the axilla. 

2. Rheumatism in the muscles of the neck, shoulders, thorax, hips or 
extremities. 

3. Swelling of the glands on the neck and ear. 

4. The materia peccans rises from within towards the outside, contrary 
to the air which passes during respiration from without inward. The chest 
feels lighter, but the trachea and larynx become affected in a manner to 
produce hoarseness, which subsiding, the nose becomes sore, and finally ends 
with pimples and pustules around the nose. 

5. The ears become affected, from mere ringing in the ears to suppura- 
tion within them. 

. 6. The eyes become inflamed. 

7. Headache and toothache set in; in such a case, let the patient suffer; 
a sudden suppression of them would quickly bring back all the troubles to 
the chest. 

8. An eruption on the thorax, with or without itching on the chest or 
back. 

9. Sweating of the feet. 

10. Hemorrhoidal irritations and tumors. 

11. Violent colds in the head, which may indicate Aeon, or Phosphor., 
and which almost always act beneficially. 



PHTHISIS. 395 

12. The morbid action goes down into the intestines, and throws out 
gall, acid, mucus or gas, until finally it developes itself in a cutaneous dis- 
ease, first attacking the head, the upper extremities, the thorax, and so all 
the way down, like small-pox. 

When a well-selected remedy brings forth any of these symptoms, never 
disturb its action by change or repetition. 

SPECIAL HINTS. — Compare the foregoing chapters on catarrhal 
and inflammatory diseases of the respiratory organs, which may contain the 
hints just needed for the individual case. Besides compare : 

Aeon., intervening pleuritic stitches and blood-spitting. 

Act. rac, intercurring congestions and inflammations from exposure, 
with dry, harrassing cough ; night-sweats and diarrhoea. 

Arsen., acute pain in the upper third of right lung; hurried respiration 
upon moderate exertion, or dyspnoea on lying down ; cough dry, or with 
expectoration of frothy, glairy and transparent mucus, or yellow and grayish- 
yellow sputa ; cough worse in the evening on lying down, and in the morning 
on rising ; haemorrhage from the lung with burning in the upper portion of 
the right lung. (R. R. Gregg.) Prostration; exhausting diarrhoea ; inter- 
mitting chills, fever and sweat ; thrush in the mouth. 

Ars. jod., soreness in larynx; hoarse, racking cough, day and night, 
with profuse purulent expectoration. (H. V. Miller.) 

Baptis., chill in the forenoon or afternoon, followed by heat and per- 
spiration, as in ague ; general weakness and languor ; sometimes loss of hope- 
fulness. (J. S. Mitchell.) 

Bellad., in the beginning of chronic lung disease, hollow, barking 
cough; often worse at midnight ; violent stitching pains from right side of 
abdomen, upwards through the right lung to mamma, point of right shoulder 
of inner border of right scapula; also chronic nasal or bronchial- fluent 
catarrh, attended with rattling respiration, in nervous or mentally active 
subjects. (R. R. Gregg.) 

Bryon., pleuritic pain and exudation; chills and fever afterwards; 
cough all day. 

Calc. carb., pain in upper half of right lung; cough with purulent 
sputa, worse in the morning on rising, and in the early evening, with par- 
oxysms during the day, less during the night. Loud breathing through the 
nose; bleeding from right nostril; rapidly growing children and youths. 
(R. R. Gregg.) Easily perspiring, with fatigue from any little exertion; 
dizziness and want of breath on going up stairs ; paleness of face, with fre- 
quent flushes; nightly seminal emissions; too early and too profuse, or sup- 
pressed catamenia; inclined to looseness of the bowels, especially towards 
evening ; damp, cold feet. " Expectoration falls to the bottom in water, with 



396 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

a trail of tough mucus behind, like a dropping star. (A. Fellger.) " The 
patient appears gaunt, hollow-eyed, great emaciation; coughs little, but 
complains of stitching pains in the upper chest ; loss of appetite ; constipa- 
tion ; fluttering of the heart upon the slightest exertion ; weary of living ; 
constant coldness and dampness of the feet; tongue covered with a thick, 
white, pasty coating; bad taste in mouth; dull, heavy, stupid feeling in 
head, particularly in the morning; pulse 94. Believes her chief troubles 
are uterine. Suppression of menses; complete loss of sexual desire, border- 
ing at times upon absolute aversion; leucorrhoea. Formerly troubled with 
chronic diarrhoea. Calc. carb., 30, brought out for a while diarrhoea again, 
and also the menses. Six weeks later, Calc. carb., 200. Soon recovered 
entirely." (H. R. Arndt., Weekly Med. Counsellor, June 7, 1882, p. 155.) 

Carb. veg., nosebleed in the night; cough, in hard spells, not ceasing 
until masses of green or yellow, or purulent and offensive sputa are dis- 
charged ; hoarseness in the evening ; cool skin ; cold knees at night in bed ; 
great prostration ; hippocratic face. 

Cinchona, after loss of blood, long-continued nursing, seminal emis- 
sions; intermittent fever; sweats when dropping asleep. 

Crocus, " asthmatic or wheezy cough, attended by frothy expectora- 
tion, containing threads of translucent, whitish or yellowish mucus, of the 
size of coarse spool cotton or fine twine; worse in hot weather, a warm room, 
lying down, etc." (R. R. Gregg.) 

Dulcam., after taking cold from any change of weather; tough, 
greenish expectoration, with moderate cough ; stitching pain here and there 
in the chest ; diarrhoea. 

Ferr. met., flying pains in the chest; nosebleed; spitting of blood ; 
feeling of fulness and pressure in the pit of the stomach ; vomiting of ingesta ; 
paleness of the buccal cavity; painless diarrhoea; watery menstruation; hectic 
fever. Especially in persons who, in consequence of any little emotion or 
exertion, flush easily in the face, or get epistaxis, or cough, dyspnoea, spitting 
of blood, or palpitation of the heart ; the symptoms are relieved by moving 
slowly about, and while eating. 

Guaiac, pleuritic stitch-pains in the chest. 

Hepar, cough excited when any part of the body gets cold from being 
uncovered; chilliness in the open air; paleness after any exertion ; perspira- 
tion easily excited ; afterwards burning redness of the face and dry heat in 
the palms of the hands. After pneumonia. The cough is barking, wheezing, 
choking, worse towards morning. 

Iodium, cough from constant tickling in the windpipe and under the 
sternum, with expectoration of a transparent mucus, sometimes streaked with 
blood ; morbid hunger even soon after a meal and yet loss of flesh, or else 
total loss of appetite; remarkable sense of weakness and loss of breath in 









PULMONARY CONSUMPTION, PHTHISIS. 397 

going up stairs; emaciation of the mammae ; copious menstruation; morning- 
sweats ; dark hair and eyes. 

Kali carb., stitching pain in temples, eyes, ears, teeth, chest and different 
parts of the body; after dinner nausea, faintishness, sleep; about noon, chilli- 
ness; at night, heat; about 3 o'clock a.m., cough worse than ever. Puffiness 
of upper eyelids. Easily frightened ; a slight touch of the feet causes the 
patient to jerk them up in affright; nursing mothers. "Expectoration of 
firm white globular masses of the size of a pea, flying from the mouth with 
considerable force when coughing or hawking; eruption of minute vesicles 
upon the soles of the feet with extensive itchmg. Burning in top of head 
and soles of feet; sweaty paleness; circumscribed red spot on one cheek; 
gastric derangement with belching, tasting like rotten eggs ; hungry and faint 
about 10 a.m.; contraction of the heel cords; trembling sensation through 
the entire body, especially through the pelvic region." The 3d trituration 
cured whereas the 200th had failed. (O. W. Smith.) 

Laches., cough worse after sleep, sometimes only through the day, but 
also during sleep without wakening; expectoration difficult, has to hawk, 
hem, cough and spit a good while before he succeeds in getting a little tough 
phlegm away. Fever worse in the afternoon; stools smell very offensive, 
even if of a natural consistency. Sore mouth in last stage. 

Ledum, phthisical symptoms alternating with rheumatism. 

Lycop., after neglected pneumonias, expectoration of large quantities 
of pus; the expectoration tastes salty; cough day and night; hectic fever, 
circumscribed redness of the cheeks; worse from four to eight p.m.; cannot 
bear covering ; night-sweats. 

Merc, sol., "great aggravation from, or utter impossibility of, lying 
upon the right side; fugitive pains, now here, then there, or anywhere, and 
changing place every hour, few hours, or day or two." (R. R. Gregg.) 

Myrtus com., stitching pain in the left chest from the upper portion 
straight through to the left shoulder-blade, worse from breathing, yawning 
and coughing ; spitting of blood. 

Natr. benz., has lately been employed successfully in consumption; 
special indications wanting. 

Natr. mur., great dryness in the mouth; follicular catarrh of fauces; 
fluttering of the heart; the patient gets worse on the seashore. 

Nitr. ac, patients tainted with syphilis or mercurial cachexia. Ulcers 
in mouth and throat; fetid breath; colliquative night-sweats, very offensive; 
morning thirst; habitual looseness or constipation of the bowels; fissures of 
the anus. 

Nux vom., "violent racking paroxysms of cough, with or without 
expectoration ; worse after eating and in the morning or forenoon ; attended 
by severe headache, pain or bruised sensation in stomach, hypochondria or 



398 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

bowels, and a dull or subacute soreness of the abdomen under pressure." 
(R.R.Gregg.) 

Ol. jecor. aselli, the genuine article, which has not been "purified," 
has been of great use where scrofulous diathesis is conspicuous. 

Phosphor., cough worse, dry and tight before midnight, tormenting; 
excited by talking, laughing, moving, eating or cold air; during cough, 
bursting pain in the head, and sore, burning pain in chest and larynx; pain 
in the left side of the chest ; heat or burning in the back between the shoulders ; 
evening chill, followed by heat and sweat during sleep till next morning; in 
the morning the cough is loose. Puffiness around the eyes ; diarrhoea alter- 
nates with constipation ; stool and flatus very fetid. 

Phosph. ac, for young persons that have grown very fast. 

Psorin., the exhalation from the body, its secretions and excretions have 
an offensive odor; after suppressed itch. 

Sambuc, profuse sweats, but only while awake; during sleep the skin 
becomes dry and hot. 

Sanguin., breath and sputa smell badly, to the patient himself dis- 
agreeable ; before and after cough, belching of wind ; after the cough, heat, 
and after the heat, gaping and stretching; circumscribed redness of the 
cheeks; diarrhoea; night-sweats; pain in the lower left side of chest, ex- 
tending upwards to left shoulder. 

Sepia, "stitching or darting pains through the central portion of the 
right lung; cough dry in the evening; free expectoration in the morning, or 
expectoration only at night, none during the day ; excessively fetid sputa." 
(R. R. Gregg.) Cough better when lying down ; the cough sounds loose, but 
there is no expectoration, or only a little after great efforts. 

Silic, profuse discharge of fetid pus; formation of cavities; profuse 
night-sweats; pale, wax-like appearance of the skin; stone-cutter's con- 
sumption. 

Spongia, cough worse from evening until midnight, from cold air, 
from talking, singing or moving; better from eating or drinking; dyspnoea 
on lying down with the head low. 

Stannum, feeling of great weakness in the chest; can talk only a few 
words at a time from want of breath; pressure and bloatedness of the 
stomach always after eating; great lassitude; hands and feet feel heavy and 
are cold, or else burning hot ; constant chilliness alternating with flushes of 
heat ; profuse night and morning-sweats ; profuse expectoration, mostly of a 
sweetish taste. 

Sulphur, dryness and burning in the throat ; the breath appears hot 
to the patient ; cough mostly dry, only now and then profuse discharge of 
purulent matter, which relieves for a while ; the patient complains constantly 
of being too hot, puts his feet out from under the cover; congestion towards 



DIGEST TO PHTHISIS. 



399 



the head and chest, with palpitation of the heart ; profuse sweating at night ; 
diarrhoea early in the morning ; after suppressed itch or other chronic erup- 
tions ; pain in left side of chest in lower portion through to left shoulder- 
blade. 

Sulph. ac, stitch-pain through the upper part of the left chest to the 
shoulder-blade. 

Tarantula cubensis, "it soothes the dying sufferer as I have never 
seen any other remedy do." (J. T. Kent.) 



Digest to Phthisis. 



LOCAL SYMPTOMS, 

Cough, barking : Bellad. 

, , choking, wheezing, worse in 

the morning : Hepar. 

, hoarse, racking: Ars.jod. 

, asthmatic wheezing: Crocus. 

, dry: Arsen. 

, in evening : Sepia. 

, , harrassing : Act. rac. 

, and tight, tormenting, before 

midnight: Phosphor. 
, paroxysmal during day, less during 

night: Calc. carb. 
, , not ceasing until masses of green 

and yellow, or purulent and offensive 

sputa are discharged : Carb. veg. 

, , racking: Nux vom. 

, all day : Br yon. 

, only through the day: Laches. 

, day and night: Lycop. 

, evening : Arsen., Spongia. 

, midnight : Arsen., Bellad. 

, morning 3 o'clock : Kali carb. 

, during sleep without wakening: 

Laches. 

, worse on lying down: Arsen., Crocus. 

, on right side: Merc. sol. 

, on rising in the morning : Arsen. 

, after sleep: Laches. 

, from cold air : Phosphor, Spongia. 

, from a part of body being uncovered : 

Hepar. 

, in hot weather, a warm room: Crocus. 

, after eating and moving: Nux vom., 

Phosphor. 
, talking, laughing : Phosphor., Spongia. 



Cough, better from eating or drinking: 

Ferrum, Spongia. 
, while lying down: Sepia. 



, with bursting pain in head: Bryon., 

Nux vom., Phosphor. 
, headache, or bruised sensation in 

stomach, bowels, hypochondria: Nux vom. 
, with sore, burning pain in chest and 

larynx: Phosphor. 
After cough, heat : Sanguin. 



morning : 



Expectoration free in the 

Phosphor., Sepia. 

only at night, none during the day: 

Sepia. 

difficult, has to hawk, hem and spit a 

good while before a little phlegm is 
brought away: Laches. 

, the cough sounds loose, but there is 

no expectoration, or only a little after 
great efforts: Sepia. 

frothy, with threads of whitish or yel- 
lowish mucus of the size of common spool 
cotton or fine twine : Crocus. 

, , glairy and transparent mucus : 

Arsen. 

, transparent mucus sometimes mixed 

with blood: Iodum. 

, firm, white globular masses, of the 

size of a pea, flying from the mouth when 
coughing or hawking : Kali carb. 

falls to the bottom in water, with a 

trail of tough mucus behind like a drop- 
ping star : Calc. carb. 

yellow, or grayish-yellow: Arsen., 

Carb. veg. 



400 



AFFECTIONS OF THE PULMONARY PARENCHYMA. 



Expectoration green or yellow: Carb. veg. 
tough, greenish, with moderate cough : 

Dulcam. 
fetid, offensive : Carb. veg., Sanguin., 

Sepia, Silic. 
, , with cough in hard spells: 

Carb. veg. 
purulent : Ars. jod., Carb. veg., Calc. 

carb., Lycop., Silic, Sulphur. 
, , worse in the morning on rising 

and early in the evening: Calc. carb. 
, , with barking cough day and 

night: Arsen., Iodium. 
, , which relieves for a while: 

Sulphur. 

salty : Lycop. 

sweetish : Hamam. 

Spitting of blood: Aeon., Arsen., Fer- 

rum, Ferr. phosph., Myrt. com. 
, with burning in upper portion of right 

lung: Arsen. 



Calc. 



Breathing hurried upon moderate exer- 
tion: Arsen. 

Loss of breath on going up stairs: 
carb., Iodium. 

, and dizziness : Code. carb. 

, sense of weakness: Iodium. 

Dyspnoea on lying down: Arsen. 

, with the head low : Spongia. 

Loud breathing through the nose: 
car b. 

Breath appears hot to the patient : Sulphur. 

of bad smell, fetid : Nitr. ac, Smguin. 



Calc. 



Throat dry and burning : Sulphur. 
Larynx sore: Arsen., Iodium. 
Hoarseness in evening: Coccyx. 
Stitching pain in upper third of right 

lung: Arsen. 

in upper half of right lung: Calc. carb. 

through the central portion of right 

lung: Sepia. 
from right side of abdomen upwards 

to the right chest, mamma and right 

shoulder: Bellad. 
through upper part of left chest: 

Sulph. ac. 
, worse from breathing, yawning 

and coughing: Myrt. com. 



Pain from lower portion of left chest 
through to the shoulder: Bryon. Sulphur, 

from left lower chest up to left 

shoulder: Sanguin. 

in left chest : Phosphor. 

Stitching pain here and there in chest : 
Dulcam. 

in chest and different parts of body : 

Kali carb. 

, pleuritic: Ghiaj. 

, and blood-spitting; Aeon. 

, and exudation : Bryon. 

Flying pains in chest : Ferr. met. 

Congestion in chest and head, and palpi- 
tation of heart : Sulphur. 

from exposure : Act. roc. 

Feeling of weakness in chest ; can scarcely 
talk: Stannum. 

Chest symptoms alternate with rheu- 
matism: Ledum. 

Bronchial catarrh with rattling respira- 
tion: Bellad. 

Formation of cavities : Silic. 



Fluttering of heart: Natr.mur. 

upon slightest exertion : Calc. carb. 

GENERAL SYMPTOMS, 

Dull, heavy, stupid, worse in morning : 

Calc. carb. 
Thinks her troubles uterine : Calc. carb. 
Loss of hopefulness, sometimes: Baptis. 
Easily frightened; a slight touch of the 

feet causes the patient to jerk them up 

in affright : Kali carb. 
Burning in top of head and soles of feet : 

Kali carb. 
Dark hair and eyes: Iodium. 
Puffiness of upper eyelids : Kali carb. 

around eyes: Phosphor. 

Nasal catarrh : Bellad. 
Nosebleed: Ferrum. 

, right side : Calc. carb. 

, in the night : Carb. veg. 

Burning redness of face: Hepar. 
Circumscribed redness of cheeks : Lycop., 

Sanguin. 

of one cheek : Kali carb. 

Paleness : Kali carb. 



DIGEST TO PHTHISIS. 



401 



Paleness after any exertion: Hepar. 

with frequent flushes: Cdlc. carb. 

Hippocratic face : Carb. veg. 
Tongue white, pasty, thick: Calc. carb. 
Dryness of mouth : Natr. mur. 
Paleness of buccal cavity: Ferrum. 
Thrush in mouth in last stage: Arsen., 

Laches. 
Ulcers in mouth and throat: Nitr. ac 
Follicular catarrh of fauces: Natr. mur. 
Bad taste : Cdlc. carb. 
Belching tasting like rotten eggs: Kali 

carb. 
Vomiting of ingesta: Ferrum. 
Morning thirst: Nitr. ac. 
Hungry and faint about 10 a.m.: Kali 

carb., Sulphur. 
Morbid hunger even soon after a meal 

and yet loss of flesh : Iodium. 
After dinner nausea, faintishness : Kali 

carb. 
Loss of appetite : Cdlc. carb., Iodium. 
Pressure and bloatedness of stomach after 

eating: Stannum. 

and fulness in pit of stomach : Ferrum. 

Soreness of abdomen on pressure: Nux 

vom. 
Diarrhoea: Dulcam., Sanguin. 

, exhausting: Arsen. 

, painless: Ferrum. 

and night-sweats: Nitr. ac. 

worse early in morning : Sulphur. 

worse towards evening: Calc. carb. 

, or constipation : Nitr. ac., Phosphor. 

Constipation : Calc. carb. 
Stool offensive : Laches. 

and flatus very fetid : Phosphor. 

Fissures of anus : Nitr. ac. 



Fugitive pains anywhere : Merc. sol. 
Contraction of heel-cords : Kali carb. 



Trembling sensation through pelvic re- 
gion and all over : Kali carb. 
Loss of sexual desire: Cilc. carb. 
Nightly emissions : Cdlc. carb. 
Menstruation copious: Iodium. 

and too early : Calc. carb. 

watery : Ferrum. 

suppressed : Cdlc. carb. 

Leucorrhcea : Calc. carb. 
Emaciation of mammae : Iodium. 
26 



Coldness and dampness of feet : Calc. carb. 

and heaviness of hands and feet, or 

heat: Stannum. 
Cool skin : Carb. veg. 
Cold knees even in bed : Carb. veg. 
Chilliness, about noon : Kali carb. 

in open air : Hepar. 

constant with flushes of heat : Stannum. 

Chill in forenoon, followed by heat and 
sweat in afternoon : Baptis. 

evening, followed by heat and sweat 

during sleep till morning : Phosphor. 

and fever afterwards : Bryon. 

Dry heat in palms of hands : Hepar, 

Stannum. 
Heat and burning in back between shoul- 
ders: Phosphor. 

Skin dry and hot during sleep : Simbuc. 

Heat at night : Kali carb. 

Hot all the time, puts feet from under 
cover: Sulphur. 

After heat, gaping and stretching : Sanguin. 

Intermitting fever: Arsen., Baptis., 
Cinchona, Natr. mur. 

Hectic fever: Ferrum, Lycop. 

Fever worse in afternoon : Laches. 

Easily perspiring : Calc. carb., Hepar. 

Sweaty paleness : Kali carb. 

Sweats when dropping asleep: Cinchona. 

only while awake : Sambuc. 

Night-sweats: Lycop., Sanguin. 

and diarrhoea: Act. roc. 

profuse: Silic, Sulphur. 

offensive and colliquative: Nitr. ac. 

and morning-sweats profuse : Stannum. 

Morning-sweats: Iodium. 



Eruption of minute vesicles upon soles 
of feet with excessive itching : Kali carb. 

Pale, wax-like appearance of skin: Silic. 

Exhalation from body, secretions and ex- 
cretions of offensive odor: Psorin. 

Fatigue from any little exertion: Calc. 
carb. 

Great lassitude : Stannum. 



402 



AFFECTIONS OF THE PULMONARY PARENCHYMA. 



General weakness and languor: Baptis. 
Prostration : Arsen., Carb. veg. 
Emaciation : Calc carb., Iodium. 

Young persons growing too fast : Calc. 
carb., Phosph. ac. 

Gaunt and hollow-eyed persons : Calc. carb. 

Nervous, active subjects : Bellad. 

Persons who from little emotion or ex- 
ertion flush easily, get epistaxis, cough, 
dyspncea, spitting of blood, palpitation 
of heart; better from moving slowly 
about : Ferrum. 

After loss of blood, long-continued nurs- 
ing, seminal emissions : Cinchona. 



Scrofulous taint : 01. jecoris aselli. 
After suppressed itch : Psorin, Sulphur. 
Syphilitic or mercurial cachexia : JSIitr. ac. 
After pneumonia : Hepar, Lycop. 
Stone-cutters' consumption: Silk. 



Worse in general from warm weather, 

warm room : Crocus. 
Cannot bear covering : Lycop. 
Worse from being uncovered and in cold 

air: Hepar, Phosphor. 
on seashore: Arsen., Carb. veg., Natr. 

mur. 

from any change of weather: Dulcam. 

from 4 to 8 p.m. : Lycop. 



Acute Miliary Tuberculosis. 

As the miliary tubercle can no longer be considered a necessary accom- 
paniment of consumption, acute miliary tuberculosis must be regarded as 
distinct from phthisis, because in it the miliary tubercle forms the only, or at 
least, the most important lesion. "Acute miliary tuberculosis attacks with 
characteristic symptoms of a typhoid type both lungs, and frequently also 
other parenchymatous organs and membranes; the tubercle is the product of 
a very high degree of the tuberculous dyscrasia, and is deposited either all at 
once or at repeated rapidly recurring times with periodical exacerbations of 
the symptoms, and in the form of the most delicate granulations, which have 
either a transparent vesicular appearance, and are scarcely as large as oat 
grains, or are gray, crude, and of the size of millet seeds. The tubercles 
always appear in great numbers; they are discrete, uniformly distributed 
throughout the pulmonary parenchyma, and only in rare instances do they 
become aggregated and coalesce in particular places, but even then there is 
uniformity in their distribution. They all exist in the same stage, viz., that 
of crudity. At the same time the lung is hypersemic and oedematous, while 
its tissue has lost its compactness as a result of emphysema. The hyperemia 
may here and there have advanced to pneumonia and hepatization." (Roki- 
tansky.) Outside of the lungs the miliary tubercles are found also in the 
spleen, liver, kidneys, pia mater, serous membranes, and in the choroid. 

Its Symptoms are : Cough, which is never absent, but not characteristic, 
and expectoration may be wanting, or consist of simple, colorless, rather 
viscid mucus, sometimes mixed with streaks of blood. 

The respiration is in almost all cases greatly increased, amounting in 
grown persons to from fifty to sixty, and in children to eighty or ninety per 
minute; the pulse runs up to 120 in the morning, and during the latter part 






EMPHYSEMA PULMONUM. 403 

of the disease to from 130 to 150. The temperature is usually not very high, 
nor does it rise parallel with the increase of the pulse. Towards the end the 
temperature falls and the extremities become cool and the face cyanotic. 

Auscultation reveals a general accentuation of the vesicular murmur, 
whistling and sonorous ronchi from apex to base, and at a later period crack- 
ling rales, which become more and more abundant. 

The disease attacks persons who are already consumptive, or have suf- 
fered from serious morbid processes in other organs, as a sudden aggravation 
of their symptoms, or in cases of persons of apparent health as an acute 
primary affection, usually setting in with a chill and subsequent high fever ; 
assuming greatly the appearance of a typhoid fever, with mental dulness, 
vertigo, slight delirium, apathy, muscular prostration and sopor. The spleen, 
as a rule, is moderately enlarged. 

It is most frequently complicated with phthisis, and typhoid fever. In 
the latter case the disease develops itself either during the height of the fever, 
or follows immediately after its termination. The differential symptoms 
between the two are: typhoid fever has a regular type in the rising and 
falling of its temperature; shows roseola on the epigastrium and hypochon- 
dria; and exhibits at times diarrhoea, meteorism, and soreness in the ileo-csecal 
region about the end of the second week and haemorrhages from the bowels 
in the third week; while miliary tuberculosis is characterized by the absence 
of these signs and the presence of a disproportionate frequency of pulse and 
respiration relative to the grade of temperature. 

From acute bronchitis it distinguishes itself by the rapid loss of strength. 
Miliary tuberculosis may be inferred, also, in all cases in which a diffused 
friction murmur can be heard without any pleuritic symptoms. Its course is 
rapid and fatal. 

THERAPEUTIC HINTS.— At the commencement compare: Apis, 
Arsen., Bellad., Bryon., Calc. carb., Gelsem., Laches., Phosphor., Sulphur. 

At a later stage: Amm. carb., Arsen., Carb. veg., Laches., Opium, Tart, 
emet., Veratr. 



Emphysema Pulmonum. 

It is an enlargement of the air-cells, either from distention, or from a 
union of several in one, by destruction of their partition walls ; or it is a 
transmission of air into the interlobular, or subpleural cellular tissue. Ac- 
cordingly, we find on post-mortem examination the lungs swell out of the 
thoracic cavity like a cushion filled with downy feathers; and if rubbed be- 
tween the fingers we do not feel that peculiar crepitation of a healthy lung ; 
the air-cells are widened, sometimes to the size of peas {vesicular emphysema). 



404 



AFFECTIONS OF THE PULMONARY PARENCHYMA. 



In the second case, where it consists in an escape of air into the interlobular 
or subpleural cellular tissue, the pleura pulmonalis is raised into little blisters, 
which, by pressure with the fingers, can be shifted; in rare cases only is the 
pleura separated and filled by air to a large extent {interlobular emphysema). 

The Yesicular emphysema originates always in the neighborhood of 
such portions of the lungs, the air-cells of which have been destroyed by 
morbid processes, such as tuberculosis and interstitial pneumonia. The vacant 
space caused by this loss of substance has to be filled up by a dilatation of the 
neighboring alveoli; it is therefore of a vicarious nature, and would often 
amount to a much greater extent, were it not that the thoracic walls them- 
selves sink in, and thus obliterate to a certain degree the vacant space caused 
by loss of substance inside. This same widening of the alveoli takes place 
when the two pleural blades have grown together to a large extent in conse- 
quence of pleuritis, and especially is this the case in the anterior and lower 
edges of the lungs, because the adhesion does not permit the upper portions 
of the lungs to extend as fully, as is the case when the two pleural blades 
move freely upon each other; the inspiratory act then overfills the lower 
anterior portions of the lungs and dilates the air-cells. The same result is 
effected when, in consequence of catarrhal inflammation of the finer bronchial 
tubes their swollen state prevents the free ingress of air, or in pneumonia, 
where the sound portion of the lungs has to perform the office of the entire 
lung. But also forced expirations as during spasmus glottidis, spasmodic 
asthma, blowing wind-instruments, bearing-down efforts during parturition, 
etc., may cause dilation of the air-cells. 

The Interlobular emphysema originates in consequence of rupture 
of the alveoli. The air then escapes into the interlobular and subpleural 
connective tissue. It is mostly the consequence of violent coughing spells, 
bronchitis and croup. 

If we bring all this clearly before our minds, we can easily perceive the 
consequences which must follow from such conditions. For instance, that 
portion of the inhaled air which occupies the distended air-cells, is never fully 
replaced by the acts of respiration, the blood coursing here remains unoxy- 
genized. In the further progress of the disease still more of the air-cells 
perish as their partition- walls become destroyed, consequently still more of 
that surface is lost by which the oxygenization of the blood takes place, and, 
therefore, the insufficiency of respiration and the accumulation of carbon in 
the blood grow greater in the same ratio. This the patient shows by his 
dyspnoea, by his great hunger for air. He strains all the muscles to widen 
the thorax and to get breath, and, in consequence, the thorax becomes arched, 
barrel-shaped, permanently dilated, and the muscles of the neck voluminous. 

Another consequence, though later in appearing, is disturbed circulation. 
Hand-in-hand with the destruction of the air-cells goes the obliteration of the 



EMPHYSEMA PULMONUM. 



405 



capillaries. The blood from the right ventricle does not find room within 
the lungs. Stagnation follows, and, in consequence, hypertrophy of the right 
ventricle with all its usual consequences, viz. : undulation of the right jugular 
vein ; cyanosis of the face ; varicosed veins on the cheeks and alse nasi 
swelling of the liver; catarrh in stomach and bowels; swelling of the hsemor- 
rhoidal veins ; scanty urine, etc. 

Its Physical Signs, on inspection, are the arched, barrel-shaped, per- 
manently dilated thorax from its upper region down to the sixth rib. How- 
ever, this condition does not obtain in all cases. We find it only in those 
persons in whom the emphysema originated in forced expirations and closed 
glottis, at a time when the bony structure of the chest was yet yielding. In 
other persons, with a long, flat, so-called paralytic thorax, emphysema may 




Emphysema (After Bock.) 
a. Heart, b. Lung sound, c. Liver, d. Stomach. 



exist, to a large extent, without any such alteration of form. The hollow 
places above and below the clavicles bulge out during a fit of coughing, the 
neck appears short and thick, and the respiratory motion, notwithstanding 
the greatest exertion, is short, superficial, and, instead of being a successive 
motion of the single ribs, is a movement of the whole surface at once, a 
mask-motion. The intercostal spaces do not bulge out; on the contrary 
they often sink in during inspiration. 

Palpation, if emphysema exists in the left lung, discovers the point of 
the heart lower down and towards the pit of the stomach, on account of the 
lower position of the diaphragm. 

Percussion affords the best pathognostic sign of emphysema, inasmuch 
as we may with certainty ascertain by it whether the dull sounds of the 
heart and liver exist in their proper places or not. If we hear lung sound 
where we ought to hear the dull sound of the heart or liver, we may be sure 
that heart or liver are covered by the distended lung. Characteristic of 
emphysema, therefore, is an abnormal extension of the lung sound over heart 



406 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

and liver. Tympanitic this sound cannot be, because the air-cells are forcibly 
distended. 

Auscultation affords no very positive information. • In the presence of 
a catarrh, which is a frequent complication, we hear no vesicular breathing, 
but rattling and bubbling noises. The inspiratory murmur is weaker, and 
the expiratory sound is wanting, unless the emphysema be accompanied by 
bronchitis. 

An emphysema which is confined to a small place only is not diagnosti- 
cable, and the interlobular and subpleural form runs its course without any 
characteristic symptoms. 

The progress of this disease is always of a chronic nature, and its more 
acute attacks depend upon an increase of bronchial catarrhs, which, more or 
less, always accompany it. It usually ends in general dropsy, as a natural 
consequence of those obstructions in the circulation which have been detailed 
above. The patient may live to a good age. 

THERAPEUTIC HINTS. — Compare Spasmus Glottidis, Croup, 
Whooping-cough, Bronchial Catarrh, Consumption. 

Arsen., highest degree of dyspnoea, even to suffocation, with great 
anxiety and restlessness ; face cyanotic, and covered with cold perspiration ; 
consumptive symptoms, with pain through upper part of right lung. 

Bellad., disturbed circulation; dizziness, headache; palpitation of the 
heart ; fulness of the abdomen. 

Bromium, after pneumonia, asthma; pressure in the stomach; must 
sit up in bed at night. 

Camphora, asthma, worse after bodily exertion; cough from talking, 
inhaling of air, and a feeling of coldness, which commences in the pit of 
the stomach, and spreads from here over the chest and is exhaled as cold 
breath. 

Carb. veg., often after Arsen.; great dyspnoea; cough in violent 
spells, with great anxiety, with watery, profuse expectoration, and under 
great exertion. 

Chin, ars., regularly every forenoon, at nine o'clock, attacks of suffo- 
cating spells in tuberculosis; limbs icy cold; cold, clammy sweat all over; 
greatest anxiety and unquenchable thirst ; must sit up, bent forward, if pos- 
sible, at the open window. 

Chlorine, easy inhalation; exhalation impossible. 

Cuprum, asthmatic symptoms worse after walking against the wind. 

Digit., complications with heart disease; better in lying perfectly quiet 
in a horizontal position. 

Hepar, combined with bronchial catarrh, worse from slightest exposure ; 
coughs from midnight till morning; sleeps with head thrown back. 



HYPEREMIA AND CEDEMA OF THE LUNGS. 407 

Ipec. , dry, spasmodic cough of old people ; collection of mucus ; difficult 
to expectorate, and giving only temporary relief; nausea. 

Kali carb., dyspnoea worse at night; strong beat of the heart; loss 
of appetite ; vomiting ; dry skin. 

Laches., all covering around the neck and even chest unbearable; 
worse after sleeping ; cough torturing until some little tough phlegm is raised ; 
stool smelling badly; follows well after Arsen. and Carb. veg. 

Lobel. infl., inclination to sigh and take a deep breath. 

Naphthal., recommended by V. Grauvogl for emphysema in con- 
sequence of forced expirations in buglers, etc., and after bronchial asthma 
without catarrh. 

Opium, nightly asthma, with whizzing and rattling during expiration, 
which is long and attended with retraction of the epigastric region ; inhalation 
short, without noise. 

Sarsap., asthma worse after eating or motion. 

Senega, feeling as though the thorax were too narrow, with constant 
inclination to widen it by deep inhalation ; burning in the chest. 

Sepia and Sulphur, both worse after sleep; getting suddenly roused 
by asthma from a deep sleep. Difference between both, see Gross' Compara- 
tive Materia Mediea. 

Tereb., asthma worse from motion. 

Besides these compare Aspar., Bryon., Lobel., Natr. mur., Nux vom., 
Pulsat., Tart, emet., Veratr., and all that is mentioned under Asthma Spas- 
modicum. 

Hyperemia and (Edema of the Lungs. 

This affection consists of a serous exudation into the air-cells and finest 
bronchial tubes of the lungs, and is either acute or chronic. Sometimes it is 
confined to a small portion, and sometimes it extends over both lungs. When 
acute, the lung appears strongly injected. with blood, tense, leaving no dent 
on pressure; when cut in two there oozes out of it a bloody serum, which 
contains a great deal of albumen. All the air is driven out by the serum, 
and the lung tissue is easily torn. On account of this similarity with pneu- 
monia, acute oedema is also called Serous pneumonia. 

In chronic cedema the lung appears pale and tough ; upon pressure a dent 
remains; the serum is pale yellowish, thin, and contains little albumen; it 
fills the air-cells and finest bronchial tubes. The lung is heavy and puffed 
similar to any dropsical swelling, and it is deprived of air as far as the infil- 
tration of serum extends. 

The acute form is generally the product of hyperemia or active con- 
gestion — a fluxion of blood to the lungs, which may be caused 1, by an 



408 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

increased action of the heart, during the period of puberty, or in consequence 
of passions, or bodily exertions, or the use of stimulants; or, 2, by direct 
irritations from inhaling cold air, or hot and irritating substances ; or, 3, by 
obstruction of the free circulation in some portions of the lungs by pleuritic 
effusions, pneumonic or tubercular infiltrations — producing a collateral 
fluxion. 

The chronic form is generally the product of stagnation in consequence 
of heart diseases, especially of stenosis and insufficiency of the mitral valves ; 
also of a weakened action of the heart due to asthenic fever in the course of 
acute exanthemata, typhoid or puerperal fevers, etc., to fatty degeneration 
of the heart, or myocarditis. 

Its most prominent Symptoms are : 

1. Dyspnoea, which oftentimes reaches such a height that the patient, in 
the greatest distress, tries all possible positions to get breath — now sitting 
erecl, now bending forward and supporting the head with the arms, etc. 

2. Spasmodic cough with a great deal of frothy and serous, sometimes 
bloody expectoration. 

3. Cyanotic symptoms, in consequence of the obstruction to the circula- 
tion; and finally, if the breathing is still more impeded, and the blood 
becomes overcharged with carbon, 

4. The patient sinks, his cheeks grow livid, and he dies of asphyxia — 
Apoplexia pulmonum vascularis. 

Physical Signs. — Inspection and palpation show, notwithstanding the 
greatest efforts of the patient to draw in air, a decrease in the respiratory 
motion of the thoracic walls. 

# Auscultation reveals all sorts of rattling and bubbling noises, at times a 
weak crepitant sound. 

Percussion, however, gives no results, unless the lung has become de- 
prived of air to a large extent, when, of course, the sound is dull, or tympa- 
nitic, when the lung tissue becomes compressed, so that it loses its natural 
elasticity. 

THERAPEUTIC HINTS— In acute oedema, compare : Aeon., Nux 
vom., Scilla, Sulphur, Tart. emet. 

Amm. carb., somnolence; poisoning of the blood by carbon. 

Arsen., great anxiety; restlessness; always worse towards midnight or 
soon after. 

Carb. veg., collapsed state. 

Cinchona, after debilitating losses. 

Ipec, spasmodic cough; sickness of stomach; fine rattling noises in 
the chest. 

Kali hydr., sputa like soap-suds. 






GAXGRJEXA PULMONUM. 409 

Laches., suffocating fits; worse after sleep; dark, almost black urine; 
offensive discharge from the bowels. 

Phosphor., if worse before midnight, with tightness in the chest. 

Tart, emet., large bubbling rattling; chest appears full of phlegm 
without capability of relieving itself. 

Besides may be indicated: Aurum, Bellad., Cactus, Cimicif., Gelsem., 
Glonoin., Sanguin., Spongia, Ver. vir. 

Compare Asthma, Pneumonia, Heart Diseases. 

Gangrsena Pulmonum 

Is a process of mortification and putrefaction of the lung tissue, owing to the 
admission of air, as it occurs in all lifeless animal tissues when under the in- 
fluence of air, moisture and a certain temperature. It is either circumscribed 
— that is, confined to one or several foci of various sizes — or diffused, with- 
out accurate lines of demarcation ; the first form may degenerate into the 
latter. 

Its Causes are: interruption, or weakness of the blood-currents, by 
pneumonic infiltrations or emboli; putrid suppuration in the neighborhood 
of the air-passages by perforation into a bronchus ; decomposing/ore^?? bodies, 
which have found their way into the lung through the trachea; putrid con- 
tents collected in dilated bronchial tubes; injuries caused by stabs or gunshot 
wounds. 

Its most charactertstic symptom is the sputum, which consists of a 
greenish-gray or brownish-colored fluid, with an exceedingly offensive smell. 
The breath, too, or forced expiration, exhibits the same disgusting smell. 
There is almost always a racking cough attending the disease, and dangerous 
haemorrhages may ensue from the gangrenous erosion of blood-vessels. The 
temperature is usually very high. The diffused form runs a very rapid course 
with all signs of an asthenic fever, delirium, stupor, hiccough, colliquative 
diarrhoea and collapse. Physical examination yields at first generally a tym- 
panitic sound on percussion, which at a later period grows dull. Small 
gangrenous masses, or larger ones, which do not communicate with a bronchus, 
or which, from some other cause, cannot discharge their contents, are out of 
reach of diagnosis. The circumscribed gangrene may discharge and heal ; 
the diffused form usually is fatal. 

THEKAPELTIC HINTS.— Compare : Arsen., Carb. ac, Carb, veg., 
Kreos., Silic. 



410 AFFECTIONS OF THE PULMONARY PARENCHYMA. 



Haemorrhages of the Lungs, Haemoptoe, Haemoptysis. 

Haemoptoe — haemorrhage of the respiratory organs, Haemoptysis — 

expectoration of blood, consists either of mere exudation of blood-corpuscles 
through the uninjured walls of the capillaries — Diapedesis, or of a pouring 
out of blood through ruptured vessels. 

Haemorrhages occur most frequently in the smaller and terminal bronchi 
— Bronchial haemorrhages; parenchymatous bleeding is less frequent, and 
is either confined and sharply outlined, without destruction of the parenchyma 
— Haemorrhagic infarction, — or, is diffuse, abundant and associated with 
destruction of the lung tissue, and causing the formation of cavities — Pul- 
monary apoplexy. 

Bronchial haemorrhages may be caused in the main by all such 
morbid conditions as will produce either active or passive congestion of the 
bronchial mucous membrane, for instance: bronchitis, whooping-cough, pneu- 
monia, tuberculous infiltrations, acute exanthemata, inhalation of irritating 
gases, excessive heat or cold, severe strains and bodily exertions, suppression 
of menstrual or hemorrhoidal flows, disorders in the circulation resulting from 
heart disease, and peculiar altered conditions of the blood, which impair the 
nutrition of the vascular parietes, and manifest themselves in scorbutus, 
haemophilia, scarlatina, typhus, variola, etc., also in bleedings from other 
portions of the body. 

Haemorrhagic infarctions are most frequently due to organic heart 
diseases, especially of the right heart, to pulmonary emphysema, senile or 
early acquired atrophy of the lungs, and thrombosis of the peripheric veins 
of the body. 

Pulmonary apoplexy arises from the rupture of large, generally 
arterial vessels, most frequently in consequence of injuries, gun-shot and 
penetrating wounds, contusions and concussions of the thorax; rarer from 
endarteritis and aneurismal changes of the walls of the pulmonary arteries, 
or their erosion by cancer, abscesses and pulmonary gangrene. 

In order to decide whether the blood comes from the nose, larynx or 
trachea, a close inspection of these parts will best decide. If in doubt 
whether the haemorrhage comes from the stomach, we will have to inquire 
about the conditions of the digestive organs and those of the portal circula- 
tion. 

Small haemorrhages issue usually from capillaries, profuse ones from a 
large vessel; Haemorrhagic infarction is, as a rule, associated with a 
high degree of dyspnoea, the physical signs of a circumscribed pulmonary 
solidification and heart disease. Pulmonary apoplexy kills, so to say, on 
the spot. 



HEMORRHAGES OF THE LUNGS, HEMOPTOE, HEMOPTYSIS. 411 

THERAPEUTIC HINTS. -Aeon., in many cases; but best indi- 
cated by restlessness, agitation, fright, expression of anxiety in the face, 
palpitation of the heart, congestion towards the chest and head, fear of 
death ; after wine. The blood comes hot and fresh with every little cough. 

Arnica, after mechanical injury; from slight bodily exertion; in tuber- 
culous individuals ; constant tickling cough, starting either from the larynx 
or from under the sternum. 

Arsen., after venesection, or loss of blood otherwise; great weakness 
and fainting; restlessness, must walk about; burning in chest and stomach; 
suppressed menstruation. 

Bellad., cough from constant tickling in the larynx; congestion to 
head and chest; stitching pain in chest, worse from motion; suppressed 
menstruation. 

Cact. grand., with heart disease. 

Carb. veg., pale face; cold skin; slow pulse, intermitting, scarcely 
perceptible; mostly attended with violent cough in paroxysms and hoarse- 
ness, worse towards evening ; sometimes burning in chest. 

China, after great loss of blood or vital fluids; during nursing, etc.; 
with all the signs of weakness which arise from want of blood ; continual 
pain in chest and stomach, worse from touch. 

Collin., blood dark, tough, coagulated, enveloped in viscid phlegm; 
previous discharge of blood per anum ; subsequent costiveness. 

Conium, especially after masturbation. 

Croc, sat., blood dark and stringy. 

Digit., haemoptysis before menstruation with pain in the chest, back 
and thighs; from obstruction of the pulmonary circulation in consequence 
of heart disease and tuberculosis. Engorged veins about the head, pale, livid 
complexion, coldness of skin, with cold sweats, irregular pulse and palpita- 
tion of the heart. 

Eriger., dark coagula^ passive haemorrhage. 

Ferrum, always better from walking slowly about, notwithstanding 
weakness obliges the patient to lie down ; quick motion and talking bring on 
cough; there is pain between the shoulders; the face has a yellowish tint; 
sleep is poor at night, and there is frequent palpitation of the heart. 

Hamam., blood is venous; comes into the mouth without any effort, 
seemingly, like a warm current from out of the chest ; mind calm ; sometimes 
taste of sulphur in the mouth. 

Iodium, annoying tickling cough in phthisical persons; oppression 
and palpitation ; trembling and coldness of the extremities. 

Ipec, blood frothy and bright colored; gasping for breath, pulse small 
and frequent; face livid and anxious. 

Led. pal., where there is stagnation in the liver and portal veins; 



412 AFFECTIONS OF THE PULMONARY PARENCHYMA. 

congestion towards the head and chest; hardness of hearing; tickling in the 
larynx; spitting of bright red blood. Haemoptysis, alternating with rheuma- 
tism. 

Millef., in tuberculosis. It bubbles up in the chest, as if warm blood 
were ascending, which is raised without cough. After injuries. 

Myrt. com., in phthisical persons; sharp pains through the upper 
part of the left lung, from front to shoulder-blade. 

Nitr. ac, according to Goullon, the best remedy. 

Nux vom., especially after high living, suppressed hemorrhoidal dis- 
charges, and after fits of passion, etc. 

Opium, blood is thick and frothy, mixed with phlegm; absence of all 
pain ; slumber, with starting. 

Phosphor., vicarious spitting of blood for the menses; tubercular 
diathesis, dry, tight cough, worse from evening until midnight; bronchitis. 

Phosph. ac, phthisis; typhoid fever, w T ith diarrhoea and great rum- 
bling in the bowels; fast growing youths. 

Pulsat., dark, coagulated blood; chilliness; loose stools; suppressed 
menstruation ; crying spells. 

Rhus tox., after straining, lifting, blowing of instruments, or worri- 
ment and mental excitement immediately renewed ; blood bright. 

Senec, in suppressed menstruation; after venesection. 

Sulph. ac, in climacteric period; also habitual haemoptysis excited 
from least fright, vexation, talking, running, in persons who flush easily, 
have palpitation, perspire easily, are easily excited. Also in scorbutic, alco- 
holic affections, adynamic fevers, tuberculosis. 

Stannum, in phthisical patients, when at the same time there exists 
copious expectoration. 

Tart, emet., when, after the attack, there remains for a long time a 
bloody slimy expectoration. 

In suppressed menses, compare Arsen., Bellad., Millef., Phosphor., Senec, 
Sulphur. 

After the suppression of habitually bleeding haemorrhoids, compare Aeon., 
Nux vom., Sulphur. 

After wine, Aeon. 

After whiskey, Mercur., Pulsat. 

After coffee, Nux vom. 



PLEURITIS PLEURISY, INFLAMMATION OF THE PLEURA. 413 

c. AFFECTIONS OF THE PLEURA. 

Pleuritis, Pleurisy, Inflammation of the Pleura. 

When we examine, post mortem, a ease of pleurisy, we observe on the 
pleural surfaces, pinkish dots or streaks here and there, consisting of enlarged 
capillaries, also irregular, dark red, ecchymosed patches of extravasation. 
The surface of the pleura, instead of being smooth and shining, appears dull 
and swollen, rough and villous from fine granulations and new cells upon it. 
This is the most frequently occurring form of pleurisy without exudation, 
and therefore called pleuritis sicca, dry pleurisy. 

In other cases, we observe, in addition to the above-stated features, 
which are, in fact, the ground-type of all forms of pleurisy, a scanty, fibrinous 
exudation, covering, like paste, or, (if in greater abundance) like a soft, croup- 
ous membrane, the inflamed pleural layers. During the progress of recovery 
it gradually becomes dissolved by a fatty metamorphosis and is absorbed ; 
but those fine granulations and new cells which lie underneath, and which 
are inherent parts of the inflamed pleura, frequently give rise to adhesions 
of the pleural surfaces. This fibrinous exudative pleurisy accompanies almost 
always croupous pneumonia. 

In still other cases we observe an abundant serous fibrinous exudation, 
varying in amount from a few ounces to ten or more pints. It consists of a 
greenish-yellow serum, of coagulated fibrinous masses and pus corpuscles, 
which partly float in the serum and partly are deposited upon the pleural 
surfaces, where they adhere like croupous membranes. At times the pus 
corpuscles are in such abundance, that the exudation assumes a purulent 
character; and when from rupture of the finer blood-vessels, or simply by 
transudation in consequence of a hemorrhagic diathesis, large masses of 
blood-corpuscles mix with the exudation, we have a hcemorrhagic effusion. 
In consequence of, and according to, the mass of the pleuritic effusion, the 
lung of the affected side becomes compressed at times to the fourth, sixth, or 
even to the eighth part of its normal volume; its arched costal portion is 
flattened down, and its substance appears pale reddish, or bluish-gray, or 
lead-colored, and becomes tough like leather, bloodless and airless. Heart 
or liver become displaced accordingly, as the effusion is either on the left or 
right side. The sound lung always shows more or less congestion, and in 
fatal cases a collateral oedema of high degree. 

In case of recovery the exudation is gradually absorbed, frequently 
leaving yellow cheesy masses behind, which are residues of unabsorbed pus- 
globules and fibrinous substances. 

In the same degree in which absorption takes place, the lung regains its 
normal volume and condition, provided the air-cells be not glued together, or 



414 AFFECTIONS OF THE PLEURA. 

closed by fibrinous deposits. In these conditions air cannot enter, and the 
lung, or such part of the lung, cannot regain its normal expansion. This 
would cause a vacuum in the thorax, were it not for the pressure of the 
external air, which at once flattens down the corresponding portion of the 
thoracic walls, or pushes heart or liver higher up in the thoracic cavity. 

The purulent exudation, which is so rich in pus-globules that it forms an 
opaque, yellow, thickish fluid, is called empyema or pyothorax. Even in 
such cases absorption is possible. Should, however, the pleural substance in 
consequence of the suppurating process be softened and perforated, the puru- 
lent matter would then escape either through the thoracic wall, in case the 
pleura costalis were destroyed, or through the bronchial tubes, if the pleura 
pulmonum were perforated. 

These four different forms of pleurisy must of course manifest themselves 
by different symptoms. 

The first form Pleuritis sicca, when, in consequence of inflammation, 
new cells form upon the pleural surfaces, but without exudation, seems to take 
place frequently without any particular signs. This statement is founded 
upon the existence of many adhesions, found in post-mortem examinations, 
in persons who had never complained of symptoms that could possibly have 
been taken as indications of pleurisy. 

Tho second form, with Scanty fibrinous exudation, is generally 
coupled with pneumonia or tuberculosis. It is characterized by a sharp 
stitching pain, which hinders deep inspiration, coughing, sneezing and motion, 
and for this reason the patient can breathe only superficially. If not com- 
plicated with pneumonia or tuberculosis, there is scarcely any cough attend- 
ing it. 

On inspection we observe, in consequence of the pain which is caused by 
breathing and moving, that the patient bends his body towards the affected 
side, in order to bring the ribs of that side nearer together to prevent their 
respiratory motion, in consequence of which the spine itself becomes curved, 
its convexity being directed towards the sound side. 

Palpation merely confirms the superficial breathing, and may yield the 
perception of a grating feel; more, however, towards the end than at the 
commencement of the disease, after the exudation has been absorbed, when, 
therefore, the surfaces are dryer and the breathing deeper again, so that the 
rough surfaces glide more forcibly one upon the other. 

For this same reason, auscultation reveals the friction sound more de- 
cidedly towards the end of the disease. 

The third form, with Abundant serous-fibrinous exudation, usually 
commences with a strong chill, followed by high fever. The chill is frequently 
repeated, and the whole affection may look very much like a tertian inter- 
mittent fever. It is also characterized, like the second form, by violent stitch- 



PLEURITlS, PLEURISY, INFLAMMATION OF THE PLEURA. 415 

ing pains in the sides of the chest, which, however, often subside, or at least 
diminish, before the inflammation and exudation have reached their full 
height. The subsidence of pain is therefore, in this form, not always a sign 
of conquered disease. 

Generally it is accompanied by dyspnoea as long as the fever lasts, and in 
such cases, and where an extensive exudation compresses the lung, and causes 
a hyperseniic state and catarrh in the adjoining portions of the lung, there is 
also cough. Otherwise the cough may be absent altogether. 

The disease generally reaches its height in about six or eight days, and 
commences its gradual decline from that time. Fever, pain and cough cease, 
and absorption of the pleuritic exudation takes place, diminishing at first 
much more rapidly than towards the last, so that sometimes, even after weeks, 
some fluid can still be detected. 

In some cases this form comes on quite stealthily, without either promi- 
nent fever, pain or cough. The patient feels only a gradual loss of strength, 
some difficulty of breathing; he grows pale, and loses flesh, and thinks that 
the source of all his troubles lies in his abdomen, especially when, by exuda- 
tion on the right side, the liver has become dislocated downwards. Even the 
physician may be astonished when he, by closer examination, finds the whole 
pleural sac filled with fluid, amounting to from ten to fifteen pints. Such an 
enormous quantity, of course, can be absorbed at best only very slowly, being 
alternately augmented and decreased in the meantime. It terminates finally, 
in a great number of cases, in tuberculosis. 




Excdattox ox Right Side. (After Bock.) 

a. Exudate. 

b. Heart. 

c. Compressed lung with tympanitic souud. 

d. Lung sound. 

e. Displaced liver. 




Exud\tiox ox Left Side. (After Bock.) 

a. Exudate. 

b. Displaced heart. 

c. Compressed luug with tympanitic sound 
d Right lung with normal souud. 

e. Liver. 



Inspection discovers an enlargement of the thorax in breadth and depth 



416 AFFECTIONS OF THE PLEURA. 

on the diseased side, if the exudation is sufficiently large. The intercostal 
spaces are wider, and are on a level with the ribs, or even bulging out be- 
tween them. The respiratory motion is much less, or ceases altogether on 
the diseased side. 

Palpation reveals the absence of the vocal fremitus, which is the neces- 
sary consequence of the intervening fluid between the thoracic walls and the 
lung; it reveals dislocation of the heart or of the liver, and also sometimes the 
friction of the roughened pleural surfaces above the exudation. 

Percussion yields a somewhat duller sound, in case the exudation be 
moderate, so as not to compress the lung tissue to such a degree as to drive 
all air out of it; it yields a tympanitic sound, if the pressure upon the lung 
be just sufficient to deprive it of its natural tension and elasticity; it yields 
a dull, fleshy sound, if the secretion augments to such a degree as to deprive 
the lung of all the air ; above this dull sound we hear again the tympanitic 
sound, for here the lung, although compressed, is not entirely without air. 
Variation in position does not change the result of percussion, because the 
exudation is usually enclosed and bordered by adhesions. 

Auscultation reveals an absence of the respiratory murmur over the whole 
part that is covered by exudation. In other cases, however, we kear a loud 
bronchial breathing all over the thorax, especially in case of dyspnoea ; no 
matter how much fluid intervenes between the thoracic walls and the lungs, 
or how much the lungs may be compressed. The ausculatory signs are 
therefore not very characteristic. 

The fourth form, Empyema or Pyothorax, differs from the latter only 
by the abundance of its pus-globules, and is frequently found in consequence 
of infectious diseases and a general pysemic condition. Its physical signs 
are all the same, as above stated. 

When empyema is going to discharge through the thoracic walls, we 
observe, in the region of the fourth or fifth rib, an cedematous swelling, 
which soon changes into a hard, tense swelling, protruding from between 
the ribs; by and by it becomes fluctuating, and lastly it bursts and discharges 
an immense quantity of pus. This opening sometimes remains for years, 
forming a thoracic fistula, and discharges every now and then larger or 
smaller quantities of pus. 

When empyema is going to discharge through the bronchial tubes there 
may appear, at first, symptoms of pneumonia, or the bursting takes place 
suddenly, when, with violent fits of coughing, the patient throws up large 
quantities of pus. Even here recovery is possible, though it may happen 
that the patient suffocates, or sinks under the influence of pysemic poisoning 
of the blood. The empyema may also discharge downwards through the 
diaphragm into the' abdominal cavity, where it occasions a violent peritonitis. 






PLEURITIS, PLEURISY. 417 

When the course of pleuritis is very acute, the morning and evening 
temperatures rise to above 104° F., and the pulse to 120 and higher; there 
is frequently great disturbance of the sensorium, often violent delirium, 
great dryness of the tongue, excessive thirst and total loss of appetite; the 
anterior extremity of the spleen, even in the early days, can be distinctly 
felt, and diarrhoea may set in at this time, thus simulating a case of typhoid, 
though the deeply cyanosed complexion, the constant abnornal elevation of 
temperature and pulse, and the physical examination will soon correct an 
error of this kind. 

When in the first week of illness an unusual pallor presents itself, accom- 
panied with the rapid loss of strength, high fever, and a considerable degree 
of pain in the affected side, we may assume that a hemorrhagic exudation 
has taken place, in consequence of a tubercular pleuritis, in young persons ; 
in old people, the same symptoms hint to a tendency of the exudation to 
become purulent. 

When the inflammation attacks the diaphragmatic portion of the 
pleura — known by the ancient physicians under the name of paraphrenias, 
then the pain is usually in the hypochondriac region, about the cartilages of 
the false ribs, at the level of the diaphragm ; the respirations are short and 
quick, the inspiratory expansion is confined to the upper ribs, the body is 
inclined forwards, the countenance is much altered, with twitchings about 
the lips, and occasionally risus sardonicus ; there is also, at times, hiccough, 
nausea, and even actual vomiting. Still, these symptoms are not constant; 
there are cases of diaphragmatic pleurisy without the one or the other of 
these signs, or they appear in consequence of inflammation of one or more 
of the organs lying beneath the diaphragm. 

Pleurisy may become complicated with many acute and chronic diseases, 
such as: pericarditis, tuberculosis (when it usually appears simultaneously 
on both sides), pneumonia, bronchial catarrh, inflammation of the mediasti- 
num and of the peritoneum (in purulent pleuritis), caries of the ribs and 
spine (also in its purulent form), scarlet fever, measles, small-pox, articular 
rheumatism. 

Its Sequelae are: adhesions of the two pleural layers, inveterate bron- 
chial catarrhs, caseous pneumonia, bronchiectasis, etc. 

The Differential Diagnosis between Pleurisy and Croupous 
pneumonia is : 



Pleurisy. 
Repeated chills. 
Catarrhal sputa. 
Stitching pain. 



27 



Pneumonia. 

One chill. 

Kust-colored sputa. 

No pain or dull when the bronchial tubes, 
and stitch-like when the pleura is in- 
volved. 



418 AFFECTIONS OF THE PLEURA. 

Pneumonia. 



Pleurisy. 
Enlargement of the thorax. 
Absence of vocal fremitus. 
Dislocation of heart, liver, or spleen. 
Friction sound. 



None. 

Increased vocal fremitus. 

None. 

Crepitant sound. 



Its Prognosis varies greatly according to its character. As unfavorable 
signs Fraentzel considers the following: "1. A double-sided pleuritis, as it 
almost always indicates tuberculous disease of the pleura. 2. Continued 
high fever. 3. Rapid increase of the effusion, accompanied with high fever 
and with great displacement of adjacent organs, unless, after a course of from 
four to six weeks, signs of commencing absorption are observed. 4. Symp- 
toms of impending suffocation. 5. Discharge of the pus either into the 
bronchi, with simultaneous production of pyo-pneumothorax, or externally 
through one of the intercostal spaces. 6. The rapid increase of an effusion 
which has for a long time remained stationary, because in that case the 
pleuritis, as a rule, has assumed a tuberculous and hseinorrhagic character. 
7. A rapid return or increase of the effusion after spontaneous, or a single 
or repeated artificial discharge of the same, especially where the quality of 
the discharged fluid degenerates and becomes purulent, bad-smelling, ichorous, 
chocolate-like, etc." 

THERAPEUTIC HINTS— Aeon., chill; fever; great thirst; quick 
pulse; dry skin; anxious restlessness; agonizing tossing about; stitching 
pain in chest ; inability to lie on the right side ; dry, hacking cough. Trau- 
matic form with torn pleurae and consequent external emphysema. 

Arnica, after mechanical injuries; bruised feeling in chest; expectora- 
tion of bloody foam. Is followed well by Sulph. ac, in the traumatic form. 
Nervous persons ; torpidity even to sepsis ; dry, cold extremities ; head hot, 
remaining body cool ; constant change of position on account of a feeling as 
though the bed were too hard. 

Arsen., profuse serous effusion; great dyspnoea and little pain; weak 
and cachectic persons ; drunkards ; intermittent paroxysms ; pyothorax. 

Bellad., when the inflammation ascends from the diaphragm; plethoric, 
lymphatic persons, tuberculous women with affections of the cerebral mem- 
brane; in exanthematic, typhoid, puerperal phlogosis; after scarlet fever. 

Bryon., stitching pain in chest, worse from slightest motion; better 
when lying on the affected side, not always, however; tongue white; thirst 
great. 

Calc. carb. has rapidly diminished the pleuritic exudation. 

Canthar., profuse serous exudation; frequent cough; dyspnoea; palpi- 



419 

tation ; profuse sweats ; great weakness ; tendency to syncope ; scanty urine. 
(E. Faivre.) 

Carb. veg., prostration; sunken features ; sallow complexion ; emacia- 
tion ; hectic fever ; purulent or ichorous degeneration. 

Colchic, arthritic form; sour-smelling sweat not alleviating; scanty, 
turbid, red urine with acid reaction and containing albumen. 

Hepar, croupous exudation with a yellow or yellowish-brown tint in 
face, in scrofulous and lymphatic persons; hectic fever with intermittent 
paroxysms; empyema. . 

Kali carb., when the violent stitching pain does not yield to Bryon., 
especially on the left side with violent palpitation of the heart ; the cough is 
dry and worse towards three o'clock a.m. Pain in epigastrium ; throbbing 
and stitching pain in back up to the nape of the neck. 

Kali hydr., in pleuritic exudation. (Grubenmann.) 

Lauroc, for drunkards and melancholic persons at the beginning with 
continual suffocating cough ; the pain in the pleura is severe and localized ; 
pulse soft though quick. 

Mercur., in syphilitic or rheumatic patients when the pain persists 
after the fever, with copious, not alleviating sweats ; frequent chills (feels 
chilly whenever moving the feet to a cooler place in bed) ; considerable 
thirst ; gastric and intestinal catarrh with icterus. Stitching pain through 
to the back when coughing or sneezing; right side. 

Nitr. ac, for old people, when the pain leaves and the pulse increases ; 
great weakness and diarrhoea. 

Phosphor., in complications with bronchitis; tightness across the 
chest; dry, tight cough, which is worse from evening until midnight. Later 
stages; purulent infiltration; hypertrophy of the right heart; Bright's disease. 

Rhus tox., after exposure to wet, or from straining, lifting, wrestling, 
etc. ; tip of tongue red ; fever-blisters around the mouth and nose ; very rest- 
less notwithstanding the pain. 

Senega, after the inflammation has passed; copious mucous secretion 
with difficult expectoration; tightness and burning in the chest. 

Sepia, recommended by Kunkel on the ground of the symptoms 1005 
to 1190 in Hahnemann's Chronic Diseases. 

Squilla, stitching pain in left side; short, rattling cough, disturbing 
sleep; inability to lie on the left side; grating of teeth; twitching of the 
lips which are covered with thick yellow crusts, more on leftside; cheeks 
bright red ; perspiring profusely especially on forehead ; red tip of tongue, 
yellowish covering on the back part. 

Sulphur, when the pain is in the left side, lower region, going through 
to the shoulder-blade and of a more steady nature; lips bright red; in con- 



420 AFFECTIONS OF THE PLEURA. 

nection with acute articular rheumatism or gout ; fibrinous pleuro-pneumonia. 
Follows well after Bryon. or Rhus tox. 

Tart, emet., in pleuro-pneumonia at the commencement, according to 
Kafka, specific. Dyspnoea, must sit up ; palpitation ; tingling and pinching 
in the pit of the stomach. When the healthy side is attacked by oedema. 

In neglected or badly treated cases, where the exudation is abundant, or 
in cases developed in cachectic constitutions, with a pysemic tendency, we 
shall have to compare: Arsen., Calc. carb., Camphora, Carb. veg., China, 
Ferrum, Hepar, Iodium, Kali hydr., Kreos., Laches., Lycop., Sepia, Senega, 
Silic, and others. 

Paracentesis has seldom proved beneficial in acute cases; in chronic 
cases it may in rare instances be the indicatio vitalis, when the rapidly in- 
creasing purulent exudation threatens suffocation. The emptying ought to 
be effected by aspiration, in order to prevent the entrance of air into the 
pleural cavity. If, after several tappings, the purulent exudation persistently 
and profusely returns, the old school of late years opens the pleural cavity 
and washes it out with w T arm distilled water until every trace of purulent 
matter has disappeared, when injections of iodine, or carbolic acid, or other 
similar substances are made, until by granulation the pleural folds have healed 
together. " Radical cure," as it is termed. Compare Frsentzel on pleuritis, 
in Ziemssen's Cyclopaedia, Vol. IV. 

Pneumothorax. 

This consists of a collection of air or gas within the pleural sac. As air 
alone, however, is rarely found in this locality, but mostly in combination 
with pus, blood, or serum, it is called, according to the nature of the coexisting 
fluid, either pyo-, or hcemato-, or hydro-pneumothorax ; when an exudation of 
pus or blood follows a collection of gas in the pleural cavity, it is termed 
pneumo-pyo-, or pneumo-hcematothorax. 

Pneumothorax, whether it be in combination with fluids or not, is always 
characterized by an enormous extension of the thoracic wall of the affected 
side, the intercostal spaces of which bulge out. When on the left side, it 
pushes the heart towards the right ; if on the right, it presses the liver down 
into the abdominal cavity. The lung itself is compressed to a small volume, 
containing little or no air, and lying close to the spine. 

The gas, which is collected within the pleural sac, consists mostly of 
carbonic acid gas and nitrogen, with very little oxygen; and in cases where 
decomposition has taken place, of sulphuretted hydrogen. These gaseous 
substances may be diffused, and fill the whole pleural cavity of one side, or 
they may, in rare cases, be limited therein to a certain portion, in consequence 
of previous pleuritic adhesions. 



PNEUMOTHORAX. 



421 



The entrance of air into this cavity almost always causes, in a short time, 
a pleuritis with either sero-fibrinous or purulent exudation ; and is occasioned 
either by a perforation of the pleura pulmonum, in consequence of lung dis- 
eases, especially pulmonary consumption and empyema, in which case the 
air enters from the air-cells* of the lungs; or by a perforation of the thoracic 
wall, by traumatic causes, when the air enters from without; that gaseous 
substances may be formed by means of decomposition in a pyothorax has of late 
been greatly doubted. 




Pneumothorax on Riuht Side. (After Bock.) 

a. Heart displaced. 

b. Liver displaced. 

c. Stomach. 

d. Distention by gas. 

e. Compressed lung and tuberculous deposit. 




Pneumothorax on Left Side. (After Bock.) 

a. Heart displaced. 

b. Right lung. 

c. Compressed lung and tuberculous deposit. 

d. Distention by gas. 

e. Stomach. 
/. Liver. 

g. Spleen displaced. 



In cases in which the air fills the pleural sac through the lungs, it takes 
place almost always quite suddenly, aud the patient has a feeling as though 
something had burst in the chest, which in fact is the case. At the same 
time he experiences great difficulty in breathing; he is obliged to sit erect, 
and can lie only on the diseased side, and for an obvious reason — to keep the 
sound lung free from any pressure. The worst cases are those which exist in 
consequence of tuberculosis, gangrene, or carcinomatous degenerations of the 
lungs. Those in consequence of emphysema or external perforations are not 
so violent. 

Inspection. Enormous enlargement of the diseased side of the thorax ; 
its intercostal spaces bulge out; perfect want of respiratory motion. 

Palpation, Total absence of vocal fremitus; liver or spleen displaced 
downwards; heart towards the middle or the right side of the thorax. 

Percussion. Tympanitic sound, unless greatly distended, when it be- 
comes non-tympanitic, or full lung sound. Dull sound in the upper posterior 
region, where the compressed lung lies, and in the lower regions of the tho- 



422 AFFECTIONS OF THE PLEURA. 

rax, when effusion exists, changiDg locality with the patient's change of 
position. 

Auscultation. Absence of respiratory murmur by full resonant percus- 
sion sound; metallic tinkling when the patient talks, coughs, or inhales 
deeply. . Bronchial breathing and bronchophony, where the compressed lung 
lies. 

In cases where air and fluids co-exist we hear a splashing sound when- 
ever the patient moves quickly, just like water in a half-filled bottle, if it be 
shaken. 

Likewise do we sometimes hear a falling of drops with a metallic tink- 
ling sound, when the patient rises from a recumbent position. 

Differential Diagnosis. — Pneumothorax differs from emphysema by 
its dyspnoea coming on suddenly and growing worse steadily; by its one- 
sided distention of the thorax, the intercostal spaces of which bulge out; by 
its want of vocal fremitus, the absence of the vesicular murmur, and the 
presence of the metallic tinkling sound. 

It differs from large superficial cavities by the distention of the thorax 
and the displacement of heart, liver or spleen, and the absence of vocal 
fremitus. 

THERAPEUTIC HINTS— For the sudden dyspnoea, Arsen. 

When caused by external injury, Aeon., Arnica, Staphis., and others. 

When in connection with consumption, compare the remedies mentioned 
there. 

For the subsequent inflammation of the pleura, compare Pleuritis and 
Pneumonia. 

Hydrothorax, Dropsy of the Chest. 

This is a collection of serum in the pleural sac, without any inflamma- 
tory process in that locality. It is mostly found on both sides of the chest at 
the same time, although one side may contain more fluid than the other. 
The serum is clear, yellowish or greenish ; sometimes reddish, when mixed 
with blood; it never contains fibrinous substances, as an exudation of pleu- 
risy always does, but in place of it a great deal of albumen. The pleura 
itself looks pale and dull, without any sign of inflammation ; the lung is 
pressed towards the spine whenever a large amount of such fluid exists, and 
generally appears oedematous. 

Hydrothorax originates mostly in consequence of lung and heart dis- 
eases, which cause obstruction to the ve^pus circulation within the lungs; or 
in consequence of such morbid states of the body as cause the blood to be- 
come thin and watery, as is the case in Bright's disease, in certain spleen and 



HYDROTHORAX, DROPSY OF THE CHEST. 423 

liver affections, in ansemia, in intermittent cachexia. It is, therefore, almost 
always attended by other dropsical conditions. 

From this it is apparent that its symptoms must vary greatly. Its most 
prominent feature, however, is dyspnoea, which is always worse in a lying, and 
better in a sitting position, and this for obvious reasons : when sitting the 
fluid settles to the lower part of the thoracic cavity and leaves the upper part 
of the lungs free for respiratory action ; whilst in a horizontal position the 
whole lung becomes overflown and compressed by the fluid. Where there is 
a great deal of serous effusion the patient seems to suffocate whenever he turns 
in bed. Niemeyer explains this important sign in the following manner: as 
the fluid is not limited to a certain place, as is the case of pleuritic effusions, 
it changes its position freely whenever the patient changes his position, fol- 
lowing the law of gravitation. Wherever it locates, there it naturally com- 
presses the lungs, makes them unfit for respiration, whilst the uncompressed 
portion fulfils this office undisturbed. A turn of the body reverses at once 
the location of the fluid ; it now compresses those portions of the lungs which 
were breathing, and sets others free that were compressed. Ere these can be 
pervaded by air, the patient has no breath. This explains fully those suffo- 
cating fits which such patients experience when turning in bed. 

Inspection. Enlargement of the thorax. 

Palpation. Absence of vocal fremitus and displacement of heart, liver, 
spleen. 

Percussion. Dull sound as far as the fluid reaches, changing locality in 
different positions of the patient. 

Auscultation. Absence of vesicular breathing where the fluid covers 
the lungs, but bronchial breathing about the spine, where the lungs are 



THERAPEUTIC HINTS.— Apis, great oppression ; inability to lie 
down ; absence of thirst ; urine dark, like coffee ; after taking cold, during 
desquamation in scarlet fever. 

Apoc. cann., inability to speak; catching of the breath; irritability 
of stomach so great that even a draught of cold water is rejected; suppression 
of urine. 

Asclep. syr., recommended especially after scarlet fever. 

Arsen., dyspnoea, worse from any exertion; when lying down at night, 
if ever so carefully, the patient experiences a sense of suffocation ; also when 
turning in bed; with great anxiety; palpitation of the heart and great dry- 
ness; drinking constantly but little at a time. 

Aspar., old people with heart-diseases. 

Bryon., pain in the side; cough, with contraction of the diaphragm; 



424 AFFECTIONS OF THE PLEURA. 

vomiting and splitting pain in the head, excited by any motion; retarded 
stool and frequent desire to pass water, but only a few drops flow. 

Colchic, asthma; oedematous swelling of hands and feet; constant 
urging to pass water, as from spasm of the bladder, but only a little is voided, 
and that with great pain ; heart disease in consequence of acute rheumatism. 

Digit., intermitting pulse; pale face; cold skin; flabby, oedematous 
swelling all over ; difficult urination ; cyanotic symptoms, with fainting. 

Helleb., slow comprehension; slow in answering questions; pale face; 
griping pain in the bowels, with diarrhoea of a jelly-like slime. 

Kali carb., whizzing breathing; oppression worse about three o'clock 
in the morning ; oedematous swelling between the eyebrows and lids, looking 
like a little bag ; insufficiency of the mitral valves ; great dryness of the skin. 

Laches., suffocating fits, waking from sleep, with throwing the arms 
about; cyanotic symptoms; swelling of the liver; black urine; offensive 
smell of feces. 

Lycop., dyspnoea w T orse when lying on the back; constipation; rumb- 
ling in the left iliac region ; red urine ; exceedingly cross after getting awake. 

Mercur., after scarlatina; oedematous swelling all over; sweating 
without improvement; dry, hard cough; inflammation of the genital organs. 

Squilla, strong urging to urinate, with scanty and dark urine; con- 
tinuous cough, with mucous expectoration ; oedematous swelling of the body. 

Senega, loose, faint, hacking cough, with expectoration of a little 
phlegm. 

Spigel., dyspnoea during motion in bed; can lie only on the right side 
and with the trunk raised; danger of suffocation when making the least 
motion or raising the arms, with anxiety and palpitation of the heart. 

Sulphur, sudden arrest of breathing at night in bed when turning to 
the other side; going off when sitting; constipation, or diarrhoea in the 
morning; liver complaint; red lips. 

Tart, emet., much coarse rattling in the chest; expectoration not 
equivalent to the secretion within ; drowsiness ; cyanotic symptoms. 

Haematothorax 

Is an effusion and accumulation of blood within the pleural cavity without 
inflammatory symptoms, brought on either by external injuries of the chest, 
from stabbing, gunshot wounds, fracture of the ribs, contusions, or from 
internal ruptures of blood-vessels, carcinoma and tubercles. 

The patient complains of sudden dyspnoea, with or without cough ; his 
face grows pale; he faints, has ringing in the ears; darkness comes before his 
eyes, and the skin is cold. 

Physical signs the same as in Hydrothorax. 






H^MATOTHORAX. 425 

THERAPEUTIC HINTS.— When from external causes, compare 
Aeon., Arnica, Calend., Eriger., Hamam., Rhus tox. and the like. When 
from internal causes, they must be considered in each individual case, and 
reference should be taken to those remedies which are indicated in haemor- 
rhages from the lungs. Great loss of blood indicates China, and a nourish- 
ing diet. 

For the subsequent pleuritis, compare the corresponding chapter. 



THE HEART. 



Auscultation. 



First step: To know how the heart works. 

The heart consists of four apartments : two antechambers (auricles) and 
two chambers (or ventricles), which are respectively named from their posi- 
tion, right and left. 

Into the right auricle the venae cavae empty all the blood which has been 
used in the body for its sustenance. From this antechamber a large aperture 
leads into the right ventricle, which is called the auriculo-ventricular opening, 
and which is guarded by a kind of gate, consisting of three triangular folds 
(the tricuspid valves), opening inward. In the right ventricle we observe 
another opening, which leads into an artery called the pulmonary artery, be- 
cause it brings the deoxygenized blood into the lungs. This opening is 
likewise guarded by a set of valves, which, from their half-moon shape, are 
called semi-lunar valves, and which open outward. 

This arrangement we find repeated in the left auricle and ventricle. 
Into the left auricle the pulmonary veins empty all the blood which has been 
oxygenized into the lungs. From this cavity a like aperture leads into the left 
ventricle, which is likewise guarded by valves, consisting, however, of only 
two segments {the bicuspid or mitral valves), opening inward. 

In the left ventricle we observe also an opening, which leads into an 
artery called the aorta, and which distributes the blood all over the body. 
This opening is likewise guarded by a set of valves of semi-lunar variety, 
which open outward. 

Now let us see how this apparatus works. The ventricles being fully 
distended, they immediately and simultaneously begin to contract. On account 
of the relation of the several valves to these two cavities, the action of the 
blood under the great pressure from this contraction forcibly shuts the 
tricuspid and mitral valves, thus closing the auriculo-ventricular openings, 
and the same action opens both sets of semi-lunar valves for the escape 
of the blood. Through the pulmonary artery the dark blood is propelled 

(426) 



AUSCULTATION. 



427 



into the lungs, whence it is returned through the pulmonary veins to the left 
auricle, thus making the lesser circuit — the pulmonic circulation. Through 
the aortic valves and artery the red blood is propelled through the whole 
body, whence it is returned through the venae cavse to the right auricle, 
thus making the greater circuit — the systemic circulation. As the two ven- 
tricles contract, the two auricles dilate, and vice versa. The contraction 
of the ventricles and simultaneous dilatation of the auricles is called the 
heart's systole, aud by causing a forcible closure of the auriculo-ventricular 
valves produce the first sound of the heart. The dilatation of the ventricles 
and simultaneous contractions of the auricles is called the heart's diastole, 
and by forcibly closing the two sets of semi-lunar valves produce the second 
sound of the heart. This explanation of the two sounds of the heart suffices 
for my purpose, and may be demonstrated to the eye by the following 
diagram : 




This first step Ave must make securely, if we want to get along at all 
towards reaching the goal of diagnosticating heart diseases : the first sound is 
caused by the shutting of the tricuspid and mitral valves. The second sound 
is the consequence of the shutting of the semi-lunar valves. 

Second step: How to find the exact situation of these different 
valves in the living subject. 

In order to find out the position of the heart, and its parts, we must first 
ascertain where it strikes against the thoracic wall. 

It does it with its apex, and in a majority of cases between the fifth and 
sixth ribs, about one inch on the right of a line drawn vertically through the 



428 HEART. 

left nipple, the person being in an upright position. In persons of a short 
stature, we find the heart's impulse between the fourth and fifth ribs ; and in 
persons with a long thorax, it may be felt still lower. So also different posi- 
tions of the body change the place of impulse. In a person lying upon the 
back, it is observed nearer to the medium line ; while lying upon the left side 
causes it to tilt over more towards the nipple line. This point of impulse we 
must take as a fixed point for determining the position of the left ventricle, 
which it never fails to represent. The other parts have a constant relation 
to this. 

The base of the heart, and consequently the aortic and pulmonary valves, 
are almost invariably situated behind the middle of the sternum. 




The ascending aorta lies somewhat to the right of the vertebral column 
and consequently its sounds and murmurs must always be sought for over the 
middle and somewhat to the right of the sternum. 

The mitral valves are situated nearly one inch below those of the aorta, 
and on the left side of the sternum. 

The tricuspid valves are to the right of and anterior to the mitral, and 
they are for the most part covered by the sternum. 

The position of the right ventricle is variable, and cannot be determined, 
unless that of the left ventricle and aorta has been previously ascertained ; 
it lies mostly under the lower part of the sternum. 






AUSCULTATION. 429 

The valves of the pulmonary artery are situated under the cartilage of 
the third rib to the left of the sternum. 

The diagram opposite shows the exact position of these parts. 

Now, if we remember all this, we shall hear those sounds ivhich originate 
in the left ventricle, in the mitral valves, most distinctly at that part of the tho- 
rax against which the apex of the heart strikes; those sounds which originate in 
the ascending aorta we shall hear best a little to the right of the centre of the 
sternum, and from thence upwards; those sounds which originate in the pul- 
monary artery we shall hear best a little to the left of the centre of the sternum; 
those sounds which originate in the tricuspid valves we shall hear loudest over 
the central and lower part of the sternum. 

If we now consider that diseases of the pulmonary valves and the tricus- 
pid valves are of very rare occurrence, we may centre our attention upon 
only these two points : 

1. Upon the sounds of the mitral valves; heard best at that part of the 
thorax against which the apex of the heart strikes ; and 

2. Upon the sounds of the aortic valves ; heard best a little to the right 
of the centre of the sternum, and thence upwards. 

Third step : Of the different morbid sounds and murmurs of the 
heart. 

1. The left chamber during its systole. 

The first sound, heard clearest at the apex, is proof, 

1. That the mitral valves shut perfectly ; not allowing any blood to regur- 
gitate into the auricle ; and, 

2. That the aortic valves and orifice offer no obstacle to the direct passage 
of the blood out of the left ventricle. 

But, suppose the mitral valves be deficient, so that they would not shut 
perfectly during the rush of blood against them, what would be the conse- 
quence of this deficiency ? Simply, the stream of blood would not be stopped 
there-, but would re-enter the auricle and thus cause a noise, but no tic. 

Or, suppose the aortic valves be stiffened or roughened, or the aortic 
opening constricted, so that the stream of blood in its course onward would 
be interfered with, what would be the consequence of such obstruction ? The 
stream of blood would rub against the obstacle and cause a noise or murmur 
at the same time when the closure of the mitral valves would give the first tic. 

Or, suppose the mitral valves be deficient, and, at the same time, the 
aortic valves stiffened and roughened, or the aortal opening constricted, what 
would be the consequence of this deficiency and obstruction? Well, the 
stream of blood would regurgitate through the auriculo-ventricular opening, 
and also rub against the obstacles in the aortic opening, and thus cause a 
noise but no tic. 

How then can we distinguish between these three different affections? 



430 HEART. 

In case of insufficiency of the mitral valves, the blood regurgitates at each con- 
traction of the heart into the left auricle; and thus it becomes retarded in 
the whole lesser circuit. In consequence of which the right ventricle must 
make stronger efforts to drive it onward, aud the pulmonary artery, becom- 
ing largely distended, contracts the more, thus causing a more violent shock 
backwards against its semilunar valves, and consequently a louder diastolic 
sound of the pulmonary artery. An increase of the second or diastolic sound 
of the pulmonary artery is, therefore, almost invariably attending an insuf- 
ficiency of the mitral valves. We must, then, when we hear a noise instead 
of the systolic sound at the heart's apex, make sure whether there is also an 
increased second sound of the pulmonary artery. The valves of this artery 
are situated under the cartilage of the third rib to the left of the sternum — 
there we put the stethoscope, and if it turns out so, we may be sure that the 
noise which we hear at the apex, instead of the systolic sound, is caused by 
an insufficiency of the mitral valves. 

In case of constriction of the aortic opening we hear the systolic sound 
and a noise besides. If we put our ear over the aorta, towards the right of 
the centre of the sternum, we hear the noise there even plainer than at the 
apex. 

In case of insufficiency of the mitral valves and constriction of the aortic 
orifice combined, we shall find these features united; an increased second 
sound of the pulmonary artery, and a noise over the aorta. 

2. The left ventricle during its diastole. 

The diastolic or second sound of the heart, is proof — 1, That the aortic 
valves shut well, not allowing any blood to regurgitate into the left ventricle ; 
and 2, that the mitral valves or the auriculo-ventricular opening offer no ob- 
stacle to the passage of blood out of the left auricle into the left ventricle. 

But, suppose the aortic valves be insufficient, so that they would not close 
tightly after the blood had been driven through them ; what would be the 
consequence of this insufficiency? The contraction of the aorta would drive 
some of the blood back again into the left ventricle, and thus cause a noise 
or murmur instead of the second sound. 

Or, suppose the mitral valves be stiffened, roughened, or the auriculo-ven- 
tricular opening constricted, so that the passage of the blood into the ventricle 
were interfered with, what would be the consequence of such obstruction? 
The stream of blood would rub against the existing obstacle and cause a 
noise or murmur during the diastole of the ventricle at the same time when 
the closure of the aortic valves would give the diastolic sound. 

Or, suppose the aortic valves be insufficient, and, at the same time, the 
mitral valves or auriculo-ventricular opening obstructed, what would be the con- 
sequence of this insufficiency and obstruction? Surely the stream of blood 
would regurgitate through the aortic valves into the left ventricle, and also 



AUSCULTATION. 431 

rub against the obstacles in the mitral valves and auriculo-ventricular open- 
ing, and thus cause a noise or murmur, but no diastolic sound. 

And how can we distinguish between these different affections? In case 
of insufficiency of the aortic valves, we shall hear a noise or murmur instead 
of the second sound most distinctly over the aorta to the right of the centre 
of the sternum. 

In case of thickening of the mitral valves, or constriction of the auriculo- 
ventricular opening, the blood accumulates in the lesser circuit, produces 
hypertrophy, with dilatation of the right ventricle, and an increased diastolic 
sound of the pulmonary artery much more readily than mere deficiency of 
the mitral valves. The more constricted the mitral orifice is, the longer will 
be the time necessary for the flow of the blood into the ventricle, and the 
more prolonged and louder the murmur. In cases of this kind the vibrations 
may even be felt and seen. 

In case of insufficiency of the aortic valves and constriction of the mitral 
orifice combined, we shall, of course, find both features united — a noise instead 
of the second sound over the aorta and a murmur over the mitral valve, with 
an increase of the diastolic sound of the pulmonary artery. 

3. The left ventricle during its systole and diastole. 

The clear systolic sound indicates that the mitral valves close perfectly, 
and that the aortic opening is not constricted. The clear diastolic sound 
indicates that the aortic valves shut well, and that the mitral orifice is not 
constricted. But suppose the mitral valves be insufficient, and, at the same 
time, the auriculo-ventricular opening constricted, what would be the con- 
sequence of such insufficiency and constriction at the same time? The systole 
would cause a regurgitation of the blood into the auricle, and the diastole a 
friction of the blood during its passage through the constricted mitral open- 
ing, and thus 'we would hear a see-saw, a noise instead of the first, and a noise 
accompanying the second sound. 

Or, suppose the aortic valves be insufficient, and, at the same time, the 
aortic orifice constricted, what will be the consequence of such a state? 

Undoubtedly the contraction of the heart would cause a noise by driving 
the blood through the constricted orifice, and during the dilatation of the 
heart the blood would regurgitate and cause a murmur instead of the second 
sound. 

And how are we to distinguish between these two different affections? 

When the mitral valves are insufficient, and the auriculo-ventricular 
opening is at the same time constricted, we must find also an increased second 
sound of the pulmonary artery. AVhen, however, insufficiency of the aortic 
valves and constriction exist in the aortic opening, we hear the murmur most 
distinctly over the aorta. 



432 HEART. 

A comparison of the diagram on circulation, page 427, will help much 
in elucidating these complicated states. 

All that I have said here of the left ventricle and its valves during its 
systole and diastole is almost verbally applicable to the right ventricle and 
its valves. As, however, valvular diseases on the right side of the heart are 
exceedingly rare compared with those of the left side, and even when present 
on the right side, they almost always exist to a greater extent upon the left 
than upon the right side (H. M. Hughes), I think it best to break off 
here, so that I may not bring confusion upon, instead of elucidation to, this 
subject; and I shall at once proceed to speak of those morbid sounds, re- 
sembling murmurs, but which have nothing to do with the valves of the 
heart. 

1. Anaemic murmurs. "They are ordinarily of the softer kind and 
resemble the blowing of a pair of bellows, but are sometimes harsh and re- 
semble the rougher morbid sounds, as that of filing or sawing." (H. M. 
Hughes.) They are generally confined to the situation of the aortic or pul- 
monary valves, or both. They do not follow the course of the large vessels 
so fully or frequently as do the murmurs arising from disease of the valves. 
They occur only during the systole of the ventricles ; they are not generally 
heard below the left nipple, because they do not originate in the mitral open- 
ing. They are almost always accompanied with a smart, smacking impulse. 
They generally disappear for a time, while the individual is quiet mentally 
as well as bodily, if by that quiet the heart assume a natural impulse ; and 
they are always diminished and generally disappear entirely under suitable 
treatment. (H. M. Hughes.) 

The origin of these anaemic murmurs have been attributed: 1, to a 
watery condition, or a diminution of ordinary viscidity of the blood, in con- 
sequence of which the particles of the fluid are more easily agitated and thus 
give rise to the vibrations which produce the murmur ; 2, to the remarkably 
quick and sudden contraction of the ventricles, in consequence of which the 
fluid contents of the cavities are propelled quicker through the arterial open- 
ings than in health, and thus give rise to greater friction, which produces the 
murmur, although no actual constriction exists there. (H. M. Hughes.) 

2. Yenous murmurs (nun's murmur, top-murmur) are heard in many 
young persons in the anterior triangular space in which the external jugular 
vein descends. It is a continuous murmur, and is generally more audible on 
the right than on the left side. This murmur disappears when the current 
of blood is interrupted by pressure upon the jugular vein, by a deep expira- 
tion, or by any position of the body in which the head lies lower than the 
thorax. 

It is heard loudest in an erect position and during inspiration. 



PERICARDITIS. 433 

It is thought to be in connection with anaemia, but Skoda says that he 
has found it also in young and quite healthy individuals. 

3. Pericardial murmurs. As long as the inner surface of the pericar- 
dium is in its natural condition, slippery and glistening, the heart moves 
within it without any sound; just as the two blades of the pleura glide over 
each other inaudibly, as long as they are in a natural condition. Not so, 
however, when this slippery and glistening surface becomes roughened in 
consequence of inflammation and subsequent fibrinous exudation. Then we 
hear at once a friction sound, which, according to Skoda, may resemble per- 
fectly an endocardial murmur. 

How are we then to distinguish between a friction sound caused in the 
pericardium, and a sound caused within the heart? 

Skoda says: "I know no sign by which the friction sounds of the peri- 
cardium can be distinguished from the internal murmurs of the heart, ex- 
cepting this — that the internal murmurs correspond pretty exactly to the 
rhythm and to the natural sounds of the heart ; whilst the pericardial friction 
sounds seem to follow upon the movements of the heart. This distinctive sign 
is only available when the murmur is somewhat prolonged ; if it be of short 
duration, we cannot determine whether it is endocardial or pericardial." 
Skoda, p. 253. 

To this difficulty still another maybe added, viz.: the friction sound 
may also arise from a roughened condition of that portion of the pleura 
which covers the unattached parts of the pericardium. The sound is pro- 
duced by the rubbing of the pleura which covers the free portion of the peri- 
cardium, either against the thoracic walls or against the surface of the 
lungs. Being caused by the action of the heart, it coincides with its move- 
ments as completely as though it had been produced within the pericardium. 
The murmur thus arising external to the pericardium exactly resembles the 
murmur arising within it, and here we have no means of distinguishing. 

The special diseases of the heart I shall arrange under the following- 
heads : 

1. Diseases of the pericardium. 2. Diseases of the endocardium and its 
valves. 3. Diseases of the heart-muscle itself. 4. Nervous diseases of the 
heart. . . 



I. DISEASES OF THE PERICARDIUM. 

Pericarditis, Inflammation of the Pericardium. 

The internal layer of the pericardium being a serous membrane, like the 
pleura, its inflammation presents precisely the same anatomical character as 
that of pleurisy. We find injection, swelling, and exudation of either a 
28 



434 DISEASES OF THE PERICAKDIUM. 

serous or sero-fibrinous, or to the most part fibrinous fluid. In this latter 
case the fibrin is precipitated upon the walls of the pericardium, and forms 
net- work-like, villous masses, which have given rise to the name of cor villo- 
sum or hirsutum, most frequently found in pericarditis complicated with ar- 
ticular rheumatism. During the process of inflammation, sometimes the in- 
jected capillaries burst, and thus cause a bloody exudation. 

When pus globules form in great abundance, the exudation becomes 
purulent, and, if it undergoes decomposition, it becomes a fetid, discolored, 
ichorous fluid, as in empyema. 

In some cases the inflammation does not result in exudation of any 
kind — pericarditis sicca — in consequence of which, adhesions form without- 
any noticeable symptoms. 

" The mere serous exudation is most thoroughly absorbed again, while the 
fibrinous fluid gives rise to adhesions between the heart and the pericardium. 

A large quantity of this fluid hinders the heart in its movements and 
pushes it back from the thoracic walls; at the same time it may compress 
part of the lung and the large vessels. 

It causes also congestion of the lungs, the brain, and the liver, serous 
exudation into the lower lobes of the lungs, the pleura, and the membranes 
of the brain and oedema of the lower extremities. 

Pericarditis may set in primarily in consequence of external injuries or 
taking cold ; such, however, is very rarely the case ; or, secondarily, during the 
progress of acute rheumatism, which is its most frequent occasion. But it 
may result also from pleurisy, pneumonia or ulcerative processes of the ribs, 
vertebrae, oesophagus, stomach, liver, etc.; or it may accompany morbus 
Brightii, tuberculosis, disease of the valves, cancer, intermittent fevers, etc. 
It occurs, too, in typhus, variola, pyaemia, puerperal and exanthematic fevers. 

Chronic forms of pericarditis are caused by long-continued mental de- 
pressions, abuse of spirituous liquors, violent exertion of the body, and 
chronic, gouty affections. 

Its Symptoms, if it is a primary affection, or in combination with acute 
rheumatism, are — 

1. More or less violent fever, sometimes commencing with chills, followed 
by hqat, great acceleration of pulse, and palpitation of the heart. 

2. As in pleurisy, we must consider the stitch or sharp cutting pain in 
the region of the heart as a characteristic, subjective sign, which is increased 
by motion, deep inspiration and external pressure. 

3. Dyspnoea is present in almost all cases ; sometimes to such a degree 
that the patient is incapable of lying down at all. 

4. Cough is sometimes wanting, but in most cases we find a short, dry, 
hacking cough. 



PERICARDITIS. 



436 



5. The position of those patients who can lie down is on their left side 
or on their back. 

Pericarditis in combination with pleurisy or pneumonia may in some 
cases not be diagnosti cable during its development even by the most careful 
physical examination. In complication with tuberculosis, Bright's disease 
and chronic heart diseases, only careful physical examination will lead to its 
detection, which is also true if pericarditis sets in during the course of grave 
blood diseases, such as scarlatina, puerperal fever, etc. 




Pericardiac Exudation. (After Bock.) 

a. Pericardial sac filled with, fluid, b. Diaphragm, c. Eight lung. d. Compressed left lung. 
e. Liver. /. Stomach. 



Auscultation reveals the heart sounds very weak, sometimes scarcely 
audible. This weak impulse of the heart's action is characteristic if we find 
at the same time on percussion the dull heart sound cover a larger s{)ace 
than normal. But the first physical sign which appears, (although seldom 
during the first two or three days of the disease) is the friction sound, pro- 
duced by the deposition of fibrinous masses upon the smooth pericardial folds. 
The now roughened surfaces give this friction sound during their continual 
gliding over each other in consequence of the motion of the heart. It is 
frequently heard first and loudest over the base of the heart, but may also be 
heard first and loudest over any other part of the heart; it does not only 
accompany the heart sounds, but is prolonged beyond them, is interposed, as 
it were, between them (Skoda), and may occupy the whole duration of the 
cardiac movement. When the exudation increases largely, it grows weaker, 
and may disappear altogether, but on the decrease of the fluid, it reappears 
again. It may also be made audible again in some of such cases, by changing 
the position of the fluid by causing the patient to sit upright, or to bend his 
body forwards. 

Inspection shows in young persons a swelling or bulging out of the pre- 
cordial region in advanced cases, with a large quantity of exudation. In 



436 DISEASES OF THE PERICARDIUM. 

older persons, where the cartilages of the ribs have become ossified, such 
enlargement cannot take place. 

Palpation discovers in the beginning of the disease a stronger impulse 
of the heart at its normal place; but later this impulse becomes weaker and 
finally ceases altogether, when the collection of fluid pushes the heart back 
from off the thoracic walls. 

When there is a loud friction sound, this becomes noticeable also to the 
sense of touch, and feels like the purring of a cat. 

Percussion at first reveals nothing. There must be already a consider- 
able quantity of fluid exudation before we perceive the natural dull percus- 
sion sound of the heart spread over a larger circumference ; and if the lung 
happens to be in a position that it covers the filled pericardium, we cannot 
get a dull sound in spite of even a very large quantity of fluid. 

At first the exudation is confined to the base of the heart and the origin 
of the arteries. Here then we have at first to look for an increase of dulness 
of the percussion sound. Later, the dull percussion sound may increase in 
the long diameter, down the heart ; and if the effusion is very considerable, 
also in its transverse diameter, so that if, according to Skoda, the pericardium 
contains as much as two pounds of fluid, the percussion sound becomes com- 
pletely dull from the second left costal cartilage to the lower border of the 
thorax, and from the right edge of the sternum to the middle of the left 
lateral region. 

Secondary pericarditis of course develops itself differently. It being a 
mere additional symptom or consequence of, or complication with, some 
other disease, its first onset is hidden by the symptoms of that disease. But, 
when once developed, its presence must of necessity be indicated by the same 
physical signs which I have detailed above. 

Uncomplicated pericarditis is, of course, much more easily cured than 
when complicated. In the latter case our prognosis has to be based alto- 
gether upon the nature of that complaint with which it is combined. 

THERAPEUTIC HINTS.— Aeon., chill at the commencement, fol- 
lowed by fever-heat; stitching pain in the region of the heart; impossibility 
to lie on the right side ; great restlessness ; frequent sighing and taking a 
deep breath ; feeling of fulness in the chest, dyspnoea ; fainting. 

Arsen., in consequence of repelled measle or scarlet fever-rash; inex- 
pressible anguish and restlessness; worse at night; the patient finds no ease 
in any position; flushed face; paralytic feeling in the upper extremities; 
tingling in the fingers ; cold perspiration. 

Bryon., stitching pain in the region of the heart, preventing motion 
and even breathing ; wants to lie perfectly quiet. 

Cact. grand., sensation of constriction in the heart, as if an iron hand 






HYDROPERICARDIOf. ' 437 

prevented its normal movement; acute pains and stitches in the heart; diffi- 
culty of breathing; attacks of suffocation, with fainting; cold perspiration 
in the face, and loss of pulse ; palpitation when walking, and at night when 
lying on the left side. 

Digit., copious serous exudation, rheumatism; irregular, intermitting 
pulse ; brick-dust sediment in the urine. 

Iodium, in complication with croupous pneumonia; purring feeling in 
the region of the heart; violent palpitation, increased from the slightest 
motion, better while lying perfectly quiet on the back ; fainting spells. 

Kali carb., stitching pain in the region of the heart; swelliug between 
the eyebrows and the upper lids, like little bags; jerking up of the limbs, 
much frightened when having the feet touched; everything worse about 
three o'clock in the morning. 

Laches., restless and trembling; hasty talking; great oppression; 
anguish about the heart in rheumatism; irregularity in the beats of the 
heart. 

Psorin., psoric nature; better while lying quietly. 

Pulsat., the patient weeps easily, is thirstless, often changes position, 
has a loose, rattling cough, worse on first going to bed; rheumatic pains, 
which quickly change locality; inclination to looseness of the bowels; sup- 
pressed menstruation. 

Rumex, during rheumatism; burning, stinging pain in the left side of 
the chest near the heart when taking a deep inspiration, when lying down 
in bed at night. 

Spigel., when, notwithstanding the use of Aconite, the fever continues 
and the rubbing sound commences ; stitching pain in the chest from the very 
slightest motion. 

Sulphur, palpitation after going up stairs, with shortness of breath ; 
steady pain in the left side through to the shoulders; red lips; sleeplessness; 
after suppressed itch. 

Tart, emet., in complication with pleuro-pneumonia. 

Ver. vir., faintness after rising from a recumbent position; syncope 
when walking; relieved only by lying down. 

Existing complications will no doubt hint to many other remedies. 

Hydropericardium, Dropsy of the Pericardium. 

The pathological character of this disease consists of a collection of 
■serum without fibrin. A fibrinous exudation never takes place without an in- 
flammatory process. The serum is a yellowish, clear fluid; sometimes, if 
mixed with blood, it is brownish or reddish, and always of alkaline reaction. 
In renal diseases it contains some urea, and in general icterus the coloring 



438 DISEASES OP THE ENDOCARDIUM. 

matter and acids of the bile. A small quantity of such fluid is found in most 
post-mortem examinations. To constitute dropsy of the pericardium, this sac 
must contain at least several ounces of serum, and it amounts in some cases 
even to over one pound. When such is the case, the pericardium is distended, 
is of a dull whitish color, without lustre; the fat upon the heart is gone, and 
the cellular tissue appears (edematous ; the lung becomes compressed and the 
thorax enlarged. 

Dropsy of the pericardium is generally the consequence of a hydrsemic 
condition of the blood, or of diseases which cause dropsical affections in other 
parts also, such as chronic affections of the spleen, morbus Brightii, cancer, 
anaemia, dilatation of the right ventricle, etc. It is also found in consequence 
of conditions which prevent the necessary oxygenation and free circulation 
of the blood, as in emphysema, in cirrhosed lungs, in defects of the valves of 
the heart. 

Hydropericardium is, therefore, altogether a disease of secondary nature, 
and its symptoms do not become very prominent, unless a very considerable 
quantity of fluid collects within the pericardium. Then we observe great 
dyspnoea, which prevents the patients from lying down ; any effort to do so at 
once causes an attack of suffocation ; they have to sit up day and night with 
their bodies bent forwards. The jugular veins swell and dropsical affections 
appear also on other parts of the body ; first in the lower extremities ; then 
in the genitals; later, within the peritoneum and the pleura?; finally, the 
dropsical swelling invades the whole body, and the impeded respiration and 
circulation cause stupor and death. 

The physical signs are: no friction sound ; distention of the precordial 
region in young subjects; impulse of the heart either absent or weak; weak 
sounds of the heart ; and dull percussion sound in a wider circumference than 
the heart alone would give rise to. 

THERAPEUTIC HINTS.— Compare Hydrothorax. The leading 
features will have to be taken from the fundamental disease. 

II. DISEASES OF THE ENDOCARDIUM. 

Endocarditis. 

Inflammations of the endocardium end either in ulcers, in thickenings 
of the membrane, or in villous formation of the connective tissue, which in 
course of time undergo further changes. 

1. The Acute ulcerative or Diphtheritic form is usually found in 
the left side of the heart, most frequently affecting the mitral and aortic 
valves, although the walls of the auricles and ventricles are not exempted. 






ENDOCARDITIS. 439 

At first the lining membrane appears only dirty gray, opaque and dull, but 
soon shows proliferations in the connective tissue, and a deposition of fibrinous 
masses, which, after softening and crumbling away, leave ulcers on the sur- 
face. As the ulceration eats through one lamella of the valves, the lamellae 
underneath stretch and bulge out by the strain of circulation and cause the 
so-called YalYlllar aneurisms, w T hich, when situated on the auriculo-ven- 
tricular valves, project into the auricles, or when on the semi-lunar valves, 
into the ventricles; they may enlarge to such a degree, as to form an acute 
stenosis of the ostium. Ulceration in the ventricles, when complicated with 
myocarditis, may lead to a so-called Partial cardiac aneurism; when 
situated at the septum, may cause perforation of the same and establish a 
communication between the two ventricles; the particles of the crumbling 
masses in the left ventricle may be swept into the terminal arteries and valve- 
less veins of the spleen, kidneys, brain or eyes, producing infarctions in these 
organs, or when arising from the right side of the heart, bring about abscesses 
from embolism in the lungs. 

The symptoms of ulcerative or diphtheritic endocarditis may be similar 
to a typhoid or {jycemic fever; the heart symptoms are not characteristic. 
Usually, however, we hear a loud, systolic and occasionally a diastolic mur- 
mur, loudest at times over the apex, at other times over the base, and 
especially in the neighborhood of the aortic ostium. Of course, in complica- 
tion with pericarditis the physical signs change accordingly. For this reason 
endocarditis may easily be confounded with typhoid fever, for in both, the 
spleen is almost always enlarged, and a roseolar or petechial exanthema is 
very often present, and frequently accompanied by meteorism. But endo- 
carditis has not the characteristic typhoid curve of temperature, exhibits a 
remarkable frequency of the pulse and is usually found in connection with 
rheumatic arthritis, puerperium, chronic valvular disease, pyaemia and trau- 
matic diseases in general. 

2. The YeiTUCOSe form of endocarditis is also more prevalent on the 
left side of the heart, and takes its favorite seat on those surfaces of the 
valves which face the current of the blood ; then we see it occur on the chordae 
tendinae and relatively seldom on the lining of the ventricles. The verrucose 
products are the fruit of inflammatory changes in the parenchyma in con- 
sequence of irritation. They consist of proliferations of the connective 
tissue, and appear either as a mere velvety coating on the smooth val- 
vular surfaces, or amount to opaque spots with wart-like, papillous, knotty 
and cauliflower-shaped excrescences of a red or gray-red color, firm at the 
base and soft or jelly-like at their points. Parts of these growths may be 
driven into the general circulation and form emboli. From the left side the 
kidneys are the organs most liable to infarction, while in affections of the 
right heart the inferior lobes of the right lung are most liable to be invaded. 



440 DISEASES OF THE ENDOCARDIUM. 

Verrucose endocarditis is almost always accompanied by pericarditis, 
and most frequently complicated with rheumatic arthritis; it also has been 
found the offspring of childbirth and pregnancy, of old valvular affections, 
and of acute exanthematic diseases. 

Its invasion, during these different affections, generally takes place un- 
noticed ; because it is quite seldom that the patient complains of pain in the 
region of the heart when attacked in this way. But once established, we 
observe the following symptoms : 

1. Pulpitation of the heart, and soft, easily compressible and small pulse. 

2. Dyspnoea, which is the greater the more the respiratory organs be- 
come involved in the morbid process, causing quick and unequal respiration, 
fainting, or congestion of the brain, with headache, delirium, sleeplessness, 
sopor. 

3. Higher degrees of endocarditis are frequently attented by icterus. 
Its physical signs are the following: 

1. The normal sounds of the heart are stronger, and audible over a larger 
space than natural — in the beginning of the disease. 

2. In place of the first tick we hear, at the apex of the heart, a noise, 
which shows that the mitral valves have become diseased. 

3. The second tick of the pulmonary artery is increased in consequence of 
the insufficiency of the mitral valves, causing an overflow in that artery. 

4. Percussion at first reveals nothing, but at a later period yields a dull 
sound over a greater space than natural, because of the dilatation of the right 
ventricle in consequence of impeded circulation. 

Both forms of endocarditis may result in recovery, but generally leave 
diseases of the valves, either thickening, adhesion, or perforation, and in con- 
sequence hereof, dilatation and hypertrophy of the heart. 

THERAPEUTIC HINTS— Compare what has been said under Peri- 
carditis. The characteristics of the remedies acting upon the heart, must be 
applied here too. In addition, I shall mention only — 

Spigel., the most important; waving palpitation, not synchronous with 
the pulse ; pulsating and trembling carotids ; purring feel over the heart ; 
rheumatism. 

Aurum, rheumatic pains, previously wandering from joint to joint, be- 
come fixed in the region of the heart and cause great anxiety ; the patient 
has to sit perfectly quiet in an upright position ; palpitation, with irregular, 
intermitting pulse and short breath, feeling as though the heart ceased beating 
for a while, and then at once one hard thump is felt. 

Bismuth., has not yet been tested in practice, but its pathological 
effects seem strongly to indicate it; they are: inflamed spots in the endocar- 
dium, black coagulum in the heart. 



ENDOCARDITIS. 441 

Iodium, according to Kafka, if Spigel. has failed to act favorably 
during 24 to 36 hours. 

Kali carb., where, in place of the first tick, a blowing noise and a 
louder second tick of the pulmonary artery is heard (Kafka) ; where there 
consequently exists already a stagnation in the pulmonary circulation. 

Spongia, in consequence of endocarditis, attacks of severe oppression 
and pain in the region of the heart ; all symptoms worse from lying with the 
head 1ow t ; inability to lie dow 7 n at all. 

In consequence of Endocarditis originate diseases of the valves ; which 
consist either in — 

1. Insufficiency of the valves; or in — 

2. Constriction of the valvular openings. 



1. Insufficiency of the Mitral or Bicuspid Valve. 

Mostly in consequence of endocarditis the valves become shortened and 
thickened, sometimes by flat calcareous substances stiffened and the fine 
fringes on their free borders obliterated ; at other times the valves are torn 
from the chordae tendineae; seldom are the chordae tendineae grown fast to 
the wall of the ventricle ; not unfrequently the capillary muscles are in a 
state of callous degeneration. 

There are also characteristic changes of other parts of the heart attend- 
ing this disease, namely : always a dilatation and hypertrophy of the left 
auricle, of the pulmonary veins and artery and of the right ventricle and 
auricle. 

In consequence of these defects of the mitral valves, the blood regurgi- 
tates during the systole into the left auricle, thus checking the normal flow T 
of the blood through the pulmonary vein. This causes an accumulation of 
blood in the lungs, in consequence of which the blood is pressed backwards 
into the pulmonary artery, causing here a widening of its volume, and, in 
consequence, a louder second tick. This increased second tick of the pul- 
monary artery is the most characteristic sign of insufficiency of the mitral 
valves. 

The check of circulation in the lungs causes further dilatation and 
hypertrophy of the right ventricle, because it requires greater power to force 
on the accumulated and obstructed blood. By-and-by, however, this increase 
of power in the right ventricle diminishes again, and thus the veins of the 
lungs become permanently overcharged wdth blood ; the same result takes 
place in the venae cavae, and, in consequence, the liver, spleen and kidneys 
grow hyperaemic, which finally ends in dropsy. This stagnation of blood in 
the lungs causes also dyspnoea, bronchial catarrhs, periodical haemorrhages 
from the lungs, passive hyperaemia of the brain, an undulation of the jugular 



442 DISEASES OF THE ENDOCARDIUM. 

veins, cyanosis, jaundice and dropsy, which usually commences in the lower 
extremities growing gradually upwards. 

The characteristic physical signs are the following : 

1. In place of the systolic sound we hear a noise at the point where the 
apex strikes at the thoracic wall. 

2. The diastolic of the pulmonary artery is much increased. 

3. The dull percussion sound of the heart extends further in breadth, 
on account of the dilatation of the right ventricle. 

2. Constriction or Stenosis of the Left Auriculo-Ventricular Opening. 

It originates mostly in this way that the mitral valves shrink and grow 
harder and narrower, or that their points grow together, or that the chordae 
tendinese adhere to the valves, or that the valves become covered with cal- 
careous substances. This state of things naturally produces at the same time 
insufficiency of the mitral valves and therefore we find in the great majority 
of cases stenosis complicated with insufficiency. The other changes in the 
heart are like those of insufficiency; the left ventricle, however, grows 
smaller and the aorta narrower on account of the diminished flow of blood 
through them. 

As in this case the narrowed and roughened orifice does not allow the 
blood to enter freely into the left ventricle, its passage through this opening 
is perceptible to the ear — we hear during the diastole a noise at the apex of 
heart. At the same time the narrowed opening prevents the normal quantity 
of blood from passing through into the left ventricle, which causes an accu- 
mulation of blood in the left auricle ; hence, a check of flow in the pulmonary 
vein ; hence, an overfilling of the lungs ; hence, a greater backward pressure 
into the pulmonary artery ; and hence all the consequences which I have 
detailed under the head of defective mitral valves, only much more rapid 
and much more intense. 

Its characteristic physical signs are the following : 

1. We hear at heart's apex instead of the diastolic sound a noise. This 
noise is sometimes similar to the purring of a cat, so that it even may be felt. 

2. The diastolic sound of the pulmonary artery is louder. 

3. The dull percussion sound of the heart extends further to the right, 
on account of dilatation and hypertrophy of the right ventricle. 

In cases where the mitral valve is defective and the left auriculo-ven- 
tricular opening constricted at the same time, when we hear a noise during 
the systole as well as during the diastole. The sound of the aorta is mostly 
weak. The pulse is in most cases weak, not corresponding to the violent 
palpitation of the heart. 



ENDOCARDITIS. 443 

3. Insufficiency of the Aortic Valves. 

As soon as these valves do not shut tightly, the blood which has been 
driven during the heart's systole into the aorta, rushes, during its diastole, 
back into the left ventricle, causing an abnormal quantity of blood to collect 
there. To get rid of this the left ventricle has to make greater efforts to rid 
itself of it; and, in this way it gradually grows wider and thicker — eccentric 
hypertrophy of the left ventricle. By this increased capacity of the left ven- 
tricle the consequences of the defective aortic valves become, so to speak, 
counterbalanced. For a good while it prevents an overfilling with blood in 
the pulmonary veins; we observe no slowness of pulse, no decrease of arterial 
blood, no cyanosis or dropsy. For, although the defective valves retard the 
circulation and make the blood venous, the hypertrophy of the left ventricle 
hastens the circulation and makes the blood arterial again. 

Therefore, we find that patients thus affected suffer at first comparatively 
little ; the most frequent signs are : congestion of the brain, which manifests 
itself as dizziness, noise in the ears, flickering before the eyes, headache, hal- 
lucinations, red face, etc., as a consequence of the hypertrophied left ventricle. 

Later, however, the increased capacity of the left ventricle is not suf- 
ficient longer to overcome the consequences of the defective valves, and thus 
all the symptoms of impeded circulation, as described above, commence to 
set in. The characteristic physical signs of defective aortic valves are the 
following: 

1. Diastolic noise of the aorta, in consequence of the regurgitation of 
blood into the left ventricle during the heart's diastole. 

2. Greater extension of the dull percussion sound in the heart's long 
axis, on account of the hypertrophy of the left ventricle. 

3. Arched appearance of the region of the heart for the same reason. 

4. The impulse of the heart's apex is felt lower down and outside of the 
nipple line. 

5. Strong, jumping pulsation of the carotid arteries. 

6. Short, jerking, wiry pulse. — Traube adds : 

7. The sounding of the crural artery. 

8. The rough systolic after-noise in the carotids. 

9. The want of the systolic sound at the heart's apex. 

4. Constriction or Stenosis of the Aortic Opening". 

The disturbance of circulation is, in such a case, of course, still greater 
than by mere defect of the valves; and therefore the patient soon shows 
symptoms of deficient circulation ; such as paleness, small, thread-like pulse; 
fits of fainting; coolness of the extremities; anaemia of the brain. At a later 
period the veins become overcharged with blood, aud in consequence we find 



444 DISEASES OF THE ENDOCARDIUM. 

the patient suffer with dyspnoea, cyanosis, and all the other symptoms of 
heart disease. 

Its characteristic physical symptoms are : 

1. Systolic noise, which is often heard in the carotid. 

2. Dull percussion sound, somewhat extended in the direction of the 
longitudinal axis of the heart. In consequence, dilatation and hypertrophy 
of the left ventricle. 

3. Apex lower down and outside of the nipple line. 

4. Pulse small, w T iry, irregular and thread-like. 

In case there exists at the same time a defect in the aortic valves, we 
may also hear a diastolic noise. 

5. Insufficiency of the Tricuspid Valves. 

This defect allows the blood to regurgitate into the right auricle, when 
the heart contracts. Thence the retrograde stream of blood goes into the 
vense cavse and jugular veins ; hence we feel a pulsation of the jugular vein, 
synchronous with the arterial pulse. This retrograde motion of the blood 
causes overfilling of all the veins, and its consequent results are hyperemia, 
cyanosis, hydrops, etc. 

Its characteristic physical signs are : 

1. Systolic noise in the right ventricle. 

2. Swelling and pulsation of the jugular veins. 

3. More extended dull percussion sound in the direction of the breadth 
of the heart on account of its right auricle having become enlarged and 
hyper trophied. 

This complaint is generally a secondary affection, in consequence of 
diseases of other valves; and then, of course, is attended by all the above- 
mentioned disturbances and signs. 

6. Stenosis of the Right Auriculo -ventricular Opening, 

7. Insufficiency of the Pulmonary Valves, 

8. Stenosis of the Pulmonary Opening 

are, uncomplicated, of such rare occurence, that even Skoda did not observe 
them on the living. Skoda, p. 371. 

The Treatment of all these different valvular affections has to be 
adapted to each single case, and it is not the diseased valve which points to 
any particular remedy, but the individual symptoms by which the whole 
morbid process manifests itself. 

Still I might give some general dietetic rules, which are of great im- 
portance for the treatment of those different affections. 



ENDOCARDITIS. 445 

Patients in whom we find symptoms of congestion of the brain or chest, 
ought not to eat much animal food ; must avoid all sorts of stimulants, and 
especially coffee, and all kinds of spices. Mental excitements and depressions 
are alike hurtful to them ; and neither too high nor too low a degree of tem- 
perature is advisable. 

Patients, however, in whom anaemia and debility prevail, ought to eat 
animal food and drink beer or wine ; ought not to overexert themselves, and 
ought to have all the fresh, pure air they can get. 

Aeon., usual symptoms of great restlessness, anxiety, fear of death, 
stitch-pains, haemoptysis with hacking cough, etc. 

Act. rac, catching pain in region of heart, worse on moving or bending 
forward, preventing inspiration ; palpitation and faintness; sexual disturbances 
in females. 

Arnica, heart feels as if bruised; palpitation from any exertion. 

Arsen., precordial anxiety and oppression; palpitation at night with 
anguish, cannot lie on back; after suppressed eruptions or foot-sweat. 

Cact. grand., livid complexion, sunken face ; difficult breathing, worse 
from exertion ; constant pain, darting and cutting from region of heart to the 
left shoulder and down the arm, worse from damp weather or any emotion; 
oedema, especially of left hand and legs up to the knees; icy-cold feet; inter- 
mittent pulse. Insufficiency of mitral valves. 

Calc. carb., trembling pulsation of the heart, worse after eating, at 
night with anguish ; inclination to take deep breaths ; menses too early and 
too profuse. 

Digit., irregular, intermittent beats of the heart; very slow when 
keeping still, but easily accelerated by any exertion ; feeling at times as if 
the heart stood still, with great anxiety, oedema of the lungs; bluish-red face, 
or death-like appearance. 

Ferrum, chlorotic symptoms ; congestion of the head ; spitting of blood ; 
palpitation, better from slowly moving about. 

Gelsem., "fears that unless constantly on the move her heart will cease 
beating." 

Kali hydr., darts in the region of the heart when walking; after mer- 
curial poisoning; after repeated attacks of inflammation of the heart. 

Laches., restless, trembling; anxiety about the heart; hasty speech; 
suffocation on lying down; weight on the chest; heart feels constricted; 
numbness of the left arm. 

Lauroc, persistence of the ductus Botalli (arterial duct), in conse- 
quence of which there exists a cyanotic discoloration of the face, fingers and 
feet, worse from external cold; dyspnoea; acute or dull pain in the heart, 
worse from a deep inspiration. Heart's action irregular; blowing sound on 
the heart's apex. (Bibliotheque homceopathique, September, 1881.) 



446 DISEASES OF THE ENDOCARDIUM. 

Lil. tigr., heart feels as if grasped, with pain and heaviness of left 
mamma to scapula; pulsations over whole body, and outpressing in hands 
and arms, as if blood would burst through the vessels; fluttering, awakens 
her at night, with cold hands and feet covered with cold sweat, with sharp, 
quick pain in left chest. 

Lithium, soreness about the heart, worse stooping; pain in the limbs; 
finger-joints tender and painful; sleeplessness. 

Natr. mur., irregularly intermitting pulsation; fluttering of the heart, 
with weak, faint feeling and necessity to lie down; coldness of hands and 
feet; numbness of hands relieved by rubbing; cutting pain in urethra after 
micturition; scanty menses. 

Phosphor., congestion of the lungs; tightness across the chest and 
tight cough; spitting of blood; palpitation worse after eating, or mental 
emotion; yellow spots on the chest; painless diarrhoea. 

Psorin., stenosis of left osteum venosum; purring in the region of the 
apex ; cyanotic lips ; dyspnoea and shortness of breath when walkin in open 
air ; better when lying down. 

Rhus tox., palpitation worse during rest; pain from region of the 
heart into left arm, with numbness ; rheumatism. 

Spigel., stitches about the heart; anxiety and oppression; can only lie 
on right side, or with head very high ; least motion aggravates. 

Spongia, violent palpitation, awakens after midnight with a sense of 
suffocation; loud cough, great alarm, agitation, anxiety and difficult breath- 
ing ; violent gasping respiration ; pain in the heart. 

Zincum, cyanotic face; great dyspnoea; dropsy of the lower extremi- 
ties, ascites and anasarca of the upper extremities. Dilatation and hyper- 
trophy of heart ; insufficiency of mitral valve ; urine scanty with albumen ; 
appetite tolerable; bronchial catarrh. (Dr. A. Pfander.) 

Besides compare: Anac, Iodium, Kali carb., Lycop., Naj a, Plumbum, 
Pulsat., Sepia, Sulphur, Veratr. 

Heart-clots. 

Fibrinous coagulations, especially in the right ventricle and auricle, are 
very frequently found on post-mortem examinations. If they have originated 
recently, either soon after death or during death-struggle, they are of a 
whitish-yellow, generally translucent appearance, frequently jelly-like in 
consistency, moist and shiny, as if oedematous, and infiltrated with blood on 
their lower surface; they may extend into the vessels and be drawn out like 
strings or cords, and can easily be separated from the subjacent parts without 
injury to either; they are the result of the natural coagulation of the blood 
during the retardation and final cessation of its current. 



HEART-CLOTS. 447 

But clots may also form during life, either in consequence of a slacken- 
ing in the current of the blood from some obstruction or loss of propelling 
force ; or in consequence of gradual deposition of fibrine on roughened sur- 
faces produced by vegetations or inflammatory processes of the inner wall of 
the heart; or in consequence of fibrinous coagula from distant portions of 
the vascular system, serving as nuclei for more extensive fibrinous clots ; or 
perhaps also in consequence of an increase of fibrine in the blood during 
certain diseases, or a greater tendency of the blood to coagulate. 

These clots, called True polypi of the heart, are dull in appearance, 
dry, rotten, friable, of a whitish-yellow, or gray color, consist of various 
layers of different color and contain at times deposits of lime salts and in 
their centre a purulent fluid. They are of various sizes, and usually firmly 
attached to the inner walls of the heart ; they are found particularly at the 
apex of the left ventricle and in the appendices of the auricles. 

The Symptoms of this affection are not characteristic enough to distin- 
guish it from other heart affections, with which it may be complicated. 
Heart-clots may occasion sudden death in patients previously in apparent 
good health. 

In other cases they may produce dyspnoea, cyanosis, or pallor of the 
whole surface, expectoration of bloody sputa, coldness of the extremities, 
stupor, convulsions, loss of consciousness, death. The heart's action usually is 
slow, seldom irregularly violent. Dropsical effusions may occur if the patient 
survives long enough. The physical signs which are occasioned by the clots 
are of no diagnostical value. The presence of heart-clots may, therefore, be 
guessed at but cannot be proven positively. 

III. DISEASES OF THE HEART-MUSCLE. 

Myocarditis, Carditis, Inflammation of the Heart-muscle, 

Is found always in connection with peri- or endocarditis ; and then, its seat is 
generally the left ventricle. The substance of the muscle appears yellowish, 
sometimes fatty degenerated. Its most frequent occasion is acute rheumatism 
of the joints, but it has also been observed in the course of puerperal and 
exanthematic fevers. 

There are no characteristic signs of this complaint, because it is almost 
always mixed up with with peri- or endocarditis. Mild forms pass over 
without any consequences ; but if it extends to the formation of abscesses, it 
may cause widening of the heart-muscle (partial aneurism), or bursting of 
the heart-muscle, and consequent sudden death. When the abscess dis- 
charges into the ventricle it causes the formation of emboli, with their 
consequences. 



448 



DISEASES OF THE HEART-MUSCLE. 



Hypertrophy and Dilatation of the Heart. 

Hypertrophy consists of an increase in mass of the heart-muscle, or a 
thickening of its walls, whereby the inner cavity becomes narrower: this is 
the so-called concentric hypertrophy; or the heart-muscle is increased in 
thickness, and the inner cavity widened at the same time: this is the so- 
called eccentric hypertrophy. 

When, however, the inner cavity is widened, and the heart-muscle at 
the same time has grown thinner, it is called dilatation of the heart. 

The most frequent of these three forms of altered conditions is eccentric 
hypertrophy. 

But it is not always the whole heart that is enlarged or dilated ; it is 
generally only one-half of it that is thus affected. A hypertrophied left ven- 
tricle makes the heart longer, reaching further down in the left thorax, 
while an eccentric hypertrophy of the right ventricle makes the heart broader, 
so that it reaches further over into the right thorax. 




^ff/gfl 




Hypkrtkophy of Left Ventricle. 

a. Heart elongated. 

b. Liver. 

c. Stomach. 

d. Lungs. 



Eccentric Hypertrophy of Eight Ventricle. 

a. Heart widened. 

b. Left lung. 
c. Eight luog. 

d Enlarged liver. 

e. Stomach. 

/. Enlarged spleen. 



Both, hypertrophy and dilatation, are most frequently caused by dis- 
turbed circulation, in consequence either of diseases of the valves or diseases 
of the arteries, like aneurism, or obstacles in the capillaries in the lungs. 
Also pericarditis and myocarditis, mental excitements, strong coffee, tea, and 
spirituous liquors have been found exciting causes of this complaint. 

Eccentric hypertrophy of the left ventricle manifests itself by an increased 
impulse of the heart, either heaving in character or jarring the chest-wall, 
more or less towards the left of the nipple-line and further down, in some 
cases even as far as the seventh and eighth intercostal space ; it is an enlarge- 












FATTY DEGENERATION OF THE HEART. 449 

ment of the heart in its long axis, and causes sometimes an intensification of 
the sounds, especially of the second sound in the aorta, sometimes a metallic 
clink, increased pulsation of the carotids, murmurs in the larger arteries and 
also in the small vessels far removed from the heart, and a pulse perceptibly 
larger in volume under the finger. 

"In hypertrophy of the right ventricle, the heart's impulse is not increased, 
except occasionally near the lower portion of the sternum ; the apex beats 
further to the left, but not lower doivn. The area of dulness is increased in 
breadth, and the second sound in the pulmonary artery is accentuated." 

" In total hypertrophy we find a combination of symptoms corresponding 
to the hypertrophy of the ventricles. It is seldom, however, that we can 
succeed in declaring with accuracy which half of the heart is the more en- 
larged." (Schroeter.) 

Dilatation is found more frequently of the right than of the left ventricle. 
The impulse of the heart is, as a rule, weaker than normal. There follows 
retardation of circulation, and consequently dyspnoea, cyanosis and dropsy. 
Pulsation of the veins of the neck are characteristic to a dilatation of the 
right auricle. 

THERAPEUTIC HINTS.— Compare what has been said of the dif- 
ferent affections of the heart. As hypertrophy is more or less a consequence 
of the one or the other, the characteristic indications of the different remedies 
there described must also fit here. I have only to add: 

Arsen., dilatation of right ventricle, with swelling of legs and vertigo; 
scanty urine without albumen. 

Plumb, ac, stitch in the region of the heart during an inspiration, 
with anxiety ; heat and redness of the face ; rushing of blood in the region 
of the heart during a rapid walk ; anguish about the heart, with cold sweat ; 
palpitation of the heart. 

Post-mortem, after poisoning, has shown that the serous coat of the peri- 
cardium is lined with a layer of reddish-gray, fine villous, meshy, firm, ex- 
uded lymph. The heart is more than double its natural size. The wall of 
the left ventricle is more than an inch thick. 

Kalmia lat., after rheumatism; hypertrophy; palpitation; dyspnoea; 
pain in the limbs ; stitch-pain in the lower part of the chest ; prosopalgia on 
right side. 



Fatty Heart and Fatty Degeneration of the Heart. 

Under Fatty heart is understood an accumulation of fat in the sub- 
pericardial connective tissue, at the apex, in the ventricular furrows along the 
course of the vessels, at, the base around the junction of the auricles and ven- 
29 



450 DISEASES OF THE HEART-MUSCLE. 

tricles, at the origin of both the great vessels, and at times embracing the 
whole heart like a capsule of fat. By its spreading along the course of the 
fibres of the connective tissue in between the muscular bundles it causes the 
latter to atrophy and appear as thin pale stripes and layers. It is usually 
accompanied with a simultaneous deposit of fat throughout the system, espe- 
cially in drinkers. 

The Fatty degeneration of the heart takes place in the primitive 
bundles of the muscular fibres themselves; they appear cloudy and their 
transverse striae disappear; the heart substance thereby becomes pale and 
yellowish in color, and its texture flabby and friable. It may be acute and 
chronic. Its Causes are: various chronic diseases, protracted suppuration, 
great loss of blood, tubercular and cancerous cachexia, severe forms of syphi- 
lis, profound anaemia, and also diseases of the heart itself, such as pericar- 
ditis, endocarditis, valvular lesions, chronic parenchymatous myocarditis. 
Its acute form occurs after puerperal, typhoid, remittent and exanthematous 
fevers, after yellow atrophy of the liver and Bright's disease, also in con- 
sequence of poisoning with phosphorus, mineral and vegetable acids aud 
alcohol. 

The Symptoms of this disease are in no way very characteristic. Its 
acute form is usually obscured by the attending primary disease, and a de- 
posit of epicardial fat, which leads to atrophy of the muscular tissue, cannot 
be distinguished from the true fatty degeneration. Still its occurrence, es- 
pecially in advanced age, in corpulent people, its usually feeble impulse and 
pulse, its occasional attacks of dizziness and fainting, the presence of the 
arcus senilis may, by a careful exclusion of all other diseases in which simi- 
lar symptoms occur, lead to a correct diagnosis. 

Both forms may exist for many years if they act only partially destruc- 
tive to the heart -muscle, or are kept in check by judicious treatment ; death 
may occur from paralysis or rupture of the heart. 

THERAPEUTIC HINTS.— An undue accumulation of fat should be 
prevented by a judicious diet, avoiding fat meat, butter, milk and such ar- 
ticles which consist principally of starch and sugar. Allowable are lean 
meats, fish, vegetables. Of drinks, malt liquors should be forbidden, while 
red wines, claret and the like moderately used may be of benefit. Water is 
the safest drink. In case of syncope an alcoholic stimulant may be of use, 
and for the spells of dizziness, the stooping with the head low down between 
the knees has been found of great benefit, because it helps mechanically to 
bring a sufficient quantity of blood to the brain, which the weakened propel- 
ling force of the heart alone is not capable of doing. For the same reason 
in case of syncope the head should be put low. Among the remedial agents 
we may especially turn our attention to remedies that have proved beneficial 



NERVOUS PALPITATION OF THE HEART. 451 

to persons in whom a tendency of growing fat was manifest, e. g., Arsen., 
Calc. carb., Ferrum, Sulphur. 

Arnica, recommended by Kafka. 

Aur. mur., has relieved when there was a peculiar hacking cough 
with weak impulse, also where a pain existed as if from angina pectoris 
attended with blood-spitting. 

Digit., where there is slow or irregular action of the heart. 

Phosphor., produces all the spmptoms of fatty degeneration in 
different parts of the body. 

IV. NERVOUS AFFECTIONS OF THE HEART. 

Nervous Palpitation of the Heart 

Is an increased action of the heart without any detectable organic lesion of 
that organ. 

The heart's activity is accelerated by irritation of the ganglia which we 
find imbedded in its substance ; by irritation of the cardiac branches of the 
ganglion stellatum, which take their origin from fibres of the cervical por- 
tion of the sympathetic; by irritation of the nerve fibres which originate in 
the medulla oblongata, run down the spinal cord, pass out from the cord 
with the spinal nerves and become entwined with the sympathetic ; and by 
irritation of the sympathetic in general, causing a contraction of the vessels, 
and thereby an increased blood pressure in the aortic system with conse- 
quent increased labor of the heart. These are the exitor nerves of the heart's 
activity ; its restraining or inhibitory forces rest in the pneumogastric and its 
ramifications. An irritation of the vagus slackens the movements of the 
heart in frequency, but a division of the vagi increases this frequency for 
the reason that then the exitor nerves have no restraining power to overcome. 

The blood too as- regards its quantity, as well as its quality, has a 
powerful influence on the action of the heart. 

The Special Causes of palpitation are: mental excitements of all 
kinds, such as fear, joy, anger and the like; diseases of the brain and spinal 
cord of various kinds, amongst them: hyperemia and inflammation of these 
organs, psychoses, hypochondria, hysteria, exhaustion from protracted night- 
watching, or venereal and other excesses; diseases of the abdominal cavity, 
such as accumulation of gas in the intestines, worms, gall-stones, renal cal- 
culi and affections of the genital apparatus; partial hyperemia from sup- 
pressed menstrual or hemorrhoidal flow; chlorosis and anaemia, and first 
stages of consumption, gout and different drugs, especially alcohol, coffee, tea 
and tobacco. 

Xervous palpitation of the heart is at times attended with dyspnoea, dis- 



452 NERVOUS AFFECTIONS OF THE HEART. 

tress and even pain in the chest, with throbbing of the carotids, flushing of 
the face, or (oftener) with pallor and cold sweat, with dizziness, faintness, 
and specks or flashes of light before the eyes. Some persons cannot lie down, 
must sit up, or cannot lie on the left side. Auscultation often reveals the 
first sound increased and of a metallic quality; "the second sound is wanting 
only in cases of tremendous acceleration of the heart's movements, where the 
heart has not had time fully to complete its diastole." (^Schroeter.) 

After the attack the absence of murmurs, or of enlargement of the heart, 
establishes its Diagnosis. The presence of a diastolic murmur excludes the 
diagnosis of a simple nervous palpitation, because such murmurs never occur 
without organic changes in the heart. 

Its Prognosis depends entirely on the nature of the underlying cause; 
if that is removable, its effect will cease. In old people with atheroma of the 
arteries, it may end with apoplexy. 

THERAPEUTIC HINTS— Aeon., in young subjects; after fright; 
after wine. 

Arsen., after suppressed herpes circinatus and suppressed perspiration 
of the feet. 

Aurum mur., palpitation, sleeplessness, depression of spirits, with 
thoughts of suicide, constipation. Motion, wine or beer have no influence. 

Asaf., in women, after suppressed discharges, or bodily exertions, with 
small pulse ; breathing not oppressed. 

Bellad., with congestion of the head. 

Benz. ac, worse at night and when lying; alternating with tearing 
rheumatic pains in the extremities. 

Cact. grand., palpitation is preceded by rumbling in the stomach; 
pains in shoulders and arms ; change of life. 

Calc. carb., after suppressed eruptions and pimples on the face; onan- 
ism. Cold lower extremities ; vertigo on going up stairs, or up a hill ; bloat- 
ing in the pit of the stomach ; craving for boiled eggs ; copious menstruation. 

Camphora, when attended with coldness of the skin; cold extremities; 
pale face ; and sudden oppression of breathing. 

China, great weakness from loss of vital fluids; long-continued nursing. 

Coccul., tremulous palpitation from quick motion and mental excite- 
ment, with dizziness and faintness. 

CorTea, after excessive exaltation, joy, surprise. 

Digit., attended with apnoea, danger of suffocation; yellow and blue 
face, worse from motion, from moving the arms. 

Ferrum, anaemia; throbbing in all the blood-vessels; soft bellows- 
sound at the apex, with anxiety in chest and heat rising from pit of stomach ; 



ANGINA PECTORIS, STENOCARDIA. 453 

with fear; after bodily exercise; also must move about, can neither sit nor 
stand. 

Graphit., amenorrhea ; pimples on the face about the menstrual period. 

Kali carb., throat feels as if squeezed, as if the lungs came in the 
throat ; stitch-pain and anxiety in pit of stomach and through the chest ; 
pale grayish color of the face; dizziness in walking; cold feet; scanty 
menses. 

Merc, sol., wakes with nervous trembling; thumping of the heart 
and agitation as if he had been frightened ; weakness at the heart as if dying. 

Moschus., when combined with hysterical symptoms. 

Nux mosch., paroxysms after midnight, as if the heart were stopping, 
and then beating violently, with loud belching; better from drinking hot 
water and keeping warm ; must walk about. Hysteria. 

Nux vom., after coffee, wine, liquors, spices. 

Natr. mur., fluttering, long-standing chlorosis, with torpid skin and 
suppressed menses. 

Nitr. ac, when caused by the slightest mental excitement. 

Opium, after alarming events, causing fright, grief, sorrow, etc. 

Phosphor., dyspnoea, tightness across the chest, great weakness, and 
after any little mental excitement; violent hammering in the chest, aggra- 
vated by motion, benumbing all over. 

Phosph. ac, in children aud young persons who grow too fast; after 
self-abuse, long grieving. 

Pulsat., young girls during the time of puberty; from suppressed 
menses. 

Rhus tox., always worse when being quiet. 

Secale, with profuse menstruation of a watery discharge; after sexual 
excesses ; comes in paroxysms with spasmodic shocks from right side of chest 
into right arm and leg; coldness and numbness of right hand and stinging 
in fourth and fifth fingers; worse at night, after each meal; better in 
open air. 

Sepia, tremulous, intermitting pulsation ; suppressed menstruation. 

Silic, always after quick or violent motions, such as playing ball, etc. ; 
panaritia. 

Thea, after exciting talk and mental exertions, with sleeplessness. 

Ver. alb., headache, nausea, vomiting, diarrhoea; bleeding of the nose 
occasionally ; cold perspiration on forehead. 

Angina Pectoris, Stenocardia, 

Is characterized by : " Pain in the region of the heart, occurring in j^arox- 
ysms, which usually radiates over the left side of the thorax and the left 



454: NERVOUS AFFECTIONS OF THE HEART. 

arm, more rarely over both sides and arms; the pain is associated with pecu- 
liar sensation of anxiety and constriction, and often also with other motor, 
vasomotor and sensitive disturbances." (Eulenburg.) 

It is often complicated with organic diseases of the heart, such as: faults 
in the valves, or fatty degeneration of the heart, or atheromatous processes 
in the aorta, or ossification and contraction of the coronary arteries. In its 
real nature, however, it is a neurosis and may be classed according to its 
symptomatology, with the visceral neuralgias, including cardialgia, colic, 
hysteralgia, etc. For this reason it may be divided : 

1. In a Ganglionic angina pectoris, when there is either an irritation 
of the excitomotor nerves with acceleration of the pulse, or a paralysis of the 
same with retardation of the pulse. 

2. In a Regulator angina pectoris, when there is either an irritation 
of the vagus with retarded but full and hard pulse, increased force of impulse 
of the heart, sometimes a temporary arrest of the same and disturbance of 
phonation and deglutition ; or, more rarely, a paralysis of the vagus with 
acceleration of the pulse. 

3. In a Reflex angina pectoris, when there is a reflex neurosis of the 
vagus from diseases of the abdominal organs with the symptoms of irritation 
of the vagus. 

4. In a TaSO angina pectoris, when there is either an irritation of the 
vasomotor nerves which run in the sympathetic, with contraction of the 
vessels and increased pressure causing arterial ansemia, paleness and coldness 
of the skin and but little acceleration of the pulse, if any; or, more rarely, a 
paralysis with opposite symptoms. 

These principal types will, in given cases, not always be so clearly ex- 
pressed, that a recognition or distinction between them could be called an 
easy matter; the great variability of the circulatory symptoms during an 
attack of angina pectoris, on the contrary, hints to the possibility that there 
exist manifold conrplications between these different types. Of greater prac- 
tical importance, however, is it to find out whether these attacks be com- 
plicated, as they often are, with an organic disease of the heart, or of an 
abdominal organ, or whether they be a pure neurosis. If the latter, the 
prognosis is more favorable, than in the case of such complications where it 
entirely depends upon the nature of the latter. 

THERAPEUTIC HINTS.— E. T. Blake advises the patient on the 
advent of an attack to take a deep inspiration, and if possible to hold the 
breath ; to use no tea, tobacco, etc., and to avoid all unusual exertions or 
violent emotions. 

Kafka gives the following hints : 



ANGINA TECTORIS, STENOCARDIA. 455 

Aur. mur. 5 , where there is hyperemia in consequence of stagnation of 
blood in the heart. 

Glonoin. 3 , as an intercurrent remedy to prevent the orgasm from get- 
ting accustomed to the influence of Aur. mur. 

Agar. 3 , in the gastralgic or spasmodic form. 

Kali carb., when Agar, seems to lose its favorable influence; in other 
cases, however, Carb. veg., or Lact. vir., or Lycop., are better indicated 
than Kali carb. 

Sambuc. 3 , where the pressure proceeds from the spine; in individuals 
formerly fat and robust and now emaciated in consequence of mental emo- 
tions or sexual indulgence. 

Phosphor. 3 , as an intercurrent remedy, if the pressing pain is worse 
under the sternum. 

Petrol. 3 , if the pressing pain is worse between the shoulder-blades. 

Kali carb., is likewise indicated in this form, either alone or in alter- 
nation with the above. This change of remedies is best resorted to after eight 
or twelve days, if improvement seems to come to a standstill. 

Chin, sulph., where marasmus is a prominent symptom. So may also 
Phosphor., or Cuprum, or Ipec, or Veratr., be indicated. 

Arsen., Leaches., Chin, ars., are indicated when dropsical symp- 
toms, with venous hyperemia and cyanosis make their appearance. 

Nux vom., Carb. veg., are important when there is loss of appetite 
and accumulation of gas in the bowels. 



The following remedies have also proved beneficial : 

Aeon., anxious restlessness with fear of death; general and local 
tingling. 

Amyl. nitr. 

Arnica, bruised pain in region of heart; fatty degeneration. 

Arsen., anxious restlessness with great weakness; great thirst, but 
drinks little at a time; great oppression; attacks worse after midnight ; worse 
from motion. 

Cact. grand., suffocating constriction at throat, with full, throbbing 
carotids ; wants to lie perfectly quiet on the back ; mental or johysical exer- 
tion causes palpitation; attacks come on also in sleep with anxious and 
frightful dreams. Fear of some organic lessionof the heart which will cause 
sudden death. 

Coca, a girl, climbing a mountain, was seized with an attack and be- 
came quite cold. (Riehter.) 

Cuprum, attacks from excitement and exertion; slow pulse. 

Digit., indescribable deathly anguish; death-like feeling in pit of 



456 NERVOUS AFFECTIONS OF THE HEART. 

stomach; vertigo and fainting. Pulse feeble, irregular, slow, intermitting; 
heart's action more vigorous than pulse. 

Diosc. vill., neuralgic pain in stomach; cannot speak; laborious 
breathing; sudden severe pain in middle of sternum, extending to both 
arms and hands ; cannot move ; cold, clammy sweat all over ; impulse very 
feeble; pulseless. (F. E. Brown.) 

Hepar, when after the attack: dyspnoea; dry, nervous cough all night; 
pain in neck; faintness and inability to recline. 

Laches., choking constriction and rising in the throat; worse after 
sleep. 

Lact. vir., tightness and oppression of chest waking from sleep; feels 
as if suffocating, must get out of bed. 

Lauroc, suffocation and gasping for breath; violent pain in stomach 
with loss of speech ; eructations tasting of bitter almonds ; cold, moist skin ; 
convulsions of the muscles of the face. 

Naja trip., similar to Laches. 

Ox. ac, violent irritation of the alimentary canal; costiveness; diffi- 
culty of breathing; jerking inspiration, and sudden and forced expiration, as 
though the patient made a sudden effort to relieve himself of intense pain by 
expelling the air from the lungs. Oppression of the chest, especially towards 
the right side ; pain on expiration ; sharp, darting or lancinating pains in the 
heart and left lung, also in the arms ; jerking pains like short stitches, con- 
fined to a small space, lasting for a few seconds. Numbness and weakness in 
back and limbs ; peculiar numbness of whole body, approaching to palsy ; 
coldness and complete loss of power of motion in the limbs. Movement ex- 
cites and aggravates pain. Periodical remission for some hours or days. 
After other remedies had failed. (P. Dudley.) 

Phytol., pain goes to the right arm, or right side. 

Rhus tox., pain extending to the left arm; painful stiffness all over, 
worse in rest. 

Spigel., exceedingly sharp pain worse from any motion; frequently 
indicated; also in complication with other heart affections. 

Spongia, suffocating spells at night; worse with head lying low; has 
to sit up. 

Tabac, neuralgia up into the neck; pain between the shoulders; pulse 
small, irregular, imperceptible; lividity of the skin ; features drawn. Deathly 
nausea with cold perspiration. 

Ver. alb., periodical attacks of crampy pain in left chest, or cutting 
pain with excessive agony, extending to the shoulders ; general prostration, 
skin cold and clammy. 

To all these may be added for further consideration : Amm. carb., 
AmyL nitr., Angust., Apiol, Arg. nitr., Act. rac, Bellad., Bryon., Cinchona, 






ANEURISM OF THE THORACIC AORTA. 457 

Caustic, Hydr. ac, Ipec, Juglans cin., Moschus, Sepia, Stramon., Sulphur 
and Tarant. 

V. DISEASES OF THE AORTA. 

Aneurism of the Thoracic Aorta. 

Aneurism means a dilatation of a short piece of an artery forming a 
kind of sac at that place. Such dilatations are more frequently found in the 
aorta ascenclens than in the aorta descendens. It can be diagnosticated only 
when it reaches the exterior thoracic wall. In such a case it renders that 
part of the chest perfectly dull on percussion and more resisting to the touch. 
Also, we often observe on that part a pulsating swelling with a peculiar kind 
of purring in it, which extends up into the carotid arteries. We find this 
swelling on the right side of the sternum, between the second and third rib, 
if the aneurism is an enlargement of the convex part of the aorta. It makes 
its appearance, however, on the left side of the sternum in the same intercos- 
tal space when the aneurism has formed on the concave part of the aorta. 
Its symptoms are: palpitation of the heart, dyspnoea, asthma, bronchial ca- 
tarrh, hsernoptoe, swelling of the jugular veins, with cyanosis, oedema of the 
upper extremities, difficulty in swallowing, hyperemia of the brain — all 
symptoms in consequence of its pressure either upon the lungs or the oesopha- 
gus, and in consequence of disturbed circulation. 

The aneurism of the arch of the aorta has its seat behind the manubrium 
sterni, and a deep pressure with the finger into the fossa jugularis may detect 
its pulsation and purring. 

The aneurism of the aorta descendens must be very large in order to 
cause a duller sound on percussion, or a swelling between the left shoulder- 
blade and the spine. Its symptoms are the same as those of aneurism of the 
ascending aorta; and, in addition, it may cause paralysis of the lower ex- 
tremities, rectum and bladder. 

THERAPEUTIC HINTS.— Ergot., has been used hypodermically 
with success by Von Langenbeck " on account of its power to contract mus- 
cular fibres." Two cases (both women) of aneurism of the mesenteric artery 
are reported as having been cured by Secale. 200 (T. M. Pearce, Med. Inv., 
1875, Vol. I, p. 48.) 

Gallic ac, in drop doses of the tincture cured a case of aortic aneu- 
rism. (Helmuth, Gilchrist.) 

Lycop. 12 , is reported by R. Hughes as having cured a carotid aneurism 
in four days. (British Journal, 70, p. 792.) 

Spigel., then Carb. veg., and later Bryon. and Spigel., have cured 



458 DISEASES OF THE AORTA. 

a thoracic aneurism. (C. F. Nichols, New Eng. Gazette, March, 1873, p. 
106.) 

Spongia, has relieved the paroxysmal, dry, suffocative cough, coming 
at irregular intervals, especially on lying down or drinking hot tea, also a 
distressing fulness in the stomach after eating which attended an aneurism of 
the descending aorta. (T. C. Fanning, Amer. Jour, of Horn. Mat. Med., 
Vol. Ill, p. 10.) 

To finish the morbid affections of the thoracic organs I have yet to speak 
of the affections of the diaphragm, that muscle which forms the partition be- 
tween the thoracic and abdominal cavity, and which participates greatly in 
the acts of respiration. 

1. Diaphragmitis, or Inflammation of the Diaphragm. 

The substance of the diaphragm being a muscular, tendinous tissue, is 
scarcely ever primarily affected, while its serous lining on its upper surface, 
a continuation of the pleura and pericardium, and on its lower surface a con- 
tinuation of the peritoneum, frequently participates in inflammations of these 
membranes. Symptoms, such as impossibility of taking a deep breath, hic- 
cough, yawning, risus sardonicus, pain in the shoulders, vomiting of green 
masses, great difficulty in swallowing, even hydrophobia, denote in pleuritis, 
pericarditis, or peritonitis, an extension of the inflammatory process upon the 
diaphragm. 

Physical signs, are none. 

THERAPEUTIC HINTS.— Aeon., hard, feverish pulse; thirst; 
anxious impatience; restless tossing about; painful cough; difficulty in 
breathing, and pain and heat in the upper region of the abdomen. 

Apis, burning pain; must bend forwards from a contractive pain in the 
hypochondria. 

Bellad., in plethoric persons with sympathetic affection or inflamma- 
tion of the liver; or in consequence of concrements in liver or kidneys; in 
pylephlebitis; in puerperal affections; in violent headache with active 
hyperemia. (Buchner.) 

Bryon., stitching pain in the region of the diaphragm, worse from any 
motion, from coughing ; white, dry tongue without thirst, or else great thirst 
with drinking large quantities of water. 

Cact. grand., feeling as of a cord around hypochondria; congestion to 
the chest; shooting pains through to the back and up each side of the chest; 
cannot lie down ; dry, tickling cough as from dust in throat. 

Chamom., throbbing, burning pain in the region of the short ribs and 
pit of the stomach, worse from pressure; short and anxious breathing; short, 



HICCOUGH. 459 

dry cough; vomiting; belching; great restlessness; tossing about; loud 
complaining, etc. 

Colchic, similar to Bryon., for gouty persons; albuminosis. 

Digit., after pleuritis; grasping pain ; nausea and vomiting; oppres- 
sion in middle of the chest, difficult breathing ; pulse at first suppressed, then 
quick; nails blue; face long and cold. In spite of anaemia the patient can 
bear no high temperature. Better in sitting than in lying. (Buchner.) 

Dulcam., in rheumatic affections of the spinal cord. (Buchner.) 

Hepar, after Bryon., in fibrinosis, promotes resorption. (Buchner.) 

Lycop., sense of constriction from the right side all around the short 
ribs; cannot stretch himself or lie upon the back; neither stand upright. 

Nux vom., muscular pain of a grasping, rooting nature, with nausea 
or vomiting. 

Rhus tox., worse when lying still; or disposition to move notwith- 
standing the pain caused by it ; commencing on the left side and going to the 
right. 

Stramon., mixture of hyperemia and spasm in consequence of affec- 
tions of the spine and the diaphragm with hiccough, sympathetic spasms of 
the epiglottis and similar symptoms. (Buchner.) 

Sulphur, after Bryon., in fibrinosis, promotes resorption. 

Tabac, muscular pain caused by renal calculi when incarcerated in 
one of the ureters ; it contracts the longitudinal (Bellad., the circular) fibres. 
(Buchner.) 

Compare Pleuritis and Peritonitis. 

2. Singultus, Hiccough. 

Hiccough consists in a spasmodic contraction of the diaphragm, by 
which the air is suddenly drawn in, causing that sound peculiar to hiccough- 
Its causes may be of a cerebral origin, as in diseases of the brain ; it may be 
the consequence of anaemia from long-standing, weakening diseases, after 
great loss of -blood and vital fluids ; of strong mental affections, like fright, 
anger, etc. 

Or, it may be a mere reflex from diseases of the pleura or pericardium ; 
or it may accompany different affections of the stomach, the liver, the intes- 
tinal canal. If it takes place in consequence of exhausting diseases, like 
morbus Brightii, tuberculosis, typhus, cholera, pleurisy, with abundant exu- 
dation, large abscesses, etc., it is always a dangerous symptom, continues for 
days and may be the forerunner of a fatal issue. According to the different 
causes many remedies may be indicated. 



460 



DISEASES OF THE AORTA. 



THERAPEUTIC HINTS.— Buchner gives the following: 

Arsen., after cold fruit. 

Hyosc, when there is inflammation of intestinal organs. 

I gnat., especially in children. 

Nux vom., after cold drinks. 

Puis at., after cold fruit. 

Ruta, when associated with depression. 

Stramon., in the most obstinate forms; in children when attended 
with restlessness in the night and screaming during sleep. 

Ver. alb., after hot drinks. 

Also the following remedies may come into consideration : Amyl nitr., 
Bismuth., Carb. veg., Crot. tigl., Ferrum, Laches., Marum ver., Moschus., 
Niccol., Ranunc, Ratan., Staphis., Zincum. 

3. Neuralgias of the Diaphragm 

require Atrop., Rhus tox., Mezer. ; in inveterate cases: Silic. ; in inter- 
mitting cases: Ignat. and the Alkalies in combination with arsenious 
acid. (Buchner.) 



4. Rupture and Perforation of the Diaphragm. 

Ruptures are caused by violent concussions or heavy lifting; whilst 
perforations are the result of suppurating processes either in the thoracic or 
abdominal cavity. When ruptures take place from out of the thorax they 
are generally attended by dyspnoea, cough, hiccough, suffocating spells and 
fainting. When from out of the abdomen, by vomiting, colic, obstinate con- 
stipation. 

Perforation takes place from suppurating processes in the thoracic cav- 
ity ; for example, in consequence of pyothorax ; when the fluid discharges 
into the abdominal cavity it causes peritonitis. 



ABDOMEN 



When we examine the abdomen by sight or inspection we have to take 
into consideration the following conditions : 

1. Its appearance in regard to size. 

a. Enlargement of the abdomen may be partial or general. 

Partial enlargement depends upon abnormal sizes of the abdominal vis- 
cera; either the stomach, liver, spleen, uterus, ovaries, kidneys, glandular 
structures, bladder, and so on. Also, upon pathological products, as tumors 
of all kinds, encysted exudation, extra-uterine pregnancy, hernia, and so on. 

General enlargement may arise from cedematous infiltration of the ab- 
dominal walls; or from accumulation of fat in the subcutaneous cellular 
tissue, and the omentum ; from an accumulation of gas in the stomach and 
intestines; from a collection of gas or fluid in the peritoneal sac; from large 
tumors, which fill the whole abdominal cavity ; from pregnancy, and some- 
times in consequence of frequent pregnancies, the so-called pot-belliedness, 
and likewise in scrofulous children from enlarged mesenteric glands. 

b. The abdomen appears smaller — sunken in — sometimes to such a degree 
that the spinal vertebrae may be felt through the abdominal walls. This we 
observe in persons who have been starving for a considerable time ; also in 
cases of general marasmus; in strictures of the oesophagus, the cardia, the 
pylorus, or the duodenum; after severe and long-continued diarrhoea and 
cholera ; it is also a sign of painter's colic from poisoning with lead, and 
quite characteristic in brain diseases, especially tubercular meningitis. 

2. Its appearance in regard to motion. 

a. Respiratory motion. The diaphragm, moving up and down, makes, 
as we know, the abdomen participate in the respiratory motions of the chest. 

This respiratory motion of the abdomen is increased in such affections 
of the chest as prevent a normal extension of the thorax, as pneumonia, 
pleurisy, etc. 

It is decreased, or ceases altogether, in inflammation of the peritoneum, 
in large effusions of fluids or gas in the abdominal cavity, in consequence of 
large tumors which fill the abdomen, and also from injuries of the diaphragm. 

(461 



462 ABDOMEN. 

b. Pulsation. We observe it generally in the pit of the stomach, some- 
times lower down, nearly to the umbilical region, rarely below the navel. 
This palpitation may have different causes : 

1. Abnormal position of the heart, its apex lying towards the pit of the 
stomach. In this case we hear, on auscultation, both ticks of the heart, or 
noises, if there are any, in the pit of the stomach, and not at the normal place 
below the nipple. 

2. It is caused by the right ventricle, which communicates its motion to 
the left lobe of the liver. In this case Ave hear also, on auscultation, both 
ticks of the heart at the pit of the stomach, and at the same time at the 
normal place. 

3. It is caused by the descending aorta, and the pulsation extends then 
further down towards the navel. In this case we hear, on auscultation, only 
one sound, or one noise, if there be any ; this, however, appears a little later 
than the impulse of the heart at its normal place. 

The causes of this abdominal pulsation may be — 

a. Kelaxed and thin abdominal walls; collapsed state of the abdomen. 

b. A curvature of the spine forwards, whereby the aorta comes nearer 
to the abdominal walls. 

c. A thickened left lobe of the liver. 

d. Increased impulse of the heart, as in hysteric individuals; or hyper- 
trophy of the left ventricle in consequence of insufficiency of the aortic 
valves. 

3. Its appearance in regard to the elasticity of its external 
walls. We find it greatly relaxed, hanging down like a loose sack, in old 
women, or in those who have given birth to many children; also after ab- 
sorption of large quantities of fluids, by which the abdominal parietes had 
been largely distended. 

A similar effect is produced by a large accumulation of fat within the 
subcutaneous cellular tissue. 

Large distention of the abdomen, especially jDregnancies, sometimes 
causes the straight muscles of the abdomen (the m. recti) to be driven asunder, 
so that a space of several inches occurs between them, which is very thin; 
consisting merely of the fascial of the oblique muscles, the peritoneum, and 
the external covering; whilst the recti muscles lie on the sides of the abdo- 
men, forming there a pad-like protuberance. The thin, yielding space in the 
middle between them, however, bulges out as soon as the person assumes a 
standing position, not being strong enough to keep the abdominal viscera in 
their normal position. 

4. Its appearance in regard to the development of its subcuta- 
neous veins. We observe these veins largely distended whenever there 
exists an obstacle to the free circulation of the blood through the vena cava 



ABDOMEN. 463 

inferior. This may be caused by stricture or obliteration of the vein itself, or 
by pressure of enlarged abdominal organs, or abdominal tumors upon it. 
Some of the blood which cannot pass there is brought by way of the vena? 
intercostales, mammariee or axillares, from the lower portion of the body 
into the superior vena cava. 

The so-called Caput Medusae, which is a network of enlarged veins 
around the navel, arises from the umbilical vein, which has not become 
obliterated. 

5. Its appearance m regard to changes of color. Here I have to 
mention the straight line which we observe in pregnant women, extending 
from the navel to the symphisis pubis, either- of a pale yellowish, brownish 
or even blackish color. This line has been observed quite exceptionally, 
however, in men, children and also such women as never had been pregnant. 
We sometimes observe also, whitish or bluish-white stripes like cicatrices on 
the sides of the abdomen, which are generally signs of a previous pregnancy, 
as other distentions of the abdomen rarely cause them. 

On further examination of the abdomen by means of Palpation, we 
may learn, first, the seat of the affection. 

a. If in the abdominal walls, we are able to raise the affected part during 
a relaxed state of the abdomen ; or, if the abdominal walls be put upon the 
stretch, we shall observe the swelling in it becoming more prominent. 

b. If the seat of the affection is in one of the abdominal organs, the 
swelling feels deeper and cannot be raised by lifting the relaxed abdominal 
walls. In order to decide which organ is affected, we, of course, must be 
entirely familiar with the normal positions of these different organs. 

Palpation teaches further the nature of the swollen parts in the abdomen. 

A solid swelling we feel as such, whilst a fluid exudation gives to the 
examining hand a sense of fluctuation ; provided the sac which contains it be 
not too much distended, in which case it feels as solid and hard as a stone, 
and without any fluctuation. 

Palpation is also important to become certain of the character of pain 
which the patient experiences on pressure. 

If the pain is increased by slight pressure and ameliorated by gradual 
deeper and deeper pressure, the affection is mostly of a nervous nature. 
AVhen, however, the pain increases as the pressure is increased, generally it 
indicates an inflammatory affection. Pressure upon the stomach frequently 
causes sickness and belching; pressure upon the colon, desire for stool; and 
pressure upon the bladder, desire to urinate. 

Percussion gives a tympanitic tone whenever there is gas or air in the 
abdomen, unless the enclosed walls are too greatly distended; and an empty 
tone wherever there are solid bodies or fluid effusions in the abdomen. 

In this way Ave are enabled to determine the extent of the enlarged 



464 SPECIAL FORMS OF ABDOMINAL DISORDERS. 

liver, spleen, hardened stomach, tumors and fluid effusions of the peritoneum 
or ovaries; also, the accumulation of gas in the stomach and intestines, or 
the peritoneal sac. 

Auscultation teaches very little, except what I have mentioned 
already, in regard to the visible pulsation of the abdomen. Foetal pulsations. 



a. SPECIAL FORMS OF ABDOMINAL DISORDERS. 

There are many organs in the abdominal cavity ; each of them may be 
differently affected ; consequently the special forms of abdominal affections 
must amount to quite a considerable number. 

I shall speak at first of the pathological conditions of the stomach. 



Dyspepsia, Indigestion. 

Dyspepsia means nothing more nor less than indigestion. If we con- 
sider for a moment' all the causes by which indigestion may be brought 
about, we will comprehend at once the wide mouth and the big belly of that 
bag which is called dyspepda. Still, if, according to Pope, "One truth is 
clear, whatever is, is right," I shall not attempt to destroy this convenient 
bag, but shall merely endeavor to divide it, for a more intelligent use, into 
the following four departments : 

1. Dyspepsia may be caused by anatomical changes in the digestive ap- 
paratus, such as catarrh, inflammation, thickening ,ulceration, eruptions of 
the membranes of the stomach. 

2. Dyspepsia may be caused by quantitative or qualitative alterations 
of the digestive secretions, such as alteration of the gastric juice, of the juice 
of the pancreas, of the secretions of the liver and of the intestines. 

3. D}^spepsia may be caused by an abnormal condition of the nervous 
system, as we observe in consequence of mental excitements, of too great 
mental exertions, and all such influences as disturb the normal actions of the 
nervous system. 

4. And, lastly, dyspepsia may be caused by the use of irritating or stim- 
ulating food or drink ; so that we find a whiskey-dyspepsia, a pepper-and- 
mustard-dyspepsia, a coffee-dyspepsia, and all sorts of other dyspepsias, among 
which we ought not to forget the ice-cream-dyspepsia and the sugar dyspepsia. 

The symptoms of a disease which has so many different causes, must, of 
course, be variable, and I shall try to state only its most prominent features. 

Dyspepsia is characterized by — 

1. Want of appetite, or morbid appetite : craving for sour, acrid, spicy 
things, etc. 



VOMITING. 465 

2. Accumulation of wind in the stomach, and, in consequence of which, 
belching, oppression, palpitation of the heart. 

3. Formation of acids in the stomach,' and, in consequence, sour, rancid 
eructations, pyrosis or heartburn, waterbrash. 

4. The food does not digest at all, causing vomiting or diarrhoea. 

5. The pit of the stomach is mostly sore to the touch ; ve*y sensitive to 
the pressure of clothes; it feels full, and is oftentimes swollen. 

6. The patient feels unfit for mental and bodily work : he is morose, irri- 
table, sleeps badly ; and, if asleep, his sleep is full of dreams. 

7. His face shows a relaxed, tired, weary, sad expression, with sunken, 
dull eyes ; pale grayish or yellowish color and pale lips. 

8. His hands and feet are generally cold, and he is very sensitive to the 
cold. 

9. Gradual falling away in flesh and strength. 

THERAPEUTIC HIXTS — When we find, in an acute disease, a pa- 
tient strongly craving a particular thing to eat or drink, it is well and wise 
for the physician to satisfy this desire. In chronic cases, however, such as 
dyspepsia, which may have grown big by yielding to morbid desires, it is ab- 
solutely necessary to strictly forbid the use of all irritating nourishment, 
otherwise we feed the animal which we want to destroy. 

For special hints, compare Gastric Catarrh, acute and chronic; Liver 
Affections, Pancreatic troubles, etc. 



Vomiting. 

Vomiting consists pathologically in an antiperistaltic contraction of the 
stomach, and a spasmodic contraction of the diaphragm and abdominal mus- 
cles, caused either by a direct influence of the brain, or, which is much more 
frequently the case, an irritation of the nervus vagus, either in the stomach 
or in the pharynx, or by irradiation — (symjmthetic). 

In cases of sudden and violent vomiting, especially if it happens to other- 
wise healthy persons, we ought to think : 

Of poison: to ascertain which we must examine chemically what the 
patient throws up or what remains of what he partook. It may be arseni- 
cum, corrosive sublimate, nitrate of silver, zincum, or stannum, tartarus 
emeticus, phosphorus, iodine, different kinds of acid, sulphuric, nitric, or mu- 
riatic, alkalies, as caustic potash, or vegetable or animal poisons. 

Of pregnancy: it sets in sometimes immediately after conception, some- 
times not before the first menstrual discharge should come on and does not. 
It lasts, in many cases, through the first half of pregnancy, in some longer, 
and in some it passes over quickly or does not set in at all. During partu- 
30 



466 STOMACH. 

rition I have frequently observed vomiting shortly before the birth of the 
child. 

Of incarcerated hernia, intussusception, or invagination, which is gener- 
ally attended with obstinate constipation. 

Vomiting from affections of the stomach may have its cause in a simple 
overloading of the stomach with indigestible food, or in catarrh of the mu- 
cous membrane of the stomach ; for example, in drunkards ; or, in an ulcer- 
ated state of this membrane, in cancer of the stomach. 

Vomiting may also be caused by diseases of the peritoneum and intesti- 
nal canal ; from affections of the liver, spleen, pancreas, and urinary organs- 

Sometimes it may be merely the effect of the mechanical concussion 
during hard coughing, laughing, etc. 

Vomiting from affections of the brain is found in consequence of exter- 
nal injuries of the head and concussion of the brain; may be caused by 
strong impressions upon the sensorial and sensitive nerves; the swinging mo- 
tion of a ship, seasickness, etc. ; is found in hyperemia and anaemia of the 
membranes of the brain ; in inflammation of the brain and its membranes ; 
in different organic diseases of the brain ; in megrim and sick headache. 

THERAPEUTIC HINTS.— If vomiting be caused by poison, the 
poison should be removed or neutralized as soon as possible. The stomach- 
pump is often greatly preferable to emetics. 

The antidotes of the different poisons may be found in the Materia 
Medica, and they are well arranged in Dr. Hering's "Domestic Physician." 

If it be caused by an incarcerated hernia, the hernial sac should be put 
back by taxis or surgical operation. Compare : 

Aeon., Lycop., Nux vom., Opium, Plumbum, Sulphur, Tabac. 

For vomiting in pregnancy, Nux vom., Veratr., and many others. 

Stramon., vomiting of grass-green masses, aggravated by raising the 
head, and, at times, by light. (S. A. Jones.) 

For all other kinds of vomiting we must select the remedy in accordance 
with the indications in each individual case, and its underlying cause. 

Acute Catarrh of the Stomach, Gastritis. 

Pathologically gastritis is similar to catarrhal inflammation of any 
other mucous membrane. We observe redness and velvet-like swelling of 
the mucous membrane, which is oftentimes covered with a tough, transparent, 
or whitish-gray slime. In severe cases the mucous membrane appears sof- 
tened that it may easily be scraped off like • a mushy covering ; but this 
change may be the result of self-digestion after death, due to the specific con- 
tents of the stomach. (Compare Softening of the Stomach.) 



ACUTE CATARRH OF THE STOMACH, GASTRITIS. 467 

Primarily, catarrh may be caused by taking cold or getting wet, like 
any other catarrh; but principally it is caused by either too cold or too hot 
food or drink; or certain kinds of food, like too fat or old meat and fish, 
pork sausages, cheese, alcoholic drinks, ice cream, ice water ; iced milk is still 
worse than ice water. 

Starvation is not less a cause of it. Also mental exertions and excite- 
ment, fright, grief, worriment and the like, may cause it. 

Secondarily, we find it in combination with the perforating round ulcer 
of the stomach ; cancer of the stomach ; as a continuation of inflammation of 
the fauces and the oesophagus ; inflammation of the intestines ; or as a con- 
comitant of typhus, pneumonia, exanthematic fevers and erysipelas. 

The heat of the summer is most favorable for its development ; no doubt 
on account of the free use of ice water in a heated stomach ; but it also fre- 
quently occurs in spring and fall. 

Symptoms. — The patient gets morose ; feels weak and chilly, with pale- 
ness of the face and cool extremities. The chilliness alternates with flushes 
of heat, red face, and febrile motions. The pit of the stomach feels full, and 
sore to the touch, so that even the pressure of garment feels uncomfort- 
able. The appetite is gone ; thirst, however, is generally present. At the 
same time the patient feels nauseated ; frequently gulps up a sour or flat- 
tasting fluid; and generation of gas in the stomach swells the region of the 
stomach and causes belching of wind. In the cases in which the catarrhal 
affection extends into the bowels, it causes rumbling flatulency, escape of 
fetid flatus, and mushy, fetid discharges. At the commencement of the dis- 
ease the bowels are mostly constipated, and the urine is dark colored. 
Toward the close we frequently observe the formation of herpes labialis or 
hydroa. 

In some cases gastritis is attended with a higher or less degree of fever, 
and then it goes under the name of Gastric fever. The fever generally 
augments in the first days, shows evening exacerbation, and may last from 
one to two weeks, when the patients gradually recover. 

In other cases, which generally are characterized by great obstinacy, 
there is an abundant secretion of tough mucus, not only throughout the ali- 
mentary canal, but also in the bronchial tubes and the urinary organs. 
This form is known under the name of Feforis mucosa. The patients be- 
come greatly exhausted and apathic, and after a slow recovery are very 
liable to relapses. 

Still another form is the so-called Bilious fever, when the gastric 
catarrh is complicated with an abundant secretion of bile. Here the pulse 
is much more frequent and the temperature much higher than in an ordinary 
gastric fever ; there is vomiting of bitter and green masses ; the liver is some- 
what swollen, and a light icteroid coloring of the white of the eyes may 



468 STOMACH. 

appear, until finally after a week's duration, the whole train of symptoms is 
wound up with a bilious diarrhoea. In the first days it is often difficult to 
discern between these forms of gastric catarrh and Typhoid fever. How- 
ever, gastric fever is generally preceded by dietetic faults ; its temperature 
ranges never very high, nor does it show the characteristic step-like increase 
of a typhoid fever temperature, and the fever blisters around the mouth, a 
frequent occurrence in gastric catarrh, are extremely seldom met with in 
typhoid fever. 

THERAPEUTIC HINTS— Aeon., after taking cold; stitch-like, 
burning and pressing pain in the pit of stomach, with anguish and fear of 
death ; fever with great thirst and vomiting. 

Ant. crud., total loss of appetite; tongue thickly coated, yellow or 
white; great thirst at night; nausea; belching, with taste of what had been 
eaten ; vomiting ; after bad, sour wine ; after bathing. 

Apis, painful sensitiveness in the pit of the stomach, with burning; 
painless, yellow diarrhoea. 

Arnica, after a blow or fall; sense of fulness in the pit of the stomach; 
belching, with taste of putrid eggs ; hot head, remainder of body cool. 

Arsen., nausea and vomiting, worse from rising up; quick prostration; 
anxious restlessness ; great thirst, but drinking little at a time ; after abuse 
of ice, ice water, ice cream, vinegar, sour beer, tobacco (chewing), alcoholic 
drinks. 

Bellad., cutting pain in stomach, worse from motion and pressure; 
vomiting; gagging; hiccoughing; great thirst, but drinking makes it worse, 
consequently the patient abstains from drinking. 

Bryon., stitching pain in the region of the stomach, worse from motion, 
and especially from a misstep; tongue coated; dry without thirst; or else 
great thirst day and night, and drinking large quantities; constipation. In 
warm weather, and after eating of flatulent food. 

Carb. veg., great deal of belching, sour and rancid; burning in the 
stomach; bloatedness of the abdomen; disgust for meat; desire for acids; 
after debauching. 

Chamom., bitter taste in the mouth ; vomiting of bile or green mucus; 
belching; rumbling in the bowels; hot and red face; much excited, as if 
beside himself; sleeplessness ; after offence, vexation, anger. 

China, feeling satiated all the time; however, when trying to eat, he 
can eat something, but feels bad afterwards, and cannot say how; fulness in 
the stomach and bowels; belching; sour rising; cold feeling in the stomach; 
great lassitude and weakness. 

Euphorb. cor., sudden nausea, vomiting and diarrhoea of watery 
fluid, with sinking, anxious feeling of the stomach; faintness; slow and weak 
pulse ; cool skin ; cool hands and feet, which become affected with cramps. 



ACUTE CATARRH OF THE STOMACH, GASTRITIS. 469 

Hydrast., dull, aching pain in the stomach, which causes a very weak 
faintish feeling, "goneness" in the epigastric region; acidity; constipation. 
"After drugging." (W. Goodno.) 

Ipec, constant nausea proceeding from the stomach, with empty eructa- 
tions and accumulation of much saliva; easy vomiting; diarrhoea; after eat- 
ing sour, acrid things ; sour, unripe fruit, berries, salads, etc. 

Iris ver., great burning distress in the epigastric region; vomiting with 
diarrhoea, accompanied with great prostration ; burning in the mouth, fauces 
and oesophagus ; and headache. 

Kali carb., emptiness and gone feeling in pit of stomach; after eating, 
fulness, heaviness and pressure in pit of stomach ; vomiting ; dry stool ; tur- 
bid urine; constantly chilly. 

Lycop., great fulness in pit of stomach, after taking the least food. 

Nux vom., always after the use of tinctures, mixtures, tonics, vegetable 
pills, coffee, wine, condiments ; after mental overexertions ; in leading a sed- 
entary life; bitter or sour taste; sour belching; fulness and pressure in the 
stomach; constipated bowels; dizziness, headache; irritable, cross; all worse 
in the morning, in the open air and after eating. 

Podoph., food turns sour after eating; belching of hot flatus, which is 
very sour; great thirst; vomiting; the stomach contracts so hard and rapidly 
in the efforts to vomit, that the wrenching pain causes the patient to utter 
sharp screams ; vomiting of bilious matter, mixed with blood. 

Pulsat., no appetite; no thirst; bitter taste in the mouth; everything 
tastes bitter ; dizziness when rising from a chair ; chilliness ; after fatty sub- 
stances — pork, pastry, rancid butter, etc. 

Rumex, shootings from the pit of the stomach into the chest in various 
directions ; aching pain in the pit of the stomach, and aching and shooting 
above it in the chest ; fulness and pressure in the pit of the stomach, extend- 
ing towards the throat-pit ; it descends towards the stomach upon every empty 
deglutition, but immediately returns; flatulence; eructations; pressure and 
distention in the stomach after meals. 

Sanguin., nausea, with headache, chill and heat; vomiting, with 
severe painful burning in the stomach, and intense thirst ; red tongue ; red 
and dry lips ; hot and dry throat ; tickling cough. 

Sepia, sensitiveness of the pit of the stomach to touch ; bloatedness of 
the abdomen ; congestion and heat of the head ; headache ; tongue coated 
ivithout lustre; often sore and covered with little blisters on the edges and 
tip; sour smell from the mouth, and likewise of the urine, which is clear like 
water, or pale yellowish; constant drowsiness; anxious dreams, and great 
fever heat; especially in children, from taking cold when the weather 
changes. 



470 STOMACH. 

Chronic Catarrh of the Stomach 

Is, in many cases, only a continuation of an ill-managed, acute attack, but it 
may grow out of too free a use of spirituous liquors, coffee, chewing and 
smoking of tobacco; it may have its origin in gluttony, sedentary habits, 
mental exertions, long-continued mental emotions, etc. 

Secondarily, it has been observed accompanying heart, liver, lung and 
pleura affections; ansemia, chlorosis, Bright's disease, marasmus, tuberculosis 
gout, cancer, haemorrhoids. 

Its most permanent symptoms are, indigestion or dyspepsia, belching 
after eating, mostly sour, and attended with heartburn ; pressure and full 
feeling in the epigastric region, with actual distention of the same. 

Other symptoms are, nausea and vomiting, loss of appetite, or perverted 
appetite, or ravenous hunger, with gaping and faintness ; after eating always 
pain in the stomach. Such patients feel weak; they are morose, irritable 
and quite sleepy through the day. By-and-by their skin becomes pale and 
dry, and they become emaciated. 

Its progress is a slow one, and whether curable or not curable, depends 
entirely upon its combination with other diseases. 

On the authority of Kafka I shall give the following therapeutic 
remarks : 

Aching or burning pain in the pit of the stomach : increased from palpation 
or pressure of the clothes; and distention of the epigastric region, Bellad., 
Phosphor., Arnica, Arsen. 

Aching in the pit of the stomach, not much increased by external press- 
ure: Bellad., Phosphor., Hepar, Ignat., Nux vom., Arnica, Calcar., Zincum. 

Aching in the pit of the stomach, not increased by external pressure: 
Garb, veg., China, Chin, sulph., Capsic, Natr. mur., Lycop., Sulphur. 

Sour stomach, with sour belching and taste; heartburn; gulping up and 
vomiting of sour matter: Nux vom., Calc. carb., China, Phosphor., Sulphur, 
Kali carb., Carb. veg. 

Sour stomach always after eating: Nux vom., Kali carb., Natr. mur., 
Sulphur, Phosphor., Sepia. 

Rancid belching: Pulsat., Carb. veg., Magn. mur., Sulphur, Asaf. 

Foul belching: Sepia, Phosphor., Arsen., Arnica, China, Ferr. ac, 
Mercur. 

Much mucus in mouth and stomach: Pulsat., Amm. mur., Natr. mur., 
Arnica, Sulphur. 

Accumxdation of bile in the stomach, with bitter taste, bitter belching, and 
vomiting: Chamom., Pulsat., Arsen., Ipec, Nux vom., Veratr. 

Much wind in the stomach, with distention: Nux vom., Carb. veg., Ignat., 
Arnica, Sulphur, Arsen., Phosphor. 






GASTRITIS TOXICA SEU CAUSTICA. 471 

Distention of the abdomen: Carb. veg., Nux vom., China, Arnica, \Natr. 
mur., Phosphor., Sepia. 

Relief from eructations: Laches., Carb. veg., Ignat., Ly cop., Tart, einet., 
Xux vom., Sulphur. 

Relief from wind passing down : Nux vom., Carb. veg., Pulsat, China, 
Chamom., Lycop. 

Worse from accumulation of flatulence: Nux vom., Carb. veg., Pulsat., 
Ignat., Natr. mur., Phosphor., Arnica, China, Chamom., Kali carb., Coloc. 

Slow digestion: Nux vom., Ignat., Phosphor., China, Opium. 

Total loss of appetite: Nux vom., China, Sepia, Natr. mur., Arsen. 

Feeling of emptiness and hunger in the stomach without desire for food : 
Natr. mur., Opium, Arsen. 

Ravenous hunger: Nux vom., Calc. carb., China, Iodium, Natr. mur., 
Phosphor. 

Worse after eating: Nux vom., Calc. carb., Lycop., Phosphor., Natr. 
mur., Sepia, Sulphur. 

Disgust against meat: Sulphur, Sepia, Petrol., Mur. ac, Natr. mur., 
Carb. veg., Arsen. 

Sleepiness in the daytime: Natr. mur., Pulsat., Sepia, Calc. carb., Carb. 
veg., Chiuin., Kali carb. 

Great weakness and loss of energy : China, Chin, sulph., Arsen., Phosphor., 
Iodium, Ferr. ac. 

Gastritis Toxica seu Caustica, Inflammation of the Stomach 
in consequence of Poisoning. 

Such poisoning is caused by concentrated or diluted mineral acids, caus- 
tic alkalies, salts and metals, acrid, vegetable, or animal poisons, and ethereal 
oils. 

Diluted mineral acids change the epithelium and the superficial layers 
of the mucous membrane of the stomach into a soft, brownish, even blackish 
mass. Concentrated mineral acids change all layers of the mucous mem- 
brane into a blackish mass; the other coats of the stomach become softened, 
and, in some rare cases, perforated — eaten through. The blood in the vessels 
of the stomach and in the adjoining larger vessels is black and tough, like 
tar. Caustic alkalies — for example, the kali causticum or ammonium caus- 
ticum — change the epithelium and the mucous membrane of the stomach to 
a pappy, discolored mass; they destroy and perforate the coats of the stomach 
much more readily than acids do. 

Salts of metals, like verdigris, corrosive sublimate, argentum nitricum, 
tartarus emeticus, likewise arsenicum and phosphorus, cause brown scurfs, 
sorrounded by injected and swelled portions of the mucous membrane of the 



472 STOMACH. 

stomach . Acrid, vegetable and animal poisons, and ethereal oils cause a 
highly inflamed state of the mucous membrane of the stomach. 

Poisoning is characterized by the following symptoms : violent pain in 
the stomach and bowels ; vomiting of slimy or bloody masses ; slimy, diar- 
rhoeic discharges from the bowels, mixed with blood, and tenesmus ; the fea- 
tures of the face become distorted ; there is sudden loss of strength ; coldness 
of the extremities; and cold, clammy perspiration; the pulse is small and 
thread-like. 

If the patient informs us what he has swallowed, our diagnosis is safe 
enough. If not, the ejected masses will have to be examined. Mineral acids 
and caustic alkalies leave their traces also upon the mucuous membrane of 
the mouth and fauces. 

THERAPEUTIC HINTS —If we see a case soon after the swallowing 
of poison, this poison must be either removed or neutralized — acids by alka- 
lies and alkalies by acids. 

Chronic consequences require : after acids, Calc. carb. ; after alkalies, 
Nitr. ac. ; after ethereal oils, Nux vom., Arsen. ; after metals, Hepar. 

Gastralgia, Cardialgia Nervosa, Cramp of the Stomach. 

This affection is characterized by attacks of great pain in the stomach, 
which come at intervals, leaving the patient free from pain between the at- 
tacks; there is no structural change of the stomach effected by it. We fre- 
quently find this complaint, however, in connection with anaemia, chlorosis, 
tuberculosis, or great loss of vital fluids; also with chronic catarrhal affections 
of the stomach, the round perforating ulcer, and cancer of the stomach; also 
with diseases of the womb, as falling or dislocation of the womb ; catarrh or 
ulceration of the mouth of the womb; too scanty or too profuse menstruation ; 
also, with diseases of the spine, especially such forms as present an intermit- 
tent character; and finally we observe it frequently in consequence of de- 
pressing mental emotions ; chilling the stomach by drinking ice water or eat- 
ing ice cream while being heated; or after the use of lemon-juice, or other 
acid fruits, coffee, fresh bread, and hot cakes, and other things which are 
difficult to digest. 

The attack usually commences with a feeling of pressure in the pit of 
the stomach, frequent yawning, coldness of the extremities, and an uncom- 
fortable feeling in the middle of the spine, which induces the patient to bend 
backwards frequently. Sometimes, without such premonitory signs, a violent 
pain in the stomach sets in at once, which may be various in character — 
pressing, drawing, burning, boring, gnawing, cramp-like, etc., amounting 
sometimes, to such a degree of severity that the patient faints away ; his face 



GASTRALGIA, CARDIALGIA NERVOSA. 473 

appears collapsed, his extremities become cold, and his pulse small and 
thready. The pain seems to radiate from the spine and reflect upon the 
chest, where it causes asthmatic symptoms ; or, it reflects upon the oesophagus, 
causing the so-called globus hystericus ; or, upon the larynx, causing choking ; 
or upon the sympathetica, causing spasmodic laughing and crying ; or, upon 
the nerves of the cranium, causing hemicrania ; or, upon the intestines, caus- 
ing pain in the bowels and diarrhoea. The pain is oftentimes relieved by 
hard pressure upon the stomach, but sometimes the patient cannot even bear 
the pressure of the clothing. The pit of the stomach is, in some cases, dis- 
tended, in others it is drawn in; often we observe a pulsation in the epigas- 
trium. 

The attack generally ends with belching of wind, vomiting of watery, 
sour fluids, passing of watery urine, and with a gentle perspiration. In some 
cases there is a great accumulation of wind in the stomach, so that the pit of 
the stomach and the bowels are greatly distended, with constant belching 
and rumbling in the bowels. Belching and passing wind generally brings 
relief. 

THERAPEUTIC HINTS— Abies nigra, continual distressing con- 
striction just above the pit of stomach, as if everything was knotted up, or as 
if the hard lump of undigested food remained there. 

Abrot., feeling as if the stomach were hanging or swimming in water, 
with a sense of coldness. Pains cutting, gnawing, burning, contracting, 
stinging, mostly worse at night. Never entirely free from pain. 

Arg. nitr., in the middle between the xyphoid cartilage and the navel 
a small spot, which is very sensitive to the slightest pressure ; from this spot 
a very severe pain spreads to the hypochondriac region, into the back, up 
into the shoulders, even to the head ; gradually increasing in intensity, and 
as gradually leaving again. 

Arsen., burning pain, as of red-hot coal; pit of stomach sensitive to 
slightest touch ; vomiting of ingesta as soon as taken ; anguish ; restlessness ; 
dyspnoea; fainting; pale, earthy face; worse from eating and touching; 
better from warm applications ; brought on by eating ice cream or drinking 
ice water. 

Asaf., pressing, cutting, stitching pain in spells; eructations of a smell 
like garlic or feces; accumulation of gas; constantly pressing upwards, none 
downward ; gulping up of rancid, acrid fluids ; obstinate constipation. Pain 
in paroxysms; better from eating; worse when stomach is empty. 

Bellad., gnawing, pressing, crampy, drawing, wrenching pain, which 
compels the patient to bend backwards, and to hold his breath ; pain extend- 
ing through to the spine, with tired feeling in the spine ; great thirst, but 



474 STOMACH. 

feels worse after drinking ; face hot, red, bloated ; pupils enlarged ; especially 
for the female sex, when the menstrual period has been disturbed. 

Bismuth., sense. of heaviness like a weight in stomach; intense press- 
ure in a defined spot with pain in the spine, compelling the patient to bend 
backwards. 

Bryon., pressing pain as of a stone or a load in the stomach; worse 
from eating or drinking; from any motion; better when lying quiet on the 
back. 

Calc. carb., pressing pain as of a load or stone in the stomach; or 
from the abdomen rising up into the throat; sour belching and vomiting; 
better from motion ; too profuse catamenia. 

Calc. hypophosph., sudden appearance of the attacks; absence of 
gastric catarrh ; entirely free at intervals ; sensation as if the pain and dis- 
tress were caused by wind; spreading of. the pain upwards, never downwards. 
Attacks appear suddenly two hours after each regular meal, and are appeased 
by taking a cup of milk or other food carefully chewed. Without this 
the pain steadily increases, extends to the spine, into the chest and throat, 
and is accompanied by a rising of clear, white, brackish, sour froth, and a 
gnawing in the stomach. (F. G. Oehme.) 

Carb. veg., after Nux vom., burning pain, extending down to the 
small of the back and up to the shoulders; sour, rancid belching; cold 
limbs; cold sweat; worse from lying down; after rich living; drinking of 
spirituous liquors. 

Chamom., when sitting or standing the pain doubles him up; in bed 
he tosses about in great agony ; hands and feet cold ; after anger or vexation. 
Chelid., gnawing, grinding pain, ameliorated by constantly eating 
something. 

Coloc, violent cutting, tearing pains which, from different parts of the 
chest and abdomen, concentrate in the pit of the stomach; relieved by hard 
pressure and bending double; after vexation and indignation. 

Ferrum, pressure in the stomach; vomiting of ingesta, and better 
afterwards; worse after drinking milk; chlorotic and anaemic individuals. 

Gelsem., sensation of a heavy load with weight; tension and dull 
pain; sometimes with empty, faint sensations in the epigastrium, and a false 
hunger — a kind of gnawing. 

Graphit., anaemic, chlorotic patients. Dysmenorrhoea ; constant yawn- 
ing and bloatedness of the stomach. 

Ignat., gnawing, cutting pain in the stomach; faint feeling; false 
hunger; collection of water in the mouth; nausea and vomiting of mucus; 
poor digestion ; bloated stomach ; pale, watery, profuse urine ; after grief or 
poor living; habitual smoking. 

Leptand., sharp, cutting pains at intervals in the lower part of the 



475 

epigastrium ; constant aching distress ; worse from drinking cold water ; after 
rising; great desire for stool, that cannot be retained one moment. 

Lycop., brought on by eating fruit; flatulency; flowing saliva; con- 
stipation; pain better from bending. 

Nux vom., pressing, constricting, clawing pain in the pit of the 
stomach, extending into the chest, or towards the small of the back and to 
the anus, which is drawn in ; worse after eating and drinking; better from 
belching, after vomiting, from bending forward and rubbing the pit of the 
stomach ; great irritability ; headache ; loss of appetite ; or hanger, with fear 
of eating ; belching, vomiting, and gulping up of sour substances ; constipa- 
tion; haemorrhoids; suppressed menstruation; complaints from the use of 
coffee or liquors ; sedentary life; night-watchings; anger and w T orriment ; al- 
ways after previous use of nostrums. 

Petrol., pressing, drawing pain, ameliorated by constantly eating some- 
thing. Compare Chelid. 

Phosphor., a singular rising of the swallowed food by mouthfuls; 
gnawing pain ; worse from motion ; pain worse after eating ; during the pres- 
ence of morbid hunger eating relieves for a short time; decidedly better 
when keeping warm in bed. 

Phosph. ac, violent pressure in pit of stomach through to the back; 
worse from touch. Urine white and almost as thick as milk. 

Plumbum, the patient bends backwards during the spell; gets better 
from hard external pressure upon the stomach ; afterwards yellow appearance 
of the white of the eyes ; badly-smelling sweat of the feet ; during parox- 
ysm, abdomen hard like a board; pharynx feels constricted; hands and feet 
cold. 

Pulsat., dizziness when rising ; loss of appetite ; no thirst; sour or bitter 
vomiting; after eating fat meat, cakes, pastry, and drinking whiskey; the 
attacks are worse in the evening. 

Rumex, "shootings from the pit of the stomach into the chest in various 
directions ; aching pain in pit of stomach, and aching and shooting above it 
in the chest; fulness and pressure in pit of stomach, extending toward the 
throat-pit ; it descends tow T ard the stomach with every empty deglutition, but 
immediately returns. Pressure and distention of stomach after eating; 
stitching, cutting pain in pit of stomach ; worse on movement." (W. K. 
Knowles.) 

Staphis., after indignation. 

Sulphur, pain in right hypochondrium extends over stomach to left ; 
cannot lie on either side; when lying on back the pain spreads to chest under 
sternum and hinders respiration ; must get up and walk about. 

Ver. alb., pains radiate to back and shoulders; increase slowly and 
decrease slowly, and are attended with a shaking chill, and cold hands and 
feet. 



476 



STOMACH. 



Digest to Gastralgia. 



Paroxysms: Asaf. 

, sudden, two hours after each regular 

meal, relieved by taking a cup of milk 
or other food carefully chewed. With- 
out this the pain steadily increases, ex- 
tends to spine, chest and throat, and is 
accompanied by a rising of clear, white, 
brackish, sour froth and a gnawing in 
the stomach : Calc. hypoph. 

increase slowly and decrease as slowly : 

Arg. nitr., Stannum, Ver. alb. 

entirely free intervals: Calc. hypoph. 

Never entirely free from pain : Abrot. 

Sensations, aching: Leptand., Rumex. 

, burning: Arsen., Garb. veg. 

, bloatedness : Ignat. 

, , with constant yawning : Graphit. 

, clawing : Nux vom. 

, constriction : Abies nigra, Nux vom. 

, cutting: Abrot., Asaf ., Coloe., Ignat, 

Leptand., Rumex. 

, crampy : Bellad. 

, distention after eating: Rumex. 

, drawing: Bellad., Petrol. 

, dull: Gelsem. 

, faint feeling : Gelsem., Ignat. 

, fulness: Rumex. 

, gnawing : Abrot., Bellad., Calc. hypoph. 

Chelid., Gelsem., Ignat., Phosphor. 

, and grinding: Ignat. 

, hunger, false: Gelsem., Ignat. 

, heaviness, like a weight: Bismuth., 

Gelsem. 

, lump or stone, of a: Abies nigr., 

Bryon., Calc. carb. 

, pressing: Asaf., Bismuth., Bryon., Calc. 

carb., Ferrum, Petrol., Phosph. ac, Rumex. 

, shooting: Rumex. 

, stinging : Abrot. 

, stitching : Asaf., Rumex. 

, soreness in a small spot: Arg. nitr. 

, , to slightest pressure : Arsen. 

, tearing : Coloc. 

, tension: Gelsem. 

, water, as if stomach were swimming 

in, with sense of coldness : Abrot. 

, wind, as if caused by : Calc. hypoph. 



Direction of pain, in pit through to the 
back: Phosph. ac. 

with tired feeling in spine: 

Bellad. 

, and shoulders: Arg. nitr., Ver. 

alb. 

, into chest : Nux vom., Sulphur. 

, and throat-pit : Rumex. 

from abdomen into throat : Calc. carb. 

always upwards, never downwards: 

Asaf., Calc. hypoph. 

from pit to hypochondria, up in chest, 

even head: Arg. nitr. 

down to small of back : Carb. veg. 

and anus : Nux vom. 

descends toward stomach with every 

deglutition, but immediately returns: 
Rumex. 

from right hypochondrium over sto- 
mach to left: Lycop., Sidphur. 

from different parts of chest and ab- 
domen, concentrating in pit of stomach : 
Calc. carb. 

Attended with belching of smell like 
garlic or feces : Asaf. 

, , sour, rancid: Carb. veg. 

and vomiting : Calc. carb. 

gulping up of rancid, acrid fluids : 

Asaf. 

singular rising of swallowed food by 

mouthfuls: Phosphor. 

rising of clear, white, brackish, sour 

froth: Calc. hypoph. 

nausea and vomiting of mucus : Ignat. 

vomiting, sour or bitter : Pulsat. 

of ingesta and better after- 
wards: Ferrum. 

, as soon as taken : Arsen. 

flatulency : Lycop. 

constipation : Asaf, Lycop., Nux vom. 

great desire for stool that cannnot be 

retained: Leptand. 

GENERAL SYMPTOMS. 

Anguish: Arsen. 
Irritability : Nux vom. 
Dizziness when rising: Pulsat. 



DIGEST TO GASTRALGIA. 



477 



Headache : Nux vom. 
Pupils enlarged : JBellad. 



Yellowishness of white, of the eyes: 
Plumbum. 

Face hot and bloated: Bellad. 

pale and earthy: Arsen. 

Collection of water in mouth: Ignat. 

Flowing saliva: Lycop. 

Pharynx constricted: Plumbum. 

Loss of appetite : Nux vom., Pulsat. 

Hunger with fear of eating : Nux vom. 

Thirst, but worse after drinking : Bellad. 

Poor digestion : Ignat. 

Abdomen hard like a board during par- 
oxysm: Plumbum. 

Haemorrhoids : Nux vom. 

Urine profuse, pale, watery: Ignat. 

white and almost as thick as milk: 

Phosph. ac. 

Menstruation suppressed : Nux vom. 

Dysmenorrhcea: Graphit. 

Catamenia too profuse: Calc. carb. 



Respiration hindered by lying on the 

back: Sulphur. 
Dyspnoea: Arsen. 



Shaking chill : Ver. alb. 
Cold sweat: Carb. veg. 
Badly-smelling sweat of feet: Plumbum. 
Cold hands and feet: Plumbum, Ver. alb. 
limbs: Carb. veg. 



Fainting: Arsen. 

Chlorotic and ansemic individuals : Fer- 
ritin. Graphit. 

For females with disturbed menstrual 
period: Bellad. 



Worse after eating : Nux vom., Phosphor. 

and drinking: Bryan., Nux vom. 

and touching: Arsen. 

from drinking cold water: Leptand. 

milk: Fcrrum. 



Worse two hours after each regular 
meal : Calc. hypoph. 

when the stomach is empty : Asaf. 

from lying down : Carb. veg. 

on back : Sulphur. 

on either side : Sulphur. 

When sitting or standing the pain dou- 
bles him up ; in bed he tosses about in 
great agony: Chamom. 

Worse from motion: Bryon., Phosphor., 
Rumex. 

after rising: Leptand. 

from touch : Arsen., Phosph. ac. 

in evening : Pulsat. 

Better from belching : Nux vom. 

after vomiting : Ferrum, Nux vom. 

from eating: Asaf. 

taking a cup of milk or other food 

carefully chewed: Calc. hypoph. 

by constantly eating something: 

Chelid,, Petrol. 

by eating during the presence of 

morbid hunger : Phosphor. 

from warm application : Arsen. 

when keeping warm in bed : Arsen. 

from external pressure upon the 

stomach : Plumbum. 

and bending double : Coloc. 

lying quiet on back : Bryon. 

motion: Calc. carb. 

must get up and walk about : Sulphur. 

must bend backwards: Bellad., 

Bromium, Plumbum. 

bending forwards: Coloc, Lycop., Nux 

vom. 
Caused by grief: Ignat. 

anger or vexation: Chamom. 

indignation: Coloc, Staphis. 

sedentary life: Nux vom. 

night-watching : Nux vom. 

rich living : Carb. veg. 

poor living: Ignat. 

ice cream or ice water: Arsen. 

fat meat, cakes, pastry : Pulsat. 

spirituous liquors: Carb. veg., Nux 

vom., Pulsat. 

fruit: Lycop. 

smoking : Ignat. 

quack medicines: Nux vom. 



478 STOMACH. 

Ulcus Ventriculi Perforans (rotundum, chronicum), the 
Round Perforating Ulcer of the Stomach. 

In four-fifths of the cases the ulcer is situated upon a region bounded 
by the posterior wall, the lesser curvature and the pyloric region ; the rest of 
the surface of the stomach appears to be affected in only one-fifth of the 
cases ; it was also frequently observed in the duodenum, in cases of Chicka- 
hominy diarrhoea. Only one ulcer is usually found; exceptionally there are 
two, three or more. Its size varies: it may be smaller and also much larger 
than a three-cent silver piece; its shape is round \ sometimes oval; and in 
cases where several ulcers join, it is irregular. On the iuside of the stomach 
it is largest, and grows smaller in its progress of eating through the different 
layers of the stomach, so that it assumes a funnel-shaped appearance. When 
it reaches the serous membrane of the stomach it causes peritoneal inflam- 
mation and fibrinous exudation, which cause adhesions with the adjoining 
organs, as the pancreas, liver, omentum and colon. When even this last or 
external membrane is eaten through, it causes peritonitis. 

This ulcer may heal in any of its different stages, in which event new 
granulations are formed, and the whole is shut by a flat, radiated cicatrix, in 
consequence of which it sometimes happens that the pylorus becomes con- 
stricted, so that the exit of the food into the intestines is impeded. Such a 
cicatrized induration of the pylorus can generally be detected by palpation 
in the pit of the stomach as a hard swelling. 

In regard to its origin we are quite in the dark. Rokitansky considers 
as the next cause hemorrhagic erosions. They consist, according to Yirchow, 
in obstructions of arterial vessels, in consequence of which the mucous mem- 
brane becomes deprived of its necessary nutriment and dies off, and by the 
corroding effects of the acids of the stomach is eaten out deeper and deeper. 
Of special interest is its occurrence after extensive burns of the skin and its 
coincidence Avith trichinosis. 

The Symptoms are as follows; pain, exactly as in gastralgia, in the pit 
of the stomach, often extending to the spine, coming in spells mostly after 
eating, ameliorated, sometimes ceasing, after vomiting of slimy, tough or 
watery, clear, tasteless or sour fluid, often containing blackish or brownish 
flakes. 

Vomiting is found not only during the cardialgic spells, but also between 
these spells, although in exceptional cases it is not a prominent symptom. 
It generally happens soon after eating and frequently without previous 
nausea, and without great exertion. Acrid, sour, indigestible food causes it 
most frequently. The vomit often contains particles of decomposed blood in 
the form of blackish or brownish flakes and masses, and sometimes even clear 
blood in large quantities. But even this bloody vomit is not a constant 



ULCUS VEXTRICULI PEEFOEAXS. 479 

symptom; in cases of slow bleecliDg the blood may pass into the intestines 
and be carried off in the form of tarry faeces. 

Indigestion. In some cases the appetite is little or not at all changed, 
but in severer cases it is diminished, or altogether absent. Eating usually 
causes pain and digestion is very slow. Milk and white meat are best 
digested. Eructations, nausea, pyrosis or waterbrash, are symptoms of the 
chronic catarrh attending the disease; and obstinate constipation is of fre- 
quent occurrence. Sooner or later, the face of the patient assumes a pale, 
sallow aspect, his spirits become depressed, he loses flesh, and grows weaker 
and weaker. 

When perforation takes place, which may happen either spontaneously 
or in consequence of a strong concussion of the body, or from overloading 
the stomach, or during a hard attack of vomiting, we have in a very short 
time all the symptoms of a 'peritonitis. The patient experiences a stitch-like 
or cutting pain, altogether different from that of a cardialgic spell ; he is 
seized with a violent chill and vomiting, and his features become collapsed, 
distorted, pale, expressing deep pain and agony. The abdomen distends 
largely and is very painful, especially when touched. Eespiration is short, 
superficial, without any respiratory motion of the diaphragm. There is sin- 
gultus ; violent action of the heart ; frequent, small pulse ; fainting ; decrease 
of natural temperature ; great prostration and collapse. 

Some chronic cases take to the end a latent course, until at last dis- 
covered as cicatrices on post-mortem examination. This surely proves the 
curability of this disease. The disposition to it seems to be greater during 
middle life, and is by no means of rare occurrence. 

Differential Diagnosis. — It may be confounded with chronic catarrh 
of the stomach. The round ulcer, however, generally shows a clean, red 
tongue, has much more frequent vomiting; and the vomit is often tinged 
with either fresh or decomposed blood, and the soreness in the epigastrium is 
confined to a circumscribed spot with frequent cardialgic spells. 

It may be confounded with cardialgia. The round ulcer, however, 
has a falling away of flesh and change in features, pale, yellowish face, and 
vomiting between the cardialgic spells, which we do not observe in gastralgia. 

It may be confounded with cancer of the stomach; cancer, however, 
comes at a later period of life; its 2^>ain in the stomach, although often severe, 
never extend* to the spine; it tells much quicker upon the general constitution 
by the wasting away in flesh; it is often marked by a hard swelling in the 
pit of the stomach, which is observed in cases of round ulcers, only when the 
pylorus becomes cicatrized; it commences with feverish attacks and ends 
with a cachetic fever. 



480 



STOMACH. 



THERAPEUTIC HINTS.— Milk and mutton or beef-broth must be 
considered as the best diet. 

Arg. nitr., pain below and to the left of the xyphoid process in a small 
spot extending to a corresponding point in spine, where pressure aggravates 
it. Looks as if dying. 

Arsen., vomiting of black, decomposed blood; burning pain; always 
worse after eating or drinking ; gray-yellowish color of the face. Chlorotic 
patients, with ansemic murmur in the large blood-vessels, and scanty menses. 

Atropin., pressing pain after eating; and vomiting of acrid, sour 
masses which set the teeth on edge; hard swelling in the region of the pylo- 
rus, just above the navel towards the right, very sensitive to touch ; excru- 
ciating pain in the stomach ; constant vomiting ; deadly paleness of the face, 
with cold perspiration ; hands and feet icy-cold ; pulse very small. Peritonitis 
in consequence of perforation of the stomach. Compare Bellad. 

Carb. veg., gray, yellowish face; dry tongue; vomiting of sour, bilious 
or bloody masses ; burning in the stomach ; worse after eating ; better from 
drinking cold water; eructations; distortion of stomach and bowels; cos- 
tiveness. 

Conium, Coniin, vomiting of black masses like coffee-grounds in 
clear, sour water; violent pain in the stomach, always two or three hours 
after eating, but also at night ; somewhat relieved in the knee-elbow position ; 
swelling in the region of the pylorus. 

Ferrum, in ansemic and chlorotic patients, with murmurs in the large 
blood-vessels and scanty menses. Haemorrhage from stomach and pain in 
stomach through to the spine. 

Kali bichr., ulcers are oval; they corrode and become deeper without 
spreading in circumference; pressure and heaviness in the stomach after 
eating; giddiness, followed by violent vomiting of a white, mucous, acid 
fluid, with pressure and burning in the stomach ; vomiting of sour, undigested 
food; of bile, with pinkish, glairy fluid; of blood, with cold perspiration on 
the hands; burning in the stomach; heat of the face; all of which symptoms 
decidedly .suggest its application in the round, perforating ulcer of the 
stomach. 

Lycop., earthy color of the face; rising of sour, acrid fluid; vomiting 
of sour water and mucus; fulness of stomach and abdomen; pain in the 
stomach after eating ; rumbling and gurgling in the abdomen ; constipation ; 
scanty urine ; worse from sitting bent ; better from rising and walking about ; 
no pain at night, when warm in bed. 

Mezer., constant, violent pain and pressure in the stomach after eating, 
no matter what, even simple things like broth, milk, bread; a constrictive 
squeezing pain with much belching from one to two hours after eating ; the 
pain reaches its height and ends with vomiting and gulping up what 



CARCINOMA OR SCIRRHUS VEXTRICULI. 481 

has been eaten ; constipation ; circumscribed redness of the face ; skin cool, 
pulse very small and frequent ; chilliness alternating with flushes of heat. 

Nux vom., frequently indicated at first when the patient already has 
been drugged. Vomiting in the morning before breakfast. 

Phosphor., regurgitation of food by the mouthful without nausea; re- 
gurgitation of cold drinks as soon as it has become warm in the stomach ; 
excessive acidity ; flatulency; constipation. 

Sepia, yellow bridge over the nose; earthy complexion; sour taste in 
the mouth after eating; vomiting of mucus; pain in the stomach after 
eating the simplest kind of food ; hardness in the region of the pylorus ; 
constipation ; stitching all over the body, with breaking forth of little pus- 
tules; menses scanty. 

Silic, yellowish complexion; screwing, pressing, twisting pain after 
drinking ; pyrosis and vomiting after eating. 

Sulphur, constant pain in stomach and back after suppressed itch; 
sour taste in the mouth and sour vomiting; constipation; piles; cold legs. 

Compare also Gastralgia and Hasmatemesis. 

Carcinoma or Scirrhus Ventriculi, Cancer of the Stomach. 

According to pathological researches there are three different forms of 
cancer of the stomach: 1. ScirrlmS, a fibrous growth in which the connec- 
tive tissue stroma predominates over the crude bodies, generally originates in 
the submucous cellular tissue; 2. Carcinoma medullaris, a marrow-like 
growth, in which the cancer-cells predominate over the stroma, forms round 
isolated lumps in the mucous membrane of the stomach, and spreads sponge- 
like upon the inner surface of the stomach ; and 3. Carcinoma alyeolaris, 
a jelly-like growth, in which we observe a colloid degeneration of the cancer- 
cells, invests at first the submucous cellular tissue, but penetrates frequently 
to the peritoneum, and forms large tumors upon it. All three kinds of can- 
cer may often be seen together ; and they mostly invest the pylorus, some- 
times the lesser curvature, still rarer the cardia, and most rarely other parts 
of the stomach. 

It is often the case, that the diseased pylorus forms adhesions with ad- 
joining organs, such as the pancreas, liver, kidneys and colon, which are 
mostly invested by the same morbid product, keeping the stomach in a fixed 
position. When, however, such adhesions do not take place, the stomach 
sinks, in consequence of its increased weight, lower down into the abdominal 
cavity ; remaining there, either perfectly free and movable, or adhering to 
organs lower down such as portions of the intestines, the uterus, or its ap- 
pendages. 

The inner cavity of the stomach is much changed by this disease. It 
31 



482 STOMACH. 

becomes greatly enlarged by stricture of the pylorus, much diminished by 
stricture of the cardia, and cancerous degeneration of the coatings of the 
stomach. The mucous membrane, in the neighborhood of the cancer, ex- 
hibits chronic catarrhal inflammation, which is sometimes spread all over it ; 
and, in the further progress of the disease, ulceration and arrosion of smaller 
or larger blood-vessels with consecutive haemorrhage obtain. 

The causes of carcinoma of the stomach we do not know, just as little 
as the causes of cancer in any other part of the body ; heredity seems to 
deserve some amount of consideration. The disease has been observed most 
frequently between the years of fifty and seventy. 

Symptoms. — 1. General cancer-cachexia : emaciation; paleness of the 
skin and the mucous membranes; ash-colored or yellowish color of the face; 
brittle, dry, harsh and wrinkled skin; peeling off of branny scales, especially 
from the lower extremities. The expression of the face is sad ; the eyes are 
fallen in; the malar bones stick out; the ankles are oedematous. 

2. Tumor in the pit of the stomach. This is present, however, only when 
the cancer invests the pylorus. In this case we observe a roundish, or oval, 
or irregular lump to the right above the navel under the upper part of the 
right rectus abdominalis muscle. It is always there, and cannot be moved, 
if the pylorus should have formed adhesions with neighboring organs; but it 
changes position and is movable, when those adhesions are not formed. In 
this latter case it gradually sinks down into the abdominal cavity, and may 
appear below the navel, or even but little above the symphisis pubis, either 
as a movable or fixed tumor. But when the pylorus-carcinoma is covered 
by the left lobe of the liver, or by a distended colon, it cannot be felt. The 
same is true, when carcinoma has its seat on the cardia or on the lesser 
curvature. Cancerous degeneration of the anterior wall of the stomach is felt 
as a resisting mass in the epigastrium, changing position, however, according 
to the position of the patient; and according to the fulness and emptiness of 
the stomach, may be felt more towards the right or towards the left side, 
higher up or lower down, even below the navel. 

3. The stricture of the pylorus causes, further, a sinking in of the ab- 
domen; the intestines are empty, because the food is prevented from going 
through the pylorus ; the abdominal walls are thin, wrinkled, like parchment ; 
they may be lifted up in folds which remain; the subcutaneous cellular 
tissue is wasted away, and the full percussion sound is wanting. The spine 
even may be felt through the abdominal walls, and the aorta descendens 
pulsates perceptibly. When there is a stricture of the cardia the epigastric 
region is fallen in because not sufficient nourishment is allowed to enter the 
stomach ; the intestines are likewise empty, only the ribs and the processus 
xyphoideus protrude. 

4. Vomiting. This happens if there is a stricture of the pylorus, gener- 






CARCINOMA OR SCIRRHUS YENTRICULI. 483 

ally from four to five hours after eating. The masses which are thrown up 
are digested. In case of stricture of the cardia, the vomiting takes place 
immediately after or even during eating, without nausea or exertion ; it is 
only a regurgitation of the swallowed food. If diverticles or widenings of 
the oesophagus exist at the same time, the vomiting follows a little later. 
The masses which are thrown up are the same as swallowed. If the cancer 
has its seat on another part of the stomach, the vomiting may be entirely 
absent ; or it may, after having been regular for a time, slacken off and cease 
altogether. So also, the vomiting may cease if the stricture of the pylorus, 
by softening, gets removed, or if the w T alls of the stomach, by diffused cancer- 
ous degeneration, lose all power of contraction. 

5. Hemorrhages from the stomach. The blood is thrown up either de- 
composed as a brownish, chocolate-like mass, or when larger blood-vessels 
have been destroyed, as clear blood. 

6. The pain in the epigastrium, which has its seat generally in the can- 
cerous tumor, is worse from eating, usually of a lancinating or burning 
character, and never extending to the spine ; it may be absent altogether. 

7. The appetite is generally diminished; in some cases, how T ever, it is 
increased ; but the patients are afraid to eat, because of the following pain 
and vomiting. 

8. The stool is usually retarded ; but w^hen the cancerous growth softens 
and dissolves, we observe colliquative diarrhoea, and when there is haemor- 
rhage in the stomach, bloody evacuations. 

Differential Diagnosis. — At its commencement it can hardly be 
distinguished from a chronic catarrh of the stomach; but in its progress cancer 
has the following distinguishing features: often a tumor in the epigastrium; 
now T and then coffee-ground looking emesis ; rapidly developing marasmus ; 
ashy or yellowish color of the face ; and the age of the individual — over forty 
years ; all of which is not applicable to chronic catarrh of the stomach. 

The symptoms of cancer are also very similar to those of the perforating 
nicer of the stomach. Both have pain; both may have coffee-ground emesis ; 
both may have haemorrhages from the stomach, and even a tumor in the epi- 
gastrium. But cancer never sets in before the fortieth year of age, lasts on 
an average not longer than one year, shows a steady progress in general 
decay, and its pain does not extend through to the spine, but is often com- 
bined with swelling of the lymphatic glands, especially in the axillae and on 
the neck, and with sleeplessness; while the ulcer befalls persons mostly under 
forty years of age, may last for several years and may be cured, or end quickly 
by perforation and subsequent peritonitis, and does not so rapidly develop a 
cachectic appearance of general decay; its pain usually extends from the 
stomach through to the spine. 

Cancer is distinguished from cardialgia in that it grows uninterrupt- 



484 STOMACH. 

edly and gradually, whilst cardialgia comes in spells, with intervals of 
health ; further, by the age of the person, and its inroads upon the general 
constitution. 

How can we know what kind of cancer it is ? 

A very slow progress of the disease, together with additional ascites, 
make it probable that it is a jelly-like cancer — carcinoma alveolaris. An 
acute progress and rapid growth of tumor, with frequent and large haemor- 
rhages, point to carcinoma medullaris. A slow progress and considerable 
hardness and nodulated appearance of the tumor indicates a scirrhus. This 
latter is by far of the most frequent occurrence. 

THERAPEUTIC HINTS.— Arse n., burning pain in the stomach; 
better from warm applications ; vomiting of all he takes ; vomiting of black 
substances ; prostration ; emaciation ; restlessness. 

Arsen. jod., violent burning in stomach. (E. Huber.) 

Bellad., cutting, clawing pain; nausea, gagging and vomiting; staring 
eyes; dryness in mouth and throat; fainting. 

Bismuth., violent, crampy pains; burning and stinging in the region 
of the stomach ; stomach enlarged, hanging down to the crest of the ilium ; 
hard lump between the navel and the edges of the lower ribs on the right side ; 
scirrhus of the pylorus; abdomen bloated in ridges, with great rumbling of 
wind along the colon, which is rarely passed off, but then gives relief; 
vomiting, only at intervals of several days, when the stomach has become 
filled with blood, and then of enormous quantities, and lasting a whole day. 

Carb. veg., burning pain, extending from the pit of the stomach into 
the small of the back; anxiety; cold extremities; cold, sticky sweat; inter- 
mitting pulse. 

Carb. an., saltish water rises from the stomach and runs out of the 
mouth, accompanied by retching, and followed by violent, empty eructa- 
tions, cold feet and hiccough; pressure, clawing, griping and burning in 
the stomach; scanty, hard stools in lumps; copper-colored eruption on the 
face. 

Conium, vomiting of chocolate-colored masses, sour and acrid; press- 
ing, burning, squeezing pain, extending from the pit of the stomach into the 
back and shoulder. 

Cundur., a case well diagnosticated by Friedreich improved remarka- 
bly under the administration of the tincture. 

Hydrast., vomits everything, except water with milk; pain in pit of 
stomach; emaciation. 

Kreos., painful, hard place on the left side of the stomach. 

Laches., gnawing pressure, relieved after eating, but coming on again 



HEMORRHAGE FROM THE STOMACH. 485 

in a few hours, and the more violent the emptier the stomach ; great sensi- 
tiveness to contact, especially to that of his clothes ; drunkards. 

Lycop., after eating or drinking, vomiting of dark, greenish masses; 
bloatedness of the stomach and bowels ; rumbling in the bowels ; obstinate 
constipation ; hard swelling in the epigastric region. 

Mezer., great emaciation; the muscles of the face are tensely drawn, 
like strings ; constant vomiting of chocolate-colored masses, with great burn- 
ing in the throat ; violent retching, accompanied with the agony of death ; 
sleeplessness and exhaustion; obstinate constipation; hard lumps in the 
epigastric region. 

Phosphor., epigastric region sensitive to the touch; constant nausea 
and fulness in the stomach; after eating, or drinking even a swallow of 
water, vomiting of a sour, foul-smelling fluid, which looks as though it had 
been a mixture of water, ink and coffee-grounds ; in the sunken abdomen, a 
circumscribed, hard swelling; pale, earthy complexion; great emaciation; 
sleepiness; peevishness; fine gurgling noise in the abdomen; urine scanty, 
red, or brown, with reddish or yellowish-red sediment ; bowels constipated, 
dry, rumbling stools. 

Sepia, sour taste after eating; vomiting of mucus, caused by taking 
even the simplest food ; the pain in the stomach increases by vomiting, and 
extends to the back, with anxiety ; oppression of the chest and cold perspi- 
ration ; hard places in the region of the pylorus ; constipation. 

In addition, compare the Round Perforating Ulcer, Gastralgia, Catarrh 
of the Stomach and Hsematemesis. 

Haemorrhage from the Stomach, Haematemesis, 

Consists of an effusion of blood, either from the arteries, veins or capillaries 
of the stomach, and may have two distinct causes, viz. : 1. An increased press- 
ure in the blood-vessels. Such is the case, a. In all congestive, catarrhal and 
inflammatory affections of the mucous membrane of the stomach. The bleeding 
in such cases is not very considerable, and comes from the capillary vessels. 
b. In all those cases in ivhich the free circulation of the blood is interfered with, 
as in diseases of the vena porta, liver or spleen, in consequence of constric- 
tion of the inferior vena cava, in heart and lung diseases, all of which cause 
a mechanical interference to the free circulation, and, in consequence, a stag- 
nation and greater pressure of the blood in the mucous membrane of the 
stomach. The bleeding in such cases is mostly capillary only; but it may 
amount to large quantities, if the pressure be great enough to rupture larger 
blood-vessels, c. In cases where habitual bleedings have been suppressed, men- 
strual or hemorrhoidal. Such bleedings are called vicarious. 

The second distinct cause of haemorrhage from the stomach depends upon 



486 STOMACH. 

morbid alterations of the coats of the blood-vessels; these may arise — a. From 
chemical or mechanical influences, such as alkaline or corroding substances, or 
pointed objects within the stomach ; from violent vomiting, straining, or from 
the effects of a fall or a knock ; b. From pathological conditions, such as 
varicose veins, and aneurismal arteries; c. From general diseases, such as 
scurvy, yellow fever, and acute exanthematic fevers; d. From ulcerative pro- 
cesses, such as the round perforating ulcer, haemorrhagic erosions and cancer 
of the stomach. 

Post-mortem examinations exhibit the mucous membrane of the stomach 
pale and anaemic, especially after capillary haemorrhage. At times we find the 
mucous membrane infiltrated with blue or darkened patches here and there, 
from w T hich the blood oozes on slight pressure. On such places the membrane 
is softened and easily removable, whereby slight depressions are formed, called 
hcemorrhagic erosions. After profuse haemorrhages we find clots of blood, after 
slow bleeding or oozing the blood generally is altered by the gastric juice into 
a substance like coffee-grounds. 

Symptoms. — Slight haemorrhages usually cause no particular signs, ex- 
cept traces of blood in the masses which are thrown up. Profuse effusions 
cause a feeling of warmth and fulness in the stomach, nausea and vomiting, 
and soon all the signs of depletion, such as paleness, small pulse and cold 
extremities, great weakness, anxiety and oppression, singing in the ears, 
flickering before the eyes, dizziness and fainting. 

The vomiting brings up the blood clear, in lumps, or already decomposed 
into a chocolate or coffee-ground-like substance. After the vomiting there is 
great thirst. Sometimes no blood is thrown, up, but it is carried off through 
the bowels, making the feces appear dark, black or tar-like. 

Differential Diagnosis. — It may be counfounded with hcemoptoe. 
Hwmoptoe is preceded by heart or lung effections, attended by cough. We 
hear rattling noises in the chest. Haematemesis is preceded by affections 
of the stomach, liver, etc., and is attended by nausea and vomitting. 

Haemoptoe generally yields bright, frothy blood; haematemesis mostly 
dark or decomposed blood. 

When the blood is carried off through the bowels, how can we discern 
whether it comes from the stomach or from the intestines ? In the first case 
the blood is always mixed thoroughly with the feces ; while in the latter case 
it generally comes without fecal masses. 

THERAPEUTIC HINTS.-— Aeon., in congestion and inflammation 
of the mucous membrane of the stomach; in scarlet fever, sometimes during 
desquamation, with excruciating pains in the stomach, gagging, retching, 
gasping for breath ; distressed face ; anguish ; cold sweat on the forehead. 



HEMORRHAGE FROM THE STOMACH. 487 

Arnica, when caused by external injuries; overexertions; soreness all 
over the body. 

Arsen., headache; roaring in the head; fainting; cold, distressed, 
yellowish or deadly pale, collapsed face ; cold perspiration on the forehead'; 
constant nausea; retching; great thirst; burning in the stomach; bloated 
abdomen; stitching pain in the spleen ; black stools; groaning and moaning 
breathing ; quick, trembling, thread-like pulse, 120 to 130 per minute ; cold- 
ness over the whole body; great weakness; trembling, anxiety. 

Bellad., congestion of the head and stomach; singing in the ears; 
flickering before the eyes ; red cheeks ; feeling of fulness and warmth in the 
stomach. 

Carb. veg., frequent fainting; hippocratic face; icy-coldness of the 
extremities; intermitting, small, scarcely perceptible pulse. 

China, great loss of blood, and in consequence excessive weakness; 
paleness and coldness of the hands and feet, like marble; sensitiveness to 
touch in the pit of the stomach. 

Colonic, in a case with bloody discharges from the bowels, and deadly 
nausea from smelling the cooking of food. 

Eriger., violent retching and burning in the stomach. 

Ferr. ac, pit of the stomach sensitive to touch, and soreness all over 
the abdomen ; pulse full, excited ; face pale ; greatly exhausted. 

Hamam., previous fulness and pain in the abdomen; feverishness by 
spells; bloody vomiting and stools; weak, cold, profuse sweat; weak and 
quick pulse; restlessness; fulness and gurgling in the abdomen. 

Hyosc, dizziness; stupefaction; eyes red; face bloated; pit of stomach 
sensitive ; dull aching in the region of the liver ; abdomen bloated ; limbs 
numb, weak, trembling; during vomiting convulsions, with loud shrieks on 
account of crampy pains in the stomach. 

Ipec, sudden attack; blood dark, black, sour; paleness; coldness; 
pulse scarcely perceptible; fainting; anxiety; pressure in stomach; great 
thirst ; oppression of breathing ; constipation or bloody stools. 

Moschus, when the patient becomes pulseless and collapsed. 

Nux vom., throbbing pain in the head ; pale, distressed face; belching; 
constant nausea; stomach full and distended, sore to the touch; burning 
anxiety and pressure in the precordial region ; pain in the region of the 
spleen; constipation, with black stools ; urine turbid, dark; fainting; weak- 
ness; temperature of the skin increased; pulse full, hard, quick. 

Phosphor., bright blood; drowsiness; sleepy; face, lips, gums and 
tongue are pale ; thirsty, better from drinking cold water ; loathing of food ; 
heaviness and heat at the pit of the stomach, which is distended ; abdomen 
soft; urine dark; skin warm, with partial perspiration; pulse quick, ener- 
getic. 



488 STOMACH. 

Secale, the patient lies still, with great weakness but no pain; face, 
lips, tongue and hands deadly pale; skin covered with cold sweat; pulse 
frequent, thread-like ; oppression ; abdomen soft, without pain. 

Veratr., slow pulse; cool temperature of the skin; chilliness; fainting 
fits ; inability to stand ; moving or rising causes sickness in the stomach at 
once ; cold sweat ; even fainting. 

When in connection with suppressed menstrual discharges, compare 
Conium, Ipec, Millef., Pulsat., Sulphur; with suppressed hsemorrhoidal dis- 
charges, Carb. veg., Millef., Nux vom., Sulphur; after mental emotions, 
Aeon., Hyosc, Natr., mur., Phosph. ac. 

When in combination with scurvy, typhus: Alum., Arsen., Carb. veg., 
Nitr. ac, Phosphor., Phosph. ac, Sulph. ac 

In consequence of destructive processes within the stomach, compare 
Carcinoma et Ulcus Rotundum Ventriculi. 

Gastromalacia, Softening of the Stomach. 

Post-mortem examination reveals the coats of the stomach softened, 
changed into a kind of pappy mass ; it can easily be scraped off. The affec- 
tion is more or less extended and almost exclusively confined to the greater 
end of the stomach, or fundus ventriculi And, notwithstanding such a 
complete decay, there is never found any sign of any catarrhal or inflamma- 
tory or ulcerative process in the whole mucous membrane of the stomach ; 
neither is the decayed portion sharply defined, but passes gradually over 
into the healthy tissues. Its symptoms are such as are described under 
hydrocephaloid, or cholera infantum, the most prominent of which are con- 
stant vomiting and diarrhoea. The latest observations on this disease make 
it more than probable that gastromalacia is no disease, but a chemical process 
of decay after death. The reasons for this opinion are the following: 

1. Softening of the coats of the stomach have been found in perfectly 
healthy individuals, who died suddenly or were executed after they had a 
short time previously partaken of food. EUdsser observes that the food 
which had been taken was easily prone to an acid fermentation, or contained 
already a natural acid, as wine, beer, etc. 

2. Experiments which Elsasser made show that substances which easily 
undergo the acid fermentation, such as sugar, milk, starch, etc, bring on 
this softening in a healthy stomach, taken out of a corpse under application 
of the same degree of heat which the body retains for some time after 
death. 

3. The softening of the stomach is never found in a perfectly empty 
stomach, but always only in the presence of sour contents, and it is almost 
without exception found at the fundus ventriculi, that part of the stomach 



INTESTINAL CATARRH. 489 

which lies deepest, if the body lies stretched out on its back, on a part, 
therefore, on which the fluid contents of the stomach must collect. Further- 
more, the size of the softened tissue has been found to correspond with the 
surface that has been covered by these contents. Furthermore, Elsasser 
found that, if he brought the bodies of children who died with cholera 
infantum into another position, that then other parts of the stomach were 
softened, and the fundus perfectly free from so-called gastromalacia. 

4. The symptoms during lifetime which are ascribed to gastromalacia 
are so inconsistent and varying, that it would be almost impossible to make 
a differential diaguosis. Some writers describe it as an acute, others as a 
chronic disease; some under the form of cholera, others under the form of 
gastritis ; others under the form of irritation, or congestion, or inflammation 
of the brain. Who is right? And the most constant symptom ascribed to 
this disease — the constant vomiting — does not very well agree with a softened 
condition of the stomach as is found after death. For it is almost impossible 
to realize that a stomach so far decayed could bear such contractions and 
revolutions without bursting. 

5. There is one symptom entirely absent during life which we should 
naturally suppose would necessarily occur, if such Softening were really 
present during life, viz., the vomiting of blood. Imagine the entire destruc- 
tion of so large a piece of membrane, which is full of blood-vessels, without 
any bleeding! And yet, if this same organ is artificially injected after death, 
the injected matter escapes from all parts of the softened surface, why should 
not the blood during life do the same? 

6. According to latest observations it appears that in extremely rare 
cases the softening of the stomach may begin before death, and even proceed 
to complete perforation. (Lauber.) 

I will close by simply suggesting that time and research may reveal the 
fact, that many other conditions, now considered to be the result of morbid 
processes in the living organism, are but the products of changes which the 
body undergoes after it has been given over to the sole influence of chemical 
and mechanical agencies. 

b. DISEASES OF THE INTESTINAL CANAL. 

Catarrhus Intestinalis, Enteritis Catarrhalis, Intestinal 

Catarrh. 

In its acute form this affection presents the same appearance as that by 
which a catarrhal inflammation of any other mucous membrane is character- 
ized — injection, swelling, infiltration of the submucous tissue; besides there 
is almost always swelling of the solitary and Peyer's glands, also frequently 



490 INTESTINAL CANAL. 

hyperemia and enlargement of the mesenteric glands; the serous fluid is 
mixed with epithelial cells changing gradually into a thick, turbid phlegm, 
which adheres to the walls of the intestines. 

Primarily, it may take place after overloading the stomach, the use of 
purgative medicines, taking cotd, and after mental emotions. 

Secondarily, it accompanies tuberculosis, cancer, typhus, puerperal fever, 
pneumonia, dentition, and wide-spread external inflammations in consequence 
of burns. 

The Symptoms vary according to the locality of the affection. A ca- 
tarrhal inflammation of the duodenum, is almost always found in connection 
wdth catarrhal inflammation of the stomach, and is characterized by obstruc- 
tion of the ductus choledochus and consequent icterus. A catarrhal inflam- 
mation of the colon almost always extends to the rectum, and is characterized 
by colicky pains, also pains in the sphincter ani, tenesmus, and burning at 
the anus. A catarrhal inflammation confined to the rectum alone offers the 
same symptoms. 

In all cases, however, diarrhoea is the most permanent symptom, except 
where the inflammation is confined to the upper portions of the small intes- 
tines, when there may be no diarrhoea at all. The color of the discharges is 
at first usually green, from an admixture of bile which has not been changed 
by the normal digestive process; later, when the discharges become more 
abundant, the dejections grow pale and whitish. In case of affections of the 
lower portion of the colon and of the rectum, the evacuations are slimy and 
even bloody. The frequency of stools varies according to the severity of the 
case. The evacuations are usually preceded by sharp, cutting pains in the 
abdomen, which subside after each evacuation. Severe cases are attended 
with fever, headache, delirium, want of appetite, sickness of the stomach, 
and thick coated tongue. 

Secondary catarrh of the intestines, according to its seat, presents the 
same symptoms, but modified by the original affection and sometimes dis- 
guised by it. That which ensues in consequence of severe external burns, 
according to Curling, usually sets in at or about the tenth day after the in- 
jury, and is characterized by a sharp pain in the epigastrium and towards 
the region under the right ribs, and sometimes by a severe diarrhoea. 

In most books we find a chapter on "enteritis," or inflammation of the 
bowels. The term is too wide. It embraces what we have to diagnosticate 
specially : as dysentery, ulceration of the bowels, peritonitis ; in short, any 
inflammatory affection of the bowels, and is, therefore, worth about as much 
as the enchanting term of " liver complaint" 



INTESTINAL CATARRH. 491 

THERAPEUTIC HINTS.— Aeon., after checked perspiration; fre- 
quent, scanty, and loose stools with tenesmus; green stools, like spinage; 
jaundice. 

Aloes, pain and rumbling in the bowels before stool; escape of large 
quantities of wind with the stool ; pain in the small of the back. 

Ant. crud., disordered stomach from sour wine or beer; white tongue; 
watery discharges; thirst at night. 

Aranea, colicky pain and diarrhoea daily at the same hour, with a 
feeling as if the arms and legs were asleep. (Nunez.) 

Arsen., after chilling the stomach by taking cold substances; painful 
or painless diarrhoea ; worse about midnight ; sudden prostration and great 
thirst ; also diarrhoea in consequence of severe external burns. 

Benz. ac, fetid, white, frothy stools, like soap-suds; urine high-colored 
and very offensive ; child weak and very cross ; wants to be nursed all the 
time. (A. Korndoerfer.) 

Bryon., when the weather changes suddenly from cold to warm, or 
from warm to cold ; in the summer season ; after eating fruit or sour-krout 
after vexation and anger; painful diarrhoea, worse from motion and in the 
morning. 

Calc. carb., during dentition, with vomiting and diarrhoea, which is 
generally worse in the after part of the day. 

Chamom., painful diarrhoea of little children; they draw their limbs 
up; their belly is bloated, hard; the discharges are watery, or greenish and 
slimy, or "undigested, looking like chopped eggs; there is rumbling in the 
bowels, and soreness of the anus; jaundice. 

China, frothy diarrhoea, generally painless; after sour beer; with a 
great deal of fermentation in the bowels ; worse after eating, and in the night. 

Collin., diarrhoea of children, accompanied with colic, cramps, flatu- 
lence, etc. 

Coloc, with every pain he doubles up, or presses the belly against a 
hard object. 

Corn, circ, dark and bilious stools, with griping and tenesmus; gene- 
ral debility and nervous excitability; chilliness, followed by flushes of heat 
and sweat. 

Crot. tigl., suddenly gushing out of yellowish watery substances, with 
pain before. 

Cupr. arsen., with abdominal pains. 

Dulcam., when the weather changes suddenly to cold; cold, chilly feel- 
ing in the small of the back; griping in the region of the navel, with nausea 
in the stomach. 

Ferrum, painless, large, watery discharges, with a good appetite. 

Ipec, diarrhoea and vomiting during dentition; in consequence of eating 



492 INTESTINAL CANAL. 

sweet, fat, or sour things (raisins, pound-cakes, pastry, salad, etc.) ; accompa- 
nied by pain in the bowels; paleness of the face; cold extremities; even 
spasms. 

Iris vers., burning in the rectum and anus after a passage; painful, 
green discharges ; periodical spells of diarrhoea ; always at night about two 
or three o'clock. 

Jatropha, painless diarrhoea, worse in the morning, thin, watery, with 
loud rumbling, and gushing out of stools. 

Leptand., profuse, watery stools, followed by severe cutting pains in 
the small intestines ; after exposure to wet, damp weather. 

Magn. carb., stools green, like scum on a frog pond; sour, frothy; or 
with white, floating lumps, like tallow. Colic before, better after stool. 

Mercur., great straining, cannot get done; discharges slimy, green or 
bloody; from taking cold; worse in the evening; jaundice; chafed at anus. 

Nux vom., always after previous use of quack medicines, teas, lauda- 
num, brandy, lavender, peppermint, etc., frequently worse early in the 
morning. 

Podoph., diarrhoea, which changes constantly in appearance, now 
green, now yellowish, now whitish, slimy, etc. ; always worse in the forepart 
of the day; during teething; rolling the head from side to side. 

Pulsat., chilliness; thirstlessness; bitter taste in the mouth; coated 
tongue ; diarrhoea worse at night ; disordered stomach ; nausea. 

Rheum, during dentition; the whole child smells sour; sour discharges, 
green, brown, fermented; great pain in bow T els and crying; pain w r orse at 
once from uncovering an arm or leg. " The child asks for many things with 
vehemence and tears; is temporarily satisfied after its whims are gratified, 
attended by pallor of countenance, occasional twitching of eyelids, soreness 
of month, lips and fingers; sweat of the hairy scalp asleep or aw T ake; sw T eat 
sour or not ; crying desires for various articles of diet, but quickly satisfied. 
Colic often worse after a diarrhoeic stool ; increased urging to stool, when 
moving about." (M. B. Tuller.) 

Rhus tox., great pain in the bowels before evacuation, which is green- 
ish, and contains jelly-like globules or flakes; worse in the night or when 
keeping quiet. 

Rumex, diarrhoea in the morning, with cough from tickling in the 
throat-pit. 

Sulphur, either without pain or with straining; always worse in the 
morning, driving out of bed ; excoriating the anus. 

Veratr., in summer season with vomiting, coming on suddenly at night, 
generally painless; white. Great thirst; feels worse after drinking. 



CHRONIC INTESTINAL CATARRH. 493 



Chronic Intestinal Catarrh, 



Its pathological features differ much from those of the acute form. The 
mucous membrane of the intestines appears livid, brownish-red, or gray, 
slate-colored; it is thickened and swollen; its follicles are hypertrophied, and 
the whole surface is covered with a tough, grayish, sometimes transparent 
and jelly-like slime. In some cases all the coats of the intestines are hyper- 
trophied, and polypous excrescences found upon it. Sometimes the mucous 
membrane appears pale, anaemic, and the submucous cellular tissue infiltrated. 
It is usually diffused over large tracts of the canal, but may be confined to 
the lower part of the small intestines or to portions of the colon. 

This form develops itself either in consequence of repeated acute 
attacks, or the frequent use of purgative medicines, or is a concomitant of 
various other complaints, such as cancer, tuberculosis, typhus, obstructed 
circulation in the vena porta, cirrhosis of the liver, organic diseases of the 
heart and lungs, or obstruction in the gut itself. Its Symptoms are the 
following : 

1. Diarrhoea or constipation, frequently in alternation. The diarrhoeic 
stools consist mostly of thin, fecal matter, of all colors and consistencies, 
mixed with considerable quantities of slimy, jelly-like matter. The hard 
evacuations are always covered with tough or jelly-like phlegm. 

2. Copious development of gas in the bowels, which causes partial or 
general distention of the abdomen and great distress to the patient. Its pass- 
ing off gives great relief, and for that reason the patients make much account 
of it. 

3. Hypochondriacal mood. Such patients do not think or speak of any- 
thing but their own sufferings ; tormenting everybody with the same sorrow- 
ful tale. 

4. Gradual emaciation, and, in severe cases, sinking in of the abdomen, 
in which the thickened intestines can be felt through the abdominal walls. 

As regards its location, we may conceive the inflammation as situated: 
1. In the upper part of the small intestines, if the patient complains of a dull 
pain in the middle of the abdomen and constipation. 2. In the lower part 
of the small intestines — the ileum — if it is attended with greenish-yellow, or 
yellowish-gray, watery stools, which, when left standing, form a sediment. 
3. In the large intestines, if the evacuations contain large quantities of slime 
or pus mixed with blood, and are attended with a great deal of tenesmus. 

THERAPEUTIC HINTS— Arg. nitr., diarrhoea, worse at night; 
watery, slimy; always after drinking or eating soup, immediate discharge 
from the bowels, as though the fluid were rolling through without stopping; 



494 INTESTINAL CANAL. 

soreness and burning in the region of the sigmoid flexure; fever; emaciation; 
desire for sugar. 

Arsen., worse about midnight; burning pain in the abdomen; dis- 
charges burning, cadaverously-smelling, excoriating the anus; thin, lumpy, 
of all colors ; great thirst ; restlessness ; exhaustion and emaciation ; old look 
in the face; very cross and despondent. 

Baptis., stools dark, offensive, exhausting; pain in liver and region 
of gall-bladder, sweat and urine extremely fetid ; little or no thirst ; gone 
feeling at pit of stomach ; frequent faintings. 

Bryon., pain in the bowels after eating or drinking; slightest motion 
brings on a discharge which looks like dirty water, showing, on standing, a 
whitish, finely granulated sediment of undigested food at the bottom of the 
vessel. 

Calc. carb., during dentition ; scrofulous individuals ; diarrhoea, worse 
toward evening ; whitish, chronic, soft stools ; emaciation. 

Carb. veg., great collection of wind in the abdomen, frequent dis- 
charges of very fetid flatus without relief; stool, even if soft, is passed with 
great difficulty, similar to Cinchona. 

Coccul., diarrhoea only through the day, thin, yellowish, without pain ; 
great rumbling in the bowels; hectic fever; general emaciation. 

Coloc, chronic diarrhoea in the morning; watery; with pain in the 
sides of the abdomen. 

Crot. tigl., diarrhoea, with nausea; watery discharges gushing out 
forcibly; worse after drinking, and in the summer season. 

Gelsem., when diarrhoea is always brought on by exciting news, fright 
or emotions of the mind. 

Graphit., a quantity of white mucus is expelled with the stool, or the 
hard feces are covered with slime. 

Gummi gutt., pain in ileo-csecal region, which is sensitive to the touch ; 
discharges watery, slimy, undigested, without smell; during stool, bearing 
down and colicky pain, prolapsus ani, and cold sweat on the limbs. Also 
thin, yellow, fecal or watery, frequent, copious stools, coming out all at once; 
worse in the forenoon ; sudden urging ; after stool great relief in abdomen. 

Hepar, especially after the abuse of mercury, with longing for sour or 
strong-tasting things ; empty, sinking feeling in stomach, relieved by eating. 

Ipec, cured a chronic diarrhoea with clean tongue and frequent nausea, 
constant pain at umbilicus ; miasmatic origin. Aided by milk diet. ( W. L. 
Dodge.) 

Laches., ileo-csecal region very sensitive to touch ; after great strain- 
ing, discharge of a mass of croupous exudation; stools very offensive; heat 
of abdomen. 

Mercur., discharge mostly slimy and with straining; worse towards 



CHRONIC INTESTINAL CATARRH. 495 

evening and in the night; gums swollen; teeth loose; sickly smell from the 
mouth ; the mere putting the hands upon something cold, causes pain in the 
bowels; debility; sweat without relief. 

Natr. mur., diarrhoea mostly through the day; greenish, bloody; or 
watery; perceptible falling away in flesh on the neck; the neck becomes 
quite thin. (Hering.) 

Nitr. ac, acute pain in the abdomen during stool; worse in the morn- 
ing; discharge brown and slimy. 

Nuphar lut., stool liquid, light yellow; the call is urgent, must go 
quick, every morning at six o'clock, and followed by two or four more pass- 
ages in a few hours, and no more until next morning. (J. L. Gage.) 

CEnoth. bien., relieves the melancholy and low spirits which accom- 
pany the chronic form. (J. S. Douglass.). 

Petrol., slimy discharge; also, brown fluid or pappy evacuations ; pain 
in the bowels ; before dusk a sensation of unpleasant motion and grasping in 
the bowels; disgust for meat, especially fat; bitter-sour taste in the mouth; 
cold feeling in the abdomen. Diarrhoea, sometimes only during the day. 

Phosphor., painless, watery discharges; especially in the morning 
after getting up ; in debilitated, consumptive patients ; lying-in women, etc. ; 
burning of the palms of the hands; great weakness; emaciation. Worse in 
warm weather. 

Phosph. ac, painless, watery discharges, with great rumbling in the 
bowels ; during cholera epidemics. 

Sepia, jelly-like stools, with colic; debilitating diarrhoea; worse after 
milk ; the whole aspect of the patient indicates a deep-seated disturbance in 
the digestive functions. 

Sulphur, diarrhoea; worse in the night or early in the morning; stools 
yellow or brownish or greenish, mixed with blood, slime or pus; feces pass 
off while the patient intends to relieve himself of flatus ; the abdomen is sore 
to the touch ; during stool, pain in the small of the back ; palpitation of the 
heart ; congestion of the head ; prolapsus ani ; itching, burning, smarting in 
the anus and rectum. 

Frequent alternation of costiveness with diarrhoea suggests: Ant. crud., 
Arg. nitr., Arsen., Bryon., Graphit., Xatr. mur., Phosphor., Ehus tox., 
Ruta, Sepia. 

Copious development of gas : Garb, veg., Coccul., Graphit., Nitr. ac, 
Phosphor., Pulsat. 

The patients think and talk of nothing but their ailments: Arsen., Calc. 
carb., Coccul., Mercur., Xitr. ac, Phosphor., Sepia, Sulphur. 

Emaciation and sinking in of the abdomen: Arsen., Borax, Calc. carb., 
China, Ferrum, Graphit., Iodum, Laches., Lycop., Xatr. mur., Nitr. ac, Xux 
vom., Phosphor., Phosph. ac, Pulsat., Silic, Staphis., Sulphur, Veratr. 



496 



INTESTINAL CANAL. 



Digest to Acute and Chronic Intestinal Catarrh. 



DISCHARGES. 

Bloody: Acon.,Mereur.,Natr. mur., Sulphur. 

Brown : Nitr. ac, Petrol., Rhus tox. 

Brownish: Sulphur. 

Colors, of all : Arsen., Podoph. 

Croupous masses after great straining: 
Laches. 

Dark : Baptis., Corn. circ. 

Eggs, chopped, like: Chamom. 

Fermented: China, Rhus tox. 

Frequent: Aeon., Gummi. 

Frothy : China, Magn. earb. 

, like soap-suds: Benz. ac. 

Green : Chamom., Iris, Mercur., Rheum. 

, like scum on a frog-pond : Magn. carb. 

spinage : Aeon. 

and changing constantly in color: 

Podoph. 

Greenish : Chamom., Natr. mur., Rhus tox., 
Sulphur. 

Jelly-like: Sepia. 

globules or flakes: Rhus tox. 

Lumpy: Arsen. 

Offensive, fetid : B:iptis.,Bznz. ac., Laches. 

, cadaverously: Arsen. 

Pappy: Petrol. 

Pus, containing: Sulphur. 

Slimy : Arg. nitr., Chamom., Gummi, Mer- 
cur., Nitr. ac., Podoph., Sulphur. 

, a quantity of white mucus is expelled 

with the stool, or covers hard feces: 
Graphit. 

Smell, sour : Magn. earb , Rheum. 

, without: Gummi. 

Thin : Arsen., Coccul., Jatropha. 

Undigested: Bryon., Chamom., China, 
Gummi. 

Watery : Ant. crud., Arg. nitr., Chamom., 
Coloc.,Crot. tigl, Ferrum, Gummi, Jatropha, 
Leptand., Natr. mur., Phosphor., Phosph. ac. 

Water, like dirty, with whitish, finely 
granulated sediment of undigested mat- 
ter: Bryon. 

White : Ver. alb. 

floating lumps, like tallow : Magn. carb. 



Whitish, soft stools : Cole. carb. 
Yellowish: Coccul, Grot, tigl, Gummi, 
Nuph. lut. 

PASSAGE. 

Sudden urging : Gummi. 

every morning at 6 o'clock, followed 

by two or four more passages in a few 

hours and no more until next morning: 

Nuphar. 
Coming on suddenly at night: Veratr. 

out all at once : Gummi. 

Gush out: Crot. tigl, Jatropha. 

Stool is passed with difficulty, even if 

soft: Carb. veg., China. 
involuntarily while passing flatus : 

Sulphur. 
without pain: Arsen., China, Coccul. 

Ferrum, Iris, Jatropha, Phosphor., Phosph. 

ac., Sulphur, Ver. alb. 
with pain: Ars:n., Bryon., Chamom., 

Coloc, Ipec., Iris, Nitr. ac. 

and crying: Rheum, Rhus tox. 

Before stool pain: Crot. tigl, Magn. carb. 

and rumbling in bowels : Aloes. 

During stool colic: Aranea, Chamom., 

Collin., Coloc, Ipec, Gummi, S:pia. 
, with doubling up and pressing the 

belly against a hard object: Coloc 

, with drawing the limbs up : Chamom. 

, daily at same hour, with feeling as if 

arms and legs were asleep : Aranea. 

griping : Corn. circ. 

, pain in the sides of abdomen : Coloc. 

, in small of back ; palpitation of heart ; 

congestion to head: Sulphur. 
, with bearing down, prolapsus ani: 

Gummi, Sulphur. 
, burning and smarting in anus and 

rectum : Sidphur. 
, with paleness of face and cold ex- 
tremities: Arsen., Ipec. 

cold sweat on limbs : Gummi. 

, rumbling, flatulence : Collin., Jatropha. 

, escape of much flatus : Aloes. 



DIGEST TO ACUTE AND CHRONIC INTESTINAL CATARRH. 



497 



Passage, with straining and tenesmus: 
Aeon., Corn, circ, Mercur., Nux vom., Sul- 
phur. 

, cannot get done : Mercur. 

, nausea and vomiting : Crot. tigl., Ipec, 

Ver. alb. 

, during dentition : Bellad., Cole. curb. 

After stool, relief in abdomen: Gummi, 
Magn. carb. 

, colic: Rheum. 

, severe pain in small intestines: 

Leptand. 

, burning in rectum and anus : Iris vers. 

GENERAL SYMPTOMS. 

Patients think, talk of nothing but their 
ailments : Arsen., Cede, carb., Coccid., Mer- 
cur., Nitr. etc, Phosphor., Sepia, Sulphur. 

Low-spirited and melancholy: (Enanth. 
bien. 

Cross and despondent: Arsen. 

, child wants to be nursed all the time : 

Beiiz. ac. 

, carried about : Chamom. 

, many things with vehemence 

and tears, and is satisfied for a short time 
if its whims are gratified : Rheum. 

Rolling head from side to side : Podoph. 

Hairy scalp perspiring ; sweat sour, or not : 
Rheum. 

Old look of the face: Arsen. 

Pallor of countenance, occasional twitch- 
ing of eyelids, corners of mouth, lips and 
fingers: Rheum. 



Gums swollen, teeth loose, sickly smell 

from mouth : Mercur. 
Tongue clean: Ipec. 

coated : Pulsat. 

white : Ant. crud. 

Taste bitter: Pulsat. 

bitter-sour: Petrol. 

Thirst great: Veratr. 

at night: Ant. crud. 

Thirstless: Baptis., PukcU. 
Appetite good: Ferrum. 
Desire for sugar: Arg. nitr. 

sour or strong-tasting things: Hepar. 

various things, quickly satisfied: 

Rheum. 

32 



Disgust for meat, especially fat : Petrol. 
Stomach disordered: Ant. crud., Pulsat. 
Deep-seated disturbance of digestive 

functions: Sepia. 
Nausea : Ipec, Pulsat. 
Empty, gone, sinking feeling in stomach : 

Baptis. 

relieved by eating : Hepar. 

Pain in liver and region of gall-bladder : 

Baptis. 
Jaundice : Aeon., Chamom., Mercur. 



Griping about navel with nausea : Dulcam. 

Pain constant about navel: Ipec. 

Soreness and burning in region of sig- 
moid flexure : Arg. nitr. 

Pain in ileo-csecal region, sensitive to 
touch : Gummi, Laches. 

Cold feeling in abdomen: Petrol. 

Burning pain in abdomen : Arsen. 

Heat of abdomen externally: Laches. 

Unpleasant motion and grasping in bow- 
els before dusk : Petrol. 

Soreness of abdomen to touch: Laches., 
Sulphur. 

Rumbling in abdomen: Chamom., Coccul., 
Phosph. ac. 

Fermentation in bowels: China. 

Copious development of gas: Carb. veg., 

• Coccul., Graphit., Nitr. ac, Phosphor., 
Pulsat. 

Belly bloated and hard: Chamom. 

Frequent discharges of very fetid flatus 
without relief: Cirb. veg. 

Frequent alternation of costiveness with 
diarrhoea: Ant. crud., Arg. nitr., Arsen., 
Bryon., Graphit, Natr. mur., Phosphor., 
Rhus tox., Ruta, Sepia. 

Emaciation and sinking in of abdomen : 
Arsen., Borax, Calc. carb., China, Ferrum, 
Graphit, Iodium, Laches., Lycop., Natr. 
mur., Nitr.ac., Nux vom., Phosphor., Phosph. 
ac, Pulsat, Silic, Staphis., Sulphur, Ver. 
alh. 

Urine high colored and very offensive: 
Benz. ac. 

fetid: Baptis. 

Chafed, excoriated, sore anus: Arsen., 
Chamom., Mercur., Sulphur. 



498 



INTESTINAL CANAL. 



Cough from tickling in the throat-pit 
Rumex. 



Cold, chilly in small of back: JDulcam. 
Chilliness: Pulsat. 

, followed by flushes of heat and sweat : 

Corn. circ 
Hectic fever: Coccul. 
Burning of palms of hands : Phosphor. 
Sweat fetid : Baptis. 
without relief: Mercur. 



Restlessness: Arsen. 

Nervous excitability: Corn. circ,Rheum. 

Weakness: Phosphor. 

Debility: Corn, circ, Mercur., Sepia. 

Exhaustion : Arsen., Baptis. 

Prostration, sudden: Arsen. 

Emaciation: Arsen., Calc. carb., 

Phosphor. 
, especially of neck : Nair. mur. 



Whole child smells sour : Rheum. 
aspect indicates deep-seated disturb- 
ance of digestive organs : Sepia. 



Worse in the morning : Coloc, Jatropha, 

Nitr. ac, Rumex. 

, early 2 or 3 o'clock a.m. : Iris. 

, early : Nux vom. 

, driving out of bed : Sulphur. 

, after getting up and moving about : 

Bryon., Phosphor. 

in forenoon : Gummi, Podoph. 

in afternoon and evening: Calc. carb., 

Merc. sol. 
through the day : Coccul., Natr. mur., 

Petrol. 
in the night: Arg.nitr., China, Mercur., 

Pulsat, Rhus tox., Sulphur. 

about midnight : Arsen. 

after drinking : Crotal., Ver. alb. 



Worse after drinking or eating: Bryon. 

or eating soup, as though the 

fluid were rolling through without stop- 
ping : Arg. nitr. 

after eating: China. 

from slightest motion : Bryon. 

from moving about : Rheum. 

when keeping quiet : Rhus tox. 

from uncovering an arm or leg : Rheum. 

Aided by milk diet: Ipec. 

Brought on by disordered stomach, from 

sour wine or beer: Ant. crud., China. 

from sour crout, sour fruit : Bryon. 

from milk: Sepia. 

from sweet, fat or sour things (raisins, 

pound cakes, pastry, salad, etc.): Ipec, 

Pulsat. 

by chilling the stomach with ice 

cream, ice water, ice milk: Arsen. 

after previous use of quack medicines : 

Nux vom. 

after mercurial preparations: Hepar. 

by exciting news, fright, etc. : Gelsem. 

by vexation or anger : Bryon. 

in summer season: Bryon., Crotal., 

Ipec, Phosphor., Veratr. 

when the weather changes suddenly 

to cold: Bryon., Dulcam. 
by exposure to wet, damp weather: 

Leptand. 

by taking cold : Mercur. 

by checked perspiration : Aeon. 

by putting the hands upon something 

cold: Mercur. 

during dentition: Calc. carb., Ipec, 

Podoph., Rheum. 

, lying-in women: Phosphor. 

, debilitated and consumptive patients : 

Phosphor. 

, scrofulous individuals: Calc carb. 

, external burns: Arsen. 

, during cholera epidemics : Phosph. ac. 

, miasmatic origin : Ipec. ' 



TYPHLITIS, PERITYPHLITIS. 499 

Typhlitis, Perityphlitis and Inflammation of the Vermiform 

Process. 

Although, anatomically speaking, these are three distinct forms of dis- 
eases, yet. considering them in a diagnostic point of view, their symptoms 
during life are so intimately interwoven, that a differential diagnosis among 
them is rarely possible. 

Typhlitis is an inflammation or catarrh of the mucous membrane of 
the caecum, in consequence either of cold or accumulation of hardened feces 
or foreign bodies, such as cherry-stones, plum-stones and the like. It may 
spread over a considerable portion of the colon ascendens, and to the vermi- 
form process ; it may spread to the muscular layer of the gut, cause ulceration 
and even perforation of these parts, and terminate in peritonitis, inflammation 
of the loose areolar tissue around the caecum, and formation of abscesses in 
the right iliac fossa. 

Perityphlitis is an inflammation of the loose areolar tissue around the 
caecum, either in consequence of typhlitis, or starting here independently ; it 
is attended with a feeling of numbness and formication in the right limb and 
but little meteorisra. It termiuates, if not checked, in the formation of 
abscesses in the right iliac fossa, which either discharge into the neighboring 
viscera or break through the abdominal parietes, mostly in the neighborhood 
of Poupart's ligament. As such abscesses, if not originally caused by per- 
foration of the caecum from within, mostly perforate the posterior wall of this 
organ, it occasionally happens that the abscess, when it discharges exteriorly, 
contains fecal matter also. 

Inflammation of the appendix vermiformis may be caused, like 
typhlitis, by hardened fecal matter or foreign bodies. It terminates either 
in obliteration of this process, or, when its opening gets closed, in an accumu- 
lation of a slimy, serous fluid, by which its Avails become distended, forming 
the so-called dropsy of the appendix, or in the formation of abscesses in the 
right iliac fossa, or, lastly, in more or less extended peritonitis. 

The Symptoms of these three pathological states we may sum up under 
the following heads : 

1. External swelling. It makes its appearance in the right ileo-ca?cal or 
ileo-inguinal region of the abdomen. It is felt directly under the abdominal 
wall, which is movable upon it, except in such cases where a perforation to 
the outside is going to take place, and exhibits in most cases considerable 
heat and redness. The swelling itself is immovable, its surface feels smooth, 
and its consistency varies in degree; it may reach sometimes the hardness of 
a stone; fluctuation is seldom perceptible. Its growth is rapid; in a few 
days it reaches its height. This swelling is wanting only in such cases in 
which perforation takes place, before yet exudation and pus formation could 



500 INTESTINAL CANAL. 

take place around the csecum, and it is not perceptible or at least not distinctly 
so, when, in consequence of peritonitis, the fluid exudation or meteorismus 
of the neighboring intestines covers it over. When perityphlitis follows upon 
typhlitis and the latter subsides, we find the exterior swelling likewise de- 
creasing while a tumor deeper in still remains. 

2. Pain. It usually commences suddenly, is of a sharp, lancinating or 
boring nature, and increases on motion, especially such which put either the 
abdominal or the psoas muscle on a stretch. It is worse from touch, and 
confined either to the right iliac fossa alone or extending over a larger sur- 
face in accordance to the extension of the inflammation. 

3. Obstinate constipation, which may last for days, although interrupted 
sometimes . 

4. By an intercurrent diarrhoea of a slimy, watery substance. Such diar- 
rhoea, however, is no favorable sign ; only fecal discharges afford relief. 

5. Vomiting may take place at any stage of the disease, but does so most 
frequently at its height. In some cases it is very violent, ten to twelve times 
a day, is at first of a watery, yellowish or greenish fluid, which, however, as 
the disease progresses, and the constipation continues, assumes a stercoraceous 
smell, until, by the continued antiperistaltic motion of the intestines, the con- 
tents of the smaller intestines are forced back into the stomach, whence they 
are thrown up, affording temporary relief to the patient. 

6. Belching and meteoristic distention of the stomach and upper part of 
the abdomen. 

7. Singultus or hiccough is a frequent sign, and very distressing to the 
patient, preventing all rest and sleep. 

8. Pain in the genitals, erections of the penis, drawing up of the testicles, 
difficulty in urinating, numbness of the right leg, are consequences of the 
swelling, pressing upon the corresponding nerves ; while 

9. The oedematous swelling of the right leg is the consequence of its press- 
ure upon the crural and iliacal veins. Such a desperate condition of things 
must necessarily involve the whole system 

10. In fever, which is more or less violent according to the extent of the 
inflammation. 

Differential Diagnosis. — It may be confounded with 

1. Abscesses of the psoas muscle. But in this affection the swelling lies 
deeper, nearer Poupart's ligament, and more towards the middle line of the 
abdomen. It makes any motion with the right leg, which is always held in 
a bent position, impossible ; it leaves the action of the bowels undisturbed ; 
it is associated with caries of the vertebrae or bones of the pelvis. Pus, when 
discharged through the abdominal walls, has no fecal odor. 

2. Tumors or abscesses of the right kidney cause the main part of the swell- 
ing to appear in the loin, or above the anterior termination of the crest of 



TYPHLITIS, PERITYPHLITIS. 501 

the ilium. There is no disturbance in the action of the bowels, but the urine 
contains pus, bloody gravel, pointing at once to a diseased state of the 
kidneys. 

3. Tumors of the right ovary are attended with menstrual disturbance, 
but not with affections of the bowels; they grow slowly, and from below up 
out of the pelvis, where they may be discovered by a per vaginam exami- 
nation. 

4. Cancer of the ccecum is a very rare disease, of very slow growth, and 
attended with all the general signs of cancerous diathesis. 

5. Intussusception or invagination of the intestine may be sometimes very 
difficult to be discerned from typhlitis, especially if it should happen to 
cause a swelling just in the right iliac region; but this is not always the 
case ; and, furthermore, it is preceded by diarrhoea. As soon, however, as 
invagination has taken place, there are only bloody, slimy discharges ; the 
obstruction of the intestinal canal with all its symptoms — stercoraceous 
vomiting, hiccough, etc. — is at once established, while in typhlitis it sets in 
only during the further progress of the disease. 

THERAPEUTIC HINTS.— Bellad., great pain in the ileo-cecal 
region, cannot bear the slightest touch, not even the bed-cover; nausea; 
vomiting; necessity of lying motionless on his back; high fever, increasing 
during the afternoon with red or pale face; slight perspiration during the 
fever. 

Ginseng, stinging pain and swelling and gurgling noise in the ileo- 
cecal region ; dry tongue ; heat and delirium when going to sleep. 

Hepar, after the abuse of mercury; ileo-csecal region swollen, deep, in 
a circumscribed lump ; lying on the back with the right knee drawn up, as 
easiest position ; frequent urging to stool and urination. 

Laches., great sensitiveness to contact of the abdomen; swelling in 
the ileo-ciecal region; painful stiffness from the loins down to the os sacrum 
and thighs; constipation; scanty urine, with red sediment; strangury; only 
possible position is that on the back, with the knees drawn up. Fever in- 
creases towards 3 o'clock, p.m. ; patient feels worse after sleep. 

Mercur., painful, hard, hot, and red swelling in the ileo-csecal region, 
painful to the touch; face red or pale, sickly; thirst; red, dry tongue; con- 
stipation, or frequent slimy discharges with straining; sweat without relief. 

. Plumbum, large, hard swelling in the ileo-csecal region, painful to the 
touch and least motion; or when sneezing and coughing; the whole abdomen 
sensitive; the navel drawn in; frequent sour belching; nausea; retching; 
constipation; anxious countenance; dry tongue, red on the edges, brown 
coating in the middle; great thirst, lame feeling in the legs. 

Rhus tox., hard, painful swelling of nearly the entire right side of the 



502 INTESTINAL CANAL. 

abdomen ; pain worse in sitting or when stretching the right leg ; impossibility 
of lying on the left side ; better when lying on the back with right leg drawn 
up; and when gently pressing the swelling from below upwards; pale, anx- 
ious face; burning of the palms of the hands; profuse sweat at night; small, 
frequent pulse; after taking cold by getting wet. 

Thuja, only those parts of the body perspire which are uncovered, 
those covered are hot and dry. 

Besides these compare Amnion., Arsen., Chamom., Coccul., Colchic, 
Coloc, Lycop., Nitr. ac, Platina, Silic., Sulphur, Veratr., Zincum. 

Stercoraceous smell of the vomit hints to Asaf, Mercur., Opium, Plum- 
bum. 

Already formed abscess in the right iliac fossa indicates Hepar, Iodium, 
Kali carb., Laches., Lycop., Mercur., Silic. 

Proctitis, Catarrhal Inflammation of the Rectum. 

This is either of an acute or a chronic nature, and its pathological ap- 
pearance corresponds entirely to a catarrhal inflammation of any other mu- 
cous membrane, exhibiting injection, infiltration, mucous secretion, and at 
last, thickening of the membrane, chronic blennorrhoea and ulceration. It 
may be caused by taking cold, purgative medicines, medicated injections, in- 
sertion of pieces of soap to promote evacuations ; by worms and hard fecal 
matter. 

It may, secondarily, be a mere continuation of an inflammatory process 
in neighboring organs, such as the hemorrhoidal veins, the bladder, the 
prostatic gland, or the internal sexual organs ; or it may accompany tubercu- 
lous, cancerous or syphilitic ulcers, or disorders which cause stagnation in the 
abdominal veins in general, such as diseases of the liver, of the vena porta, 
the heart and lungs. 

Its Symptoms are: pain, tearing, throbbing, burning, or as if some- 
thing were sticking in the rectum which had to be forced out ; worse during 
an evacuation; constant desire to evacuate; tenesmus; in severe cases, 
attended with retention of urine and strangury ; painful urination or drip- 
pling of urine; erection of penis; drawing up of testicles; leucorrhoea. 

The bowels are mostly constipated, but the stools natural, covered, how- 
ever, with a thin layer of slime, which is colorless or tinged with blood. The 
great straining frequently causes prolapsus ani. In its chronic form the pain 
is more of a dull, heavy nature, and its most prominent symptom is the con- 
stant discharge of a thick, yellowish, even purulent secretion from the 
mucous membrane of the rectunl. It covers either the natural discharges 
from the bowels, or it is mixed with the loose stools (if there be such), or 
oozes out of the anus, staining the linen of the patient. This chronic form 



PERIPROCTITIS. 503 

is frequently attended with chronic catarrh of the bladder, the uterus and 
vagina, and especially with hemorrhoidal affections. In both forms the 
inflammation may extend to the cellular tissue about the rectum. 

THERAPEUTIC HINTS.— In ordinary acute cases there will be 
indicated either Aeon., Bellad., Nux vom. or Sulphur. 

When there is tenesmus in the rectum and bladder at the same time : 
Alum., Aloes, Capsic, Hyosc, Lycop., Natr. carb., Merc. subl. 

During stool, discharge of urine impossible : China, Merc. subl. ; during 
stool, erections of penis: Ignat., Thuja; during stool, discharge of leucor- 
rhcea: Magn. mur., Thuja, Zincum. 

Drippling of urine: Arg. nitr., Bryon., Calc. carb., Laches., Lycop., 
Natr. carb., Petrol., Rhodod., Silic, Staphis., Thuja. 

Slimy, purulent matter oozing out of the anus: Borax, Coloc. f Sepia, 
Thuja. 

Prolapsus ani: Bellad., Calc. carb., Ignat., Lycop., Nux vom., Podoph., 
Sulphur. 

Polypi recti: Calc. carb., Calc. phosph., Phosphor., Silic, Thuja. 

Periproctitis 

Corresponds to Perityphlitis, being an inflammation of the areolar tissue 
around the rectum. 

Primarily, it is of rare occurrence, but may be brought about by falls, 
bruises, riding on horseback, surgical operations, or taking cold. 

Secondarily it is much more frequent, and may be a mere continuation 
of inflammatory and ulcerative processes in the rectum or other neighboring 
organs, the pelvic bones, the prostate gland, the bladder, the uterus ; some- 
times, however, it appears as part of a general tubercular process and puer- 
peral inflammation, without any ulcers in the rectum. 

Its most important Symptoms are : 

1. A swelling and hardness around and about the rectum, which appears 
either back of the anus in the coccygeal space, or in front of it, in the peri- 
neal region. Sometimes, however, nothing is seen or felt exteriorly, the 
swelling being higher up; and an examination'per anum, by which it might 
be detected, is so painful to the patient that it is seldom practicable. 

2. In the course of ten or twelve days, however, the hard swelling is 
converted into an AbSCBSS, which breaks either outside, in the above- 
named regions, or perforates the rectum, and discharges through the anus. 
In rare cases only, does a perforation take place into the bladder, the vagina, 
the uterus, or into any other part of the intestines. The first is the most 
favorable. After discharging itself fully, it heals and nothing is left. Per- 



504 INTESTINAL CANAL. 

foration of the rectum, however, frequently causes Fistula ; and perforations 
into any of the other organs are still more serious in their nature. Instead 
of terminating in abscess, however, the exudation is occasionally absorbed, 
leaving a chronic induration of portions of the wall of the rectum. 

3. The pain is mostly of a dull, heavy kind, or darting in the region of 
the rectum; worse in sitting and walking. Sometimes it is throbbing; 
shaking chills are a sure sign that formation of pus has taken place. 
Tenesmus is also frequently combined with it ; also difficulty of voiding 
urine. 

THERAPEUTIC HINTS —When brought about by traumatic causes : 
bruises, falls, riding on horseback: Arnica, Conium, Pulsat., Rhus tox., 
Sulph. ac. 

For heavy, dull, pressing pain : Bellad., Ignat., Nux vom. 

For darting, stitch-like pain : Bryon., Kali carb., Phosphor. 

When the swelling is hard and inflamed: Arsen., Bellad., Hepar, Laches., 
Mercur., Pulsat. 

To bring it to a head: Arsen., Calc. carb., Hepar, Kreos., Laches., 
Lycop., Mercur., Sepia, Silic. 

Fistules require: Berber., Calc. sulph., Caustic, Silic. 

Dysentery. 

The pathological character of this affection presents the following fea- 
tures : it is seated almost exclusively in the large intestines, from the valve 
of the caecum down to the rectum; occasionally, however, it passes beyond 
the csecal valve towards the ilium, but is here only seen in its mildest form. 
When commencing, the mucous membrane appears reddened, swollen ; the 
epithelium peels off; sometimes it is raised into little vesicles by an exuda- 
tion beneath. Later the mucous membrane becomes covered in patches with 
a dirty-whitish, yellowish-gray, or yellowish-red substance, which, from the 
contents of the bowels or from blood, may assume a greenish or brownish 
color, and consists of decayed epithelial cells, slime, pus and blood globules. 
If scraped off by the knife, it discloses the mucous membrane beneath red- 
dened, softened, and uneven in consequence of a serous infiltration into the 
submucous cellular tissue. The solitary follicles are swelled and in a state 
of ulceration. All this causes a collection of putrid, bloody or jmrulent 
masses within the cavity of the gut. In a still higher degree of inflamma- 
tion the mucous membrane is found decayed or chaDged into a soft, dark 
mass, which is thrown off and discharged, giving rise to irregular, larger and 
smaller dysenteric ulcers of the colon which in rare cases may cause even 
perforation of the gut. Besides these grave destructive changes within the 



DYSENTERY. 505 

intestine itself, we also find more or less inflammation of the peritoneum, 
swelling of the mesenteric glands, hyperemia and inflammation of the liver. 

Dysentery generally prevails epidemically, under the influence of a tropi- 
cal climate, or one resembling a tropical climate, on a soil of moist and per- 
haps swampy character, where by miasmatic and atmospheric conditions a 
disposition to it is produced. It is found in camps, in hospitals, in regions 
where malaria prevails. Summer heat and in autumn sudden cool nights 
are very apt to cause it. Sporadic cases we find, therefore, occur mostly after 
sudden check of perspiration, or after getting wet; fruit, if ripe, will scarcely 
ever cause it, although some people do assert it. Unripe fruit, however, is 
always hurtful. Virchow considers the epidemic form of a diphtheritic — the 
sporadic of a catarrhal — nature. 

Dysentery attacks all ages and both sexes. In its epidemic form it is 
believed by some authors to be contagious, especially when large masses of 
excreta become heaped together, as in camps or hospitals, wherefore every 
dejection should be considered as dangerous. Those who deny its conta- 
giousness do it only reservedly. Sporadic cases are generally considered as 
non-contagious. 

Symptoms. — 1. The stools, commencing almost always as diarrhoeic, 
change into characteristic dysenteric stools. At first we observe in the liquid 
diarrhoeic stools jelly-like, transparent clots of slime, looking similar to boiled 
sago ; they are dotted and streaked with blood and will sink to the bottom of 
the vessel if the evacuation remains standing a while. They soon increase 
and are discharged in larger quantities of jelly-like, transparent masses tinged 
with blood. As they augment, the fecal substance of the stool diminishes, 
until, finally, nothing but slime is discharged. By this time, however, its 
jelly-like character changes into an opaque, dirty- whitish, or reddish-gray 
appearance, like scrapings, swimming sometimes in a thin, bloody, watery 
fluid ; fecal matter disappears entirely. 

The blood contained in it varies in quantity from merely tinging the 
slime into a reddish color to clear blood. In rare cases only whole shreds 
or pieces of slough from the lining membrane pass away ; but when the dis- 
charges assume a brownish, chocolate-like color, and are of a penetrating, 
cadaverous smell, the dysenteric ulcers within have become ichorous and the 
mucous membrane is decaying. When, however, fecal matter again makes 
its appearance, which generally takes place in the shape of hard lumps, it has 
always been to me a sign that the inflammation is gradually subsiding; and, 
although after it many more evacuations of mere bloody slime may take 
place, yet the violence of the disease seems broken ; there is, after that, less 
and less slime discharged, until, at length, normal alvine discharges prove 
the restoration to health. 

The frequency of stools varies from four to twenty, thirty or even more 



506 INTESTINAL CANAL. 

in the course of twenty-four hours. The smell of the evacuations varies also. 
At first, as long as fecal matter is contained therein, the smell is, accordingly, 
stercoraceous ; later, when the fecal matter has disappeared, there is either no 
smell, or a peculiar, fleshy, sweatish, nauseating odor. vWhen, however, the 
disease is at its height, and the dysenteric ulcers become ichorous and 
sloughing, the smell is awful, penetrating, cadaverous. 

2. Pain in the bowels and tenesmus. Characteristic of dysentery is the 
colicky, cutting and drawing-together pain in the bowels before and during 
an evacuation, ceasing soon after, to be renewed by another attack, thus 
coming in spells. The evacuations are generally attended by great burning 
pain in the anus and rectum. In fatal cases, where paralysis of the colon 
takes place, the pain ceases altogether. Likewise characteristic is the tenes- 
mus or straining during an evacuation, and continuing some time after, al- 
though not more than a teaspoonful be voided. It is the most painful symp- 
tom of the disease, and may cause fainting, convulsions and prolapsus ani. 
This symptom also ceases if, in fatal cases, paralysis of the colon takes place. 

3. Reflex symptoms. To these belong the vomiting frequently found at 
the beginning, but also during the progress of the disease ; singultus (which, 
however, is not so frequent, and then is generally a sign of peritonitis), reten- 
tion of urine and painful micturition. 

4. General symptoms are, more or less fever, but the temperature of the 
skin is usually not as high as in most other inflammatory diseases. The 
skin is mostly dry. There is great thirst, little appetite, great loss of flesh. 

5. Secondary symptoms are, peritonitis, perityphlitis, periproctitis, pneu- 
monia, pleuritis, parotitis, splenitis, hepatitis, erysipelas, haemorrhages, decu- 
bitus. 

6. Unfavorable symptoms are, copious haemorrhages, ichorous, chocolate- 
colored and cadaverous-smelling discharges, great prostration of strength; 
great frequency and smallness of pulse ; cold skin ; cold, sticky perspiration ; 
livid and cyanotic face; collapsed abdomen, with want of elasticity of its 
walls; paralysis of the sphincter ani, so that the anus remains open; involun- 
tary discharges; peritonitis; perforation of the colon; shaking chills; erysip- 
elas; violent vomiting, with cholera-like symptoms; obstinate singultus; 
delirium ; convulsions and paralysis. 

THERAPEUTIC HINTS.— Aeon., after sudden check of perspira- 
tion ; chill, high fever and dry skin ; first very frequent, small, brown, pain- 
ful, and at last bloody discharges. 

Aloes, violent tenesmus; frequent stools of bloody water or with lumps 
of mucus, like jelly; during stool fainting or screaming on account of vio- 
lent pains in the abdomen, especially right side, ceasing after stool ; hunger ; 



DYSENTERY. 507 

great rumbling along the colon; large quantities of flatus escape with the 
stools ; pains in the small of the back ; when urinating, urging to stool. 

Alum., tenesmus of bowels and bladder; no flow of urine except dur- 
ing an evacuation from the bowels. 

Apis, great tenesmus, and feeling as if the intestines were bruised. 

Arsen., discharges have a fetid, foul smell; consist of fluid feces mixed 
with blood, chocolate-colored; most frequent about midnight; before stool, 
torturing sensation, as if the abdomen were being constricted ; at the stool, a 
feeling of contraction in the rectum; after stool, burning in rectum and 
anus ; trembling in all the limbs ; palpitation of the heart and distention of 
the abdomen; tenesmus with burning in the anus and rectum; great ex- 
haustion, and, lastly, some short relief from pain; great thirst, but drinking 
little at a time ; tongue white or brown or bluish ; nausea ; vomiting ; face 
sunken, expressing great anguish; great restlessness; petechial, miliary and 
nettle-rash eruptions; cold, dry skin, or else cold perspiration; very frequent, 
weak pulse ; fetid urine. 

Baptis., violent, colic-like pains before every stool and great tenesmus; 
discharges of pure blood, with very little mucus; dry, brown tongue; ty- 
phoid tendency. 

Bellad., discharges greenish, slimy, bloody, with great tenesmus; bear- 
ing down and shuddering ; afterwards burning in the anus and rectum ; the 
mucous membrane of the anus appears swollen and is pressed out; urine 
suppressed ; abdomen very sore to pressure ; cutting, tearing and constricting 
pains in the abdomen, so violent that the patient screams out; thirst, belch- 
ing, vomiting; starting in sleep; delirium. 

Bryon., during summer heat; pain and discharges are brought on 
from motion, even from turning in bed, raising the arms or bending the 
toes. 

Canthar., tremendous burning pain through the whole intestinal tract, 
from the bowels down to the anus*, with painful sensitiveness of the abdomen 
to the slightest touch; unquenchable thirst, with disgust for all kinds of 
drink ; loss of epithelium on the lips, tongue and palate ; vesicles and can- 
kers in mouth and throat; collapse, small pulse, coldness of hands and feet. 
Stools bloody and watery, with scrapings from the bowels; frequent urging 
to urinate, with burning after urination. 

Capsic, abdomen distended, as though it would burst; very frequent 
discharges, streaked with black blood, with violent tenesmus and burning 
both in the rectum and bladder; thirst after stool, and shuddering after 
drinking: taste like putrid water; pains aggravated by currents of air, 
though warm. 

Carb. veg., after Arsen., if there be cold breath, cool skin, terribly 
smelling discharges, general collapse. 



508 INTESTINAL CANAL. 

China, discharges chocolate-colored, of a terrible, cadaverous smell, 
worse at night ; great general exhaustion. 

Colonic, discharges of white, jelly-like or bloody mucus; spasm of 
the sphincter ani during a discharge, with a shuddering over the back; such 
spasms occur also without a discharge; oedema of the lower extremities, 
which are cold ; ascites ; urine dark brown and scanty. 

Coloc, discharges slimy, bloody, like scrapings; abdomen bloated; 
violent pain in the abdomen, as though the intestines were squeezed be- 
tween stones, which compels the patient to bend double; from the abdo- 
men rises a shuddering over the body ; during stool, sometimes tenesmus, at 
other times not; after stool relief of the pain. After vexation or indignation. 

Diosc, stools deep yellow, thin, watery; dark green and mucous; 
severe twisting colic with intervals of relief; faint feeling in the abdomen 
after stool. 

Eriger., stools small, streaked with blood, accompanied with tormina; 
burning in the bowels and rectum; hard lumps of feces mixed with the 
discharges ; urination painful or suppressed. 

Gummi gutti, stools watery, frequent, copious and offensive, coming 
out all at once and affording great relief. 

Ham am., when the amount of blood is unusual in quantity and 
amounts to an actual haemorrhage, generally of dark blood ; or when there 
are clots or patches of blood scattered through the mucus. Soreness of the 
abdomen. 

Ipec, when caused by eating unripe, sour fruit; great disgust and 
loathing of any sort of food; sickness and vomiting of grass-green, jelly-like 
mucus; coated tongue; headache; chilliness; great pressing to stool ; voiding 
slimy, bloody, offensive discharges, with subsequent tenesmus ; worse in the 
evening. 

Kali bichr., discharges brownish, frothy w r ater, bloody, with gnawing 
pain about the umbilicus; violent painful pressing, straining and tenesmus; 
tongue smooth, red and cracked. After Canthar. 

Laches., discharges chocolate-colored, of a cadaverous smell; during 
evacuation burning in the anus; cramp-like pain in abdomen; coldness; 
thirst; abdomen very hot; tongue red and cracked at its point, or black 
and bloody. 

Magn. carb., stools green, watery, frothy, with green scum like that 
of a frog pond; bloody mucus. In hot weather; during the day; during 
dentition. Abdominal pain before and during stool ; tenesmus. 

Mercur., discharges excoriating; before stool: cutting, pinching, and 
twisting pains in the abdomen; anxiety and trembling; during stool: burn- 
ing in the anus; eructation, nausea; faintness, colic, heat and perspiration; 
after stool: great tenesmus; cannot get done; prolapsus ani and trembling; 



DYSENTERY. 509 

the abdomen generally feels cold; bad taste in the mouth; saltish saliva; 
rheumatic pains in the limbs ; all worse at night. 

Merc, subl., with almost constant cutting pains in the abdomen, and 
intolerable, painful, almost ineffectual pressing, straining and tenesmus; 
frequent, scanty discharges of bloody slime, day and night, with great 
tenesmus of the bladder. 

Natr. carb., straining and tenesmus, with a voluptuous sensation in 
the genitals. 

•Nitr. ac, profuse discharges of blood; before stool: colic; during stool: 
spasmodic contraction of the anus; cutting and straining in the anus and 
rectum: after stool: burning in the anus; ineffectual straining; colic; ex- 
haustion; anxiety and general uneasiness. Pulse intermits every third beat. 

Nux vom., always after previous abuse of diarrhoea mixtures, pain in 
the abdomen before and during a discharge, with tenesmus, relieved after 
stool; pressing pain in the back, as if broken, before and during stool ; sick- 
ness in the stomach. 

Plumbum, in violent cases with bloody masses of exudation; burning 
in anus during discharge and long-lasting tenesmus afterwards. 

Pulsat., discharges white-slimy ; whitish-coated tongue; pappy, sticky 
taste in the mouth, without thirst ; great difficulty in breathing ; all worse at 
night. 

Rhus tox., discharges jelly-like; pains in the abdomen and limbs, 
worse when lying still, better from moving about ; nocturnal exacerbation ; 
after getting wet. 

Staphis., cutting pain before and after stool; tenesmus in rectum and 
bladder during stool; always worse after drinking cold water. After indig- 
nation. 

Sulphur, when other remedies have failed ; when, during stool, burn- 
ing, cutting, pressing and prolapsus recti, cutting in urethra, catching of 
breath, palpitation, chills about the lower part of the body; and afterwards, 
straining and throbbing in the rectum, bruised pains and pinching in the 
abdomen, chills and lassitude. Worse early in the morning, driving out of 
bed; faintish feeling in pit of stomach about 10 or 11 a.m., etc. 

Thrombid., tenesmus, prolapsus ani; discharge of mucus, pus, blood 
and occasional fecal matter. Skin dry, tongue coated, thirst moderate. 

Schiissler: Kali mur.,in most cases; if not, Calc. sulph., especially if 
the discharges consist of pus-like slime. If the tongue gets dry, with a delirious 
state and distention of abdomen, and the discharges have a putrid stench : 
Kali phosph. The same, if much pure blood passes off. If it begins with 
violent fever first: Ferr. phosph. In case of spasmodic bellyache, relieved 
from pressure and doubling up: Magn. phosph. If the pain is depending 
on inflammation, making no intervals and increased by pressure, Ferr. 
phosph. 



510 



INTESTINAL CANAL. 



Digest to Dysentery. 



DISCHARGES. 
Brown : Aeon., Kali bichr. 
Chocolate-colored : Arsen., China, 

Laches. 
Deep yellow : Diose. 
Green, watery, with green scum like that 

o'n a frog-pond: Magn. carb. 
Greenish: Bellad. 
Dark green mucus : Diose. 
White, slimy : Colchic., Pulsat. 



Bloody : Aeon., Arsen., Ipec. 

Bloody mucus or slime: Bellad., Colchic., 

Coloc., Ipec, Magn. carb., Merc, subl, 

Thrombid. 
Bloody water: Aloes, Arsen., Canthar., 

Diose, Gwnmi, Kali bichr. 
Bloody masses of exudation : Plumbum. 
Streaked with blood: Arsen., Capsic., 

Eriger., Hamam. 
Pure blood, with very little mucus: 

JBaptis. 

, profuse : Kali phos., Nitr. ac, 

, , dark in color : Hamam. 



Like scrapings from the bowels : Can- 
thar., Coloc. 
Like jelly: Aloes, Colchic, Ipec, Rhus. 
Like pus : Calc sulph., Thrombid. 
Mixed with hard lumps of feces : Eriger. 



Offensive: Gummi, Ipec. 

Putrid, foul, cadaverous, terrible smell: 

Arsen., Carb. veg., China, Kali phosph., 

Laches. 

BEFORE STOOL. 

Colic : Nitr. ac. 

, great tenesmus: Baptis. 

Cutting in abdomen: Staphis. 

, pinching and twisting in abdomen : 

Mercur. 
Pain in abdomen: Magn. carb., Nux 

vom. 
, torturing, as if the abdomen were 

being constricted : Arsen. 



Pressing pain in back, as if broken: 

Nux vom. 
Anxiety and trembling : Merc sol. 

DURING STOOL. 

Abdominal pain : Magn, carb., Mercur. 

Colic, tormina: Eriger., Mercur. 

Gnawing about umbilicus : Kali bichr. 

Violent pain right side of abdomen: 
Aloes. 

Pressing pain in back, as if broken: 
Nux vom. 

Burning in the anus: Eriger., Laches., 
Mercur., Plumbum, Sulphur. 

in the rectum and bladder : Capsic. 

Cutting in rectum: Nitr. ac, Sulphur. 

Mucous membrane of anus is pressed 
out and is swollen: Bellad. 

Pressing and straining: Bellad., Ipec, 
Kali bichr., Merc sol., Mere, subl., Nitr. 
ac, Sulphur. 

, with voluptuous sensation in geni- 
tals : Natr. carb. 

Painful stools : Aeon. 

Tenesmus: Aloes, Apis, Bellad., Capsic, 
Kali bichr., Magn. carb., Merc sol., Merc, 
subl., Natr. carb., Nux vom., Sulphur, 
Thrombid. 

at times, at other times not : Coloc 

in rectum and bladder: Alum., Merc. 

subl., Staphis. 

and prolapsus ani: Thrombid. 

, , and cutting in urethra: Sul- 
phur. 

Bearing down and shuddering: Bellad. 

Spasmodic contraction of anus: Ar- 
sen., Nitr. ac. 

, with shuddering over the back ; 

such spasms occur also without a dis- 
charge: Colchic. 

Flatus escapes in large quantities : Aloes. 

Catching of breath, palpitation, chills 
about lower part of body : Sulphur. 

Eructation, nausea; faintness, heat and 
perspiration : Merc sol. 

Fainting and screaming: Aloes. 



DIGEST TO DYSENTERY. 



511 



AFTER STOOL. 

Burning in anus and rectum : Arsen., 
Bellad., Nibr. ac 

Mucous membrane of anus pressed out 
and is swollen : Bellad. 

Excoriating anus : Mercur. 

Prolapsus ani : Mercur. 

Colic : Nitr. ac 

Cutting : Staphis. 

Bruised pain and pinching in abdomen : 
Sulphur. 

Faint feeling in abdomen: Diosc. 

Straining, ineffectual : Nitr. ac 

and throbbing i,n rectum : Sulphur. 

Tenesmus : Arsen., Ipec, Merc. sol. Plum- 
bum. 

, cannot get done : Merc. sol. 

Thirst: Capsic. 

Palpitation of heart : Arsen. 

Trembling in all the limbs: Arsen., Merc, 
sol. 

Chills and lassitude : Sulphur. 

Anxiety and general uneasiness : Nitr. ac. 

Exhaustion : Arsen., Nitr. ac. 

Relief -.Aloes, Arsen., Coloc, Gummi, Nux 
vom. 

SYSTEMIC SYMPTOMS. 

Delirium : Baptis., Bellad., Kali phosph. 
Anguish and sunken face: Arsen. 
Headache : Ipec. 



Lips, tongue and palate lose epithelium : 

Canthar. 
Tongue coated: Thrombid. 

dry : Kali phosph. 

, brown : Baptis. 

whitish : Arsen., Pulsat. 

brown or bluish : Arsen. 

smooth, red, cracked : Kali bichr. 

red and cracked at tip, or black and 

bloody: Laches. 
Vesicles and cankers in mouth and 

throat: Canthar. 



Hunger : Aloes. 

Disgust and loathing of any sort of food: 

Ipec. 
Thirst: Bellad. 

moderate: Thrombid. 

great, but drinking little at a time : 

Arsen. 
unquenchable, with disgust for all 

kinds of drink : Canthar. 
Belching: Bellad. 
Nausea, sickness in stomach: Arsen., 

Ipec, Nux vom. 
Faintish feeling in stomach about 10-11 

a.m.: Sulphur. 
Vomiting : Arsen., Bellad. 
of grass-green, jelly-like mucus : Ipec. 



Saltish saliva : Merc. sol. 
Taste bad : Merc. sol. 

like putrid water : Capsic. 

pappy, sticky, without thirst : Pulsat. 



Bruised, as if intestines were : Apis. 

Soreness of abdomen: Hamam. 

to slightest touch : Bellad., Canthar. 

Burning from bowels down to anus: Can- 
thar. 

Inflammatory pain, worse from press- 
ure: Ferr. phosph. 

Heat of abdomen : Laches. 

Cold, abdomen feels generally: Merc sol. 

Pains in abdomen and limbs, worse in 
rest, better on moving: Bhus tox. 

, as though intestines were squeezed 

between stones, compelling to bend 
double: Coloc. 

, spasmodic, better from pressure and 

doubling up : Magn. phosph. 

, cramp- like: Laches. 

, cutting, tearing and constricting, 

compelling to scream : Bellad. 

, cutting : Merc. subl. 

, twisting at intervals : Diosc. 

Distention: Capsic, Coloc, Kali phosph. 

Rumbling along colon: Aloes. 

Ascites: Colchic. 



Urine suppressed: Bellad., Eriger. 

Urination painful: Eriger. 

Urine flows only during an evacuation 
from the bowels : Alum. 

Frequent urging to urinate, with burn- 
ing after: Canthar. 



512 



INTESTINAL CANAL. 



Urine dark brown and scanty : Colchic. 
fetid: Arnica. 



Difficulty in breathing: Pulsat. 
Pulse frequent, weak : Arsen. 

small, with cold hands and feet: Can- 

thar. 
intermits every third beat : Nitr. ac. 



Pains in the small of back: Aloes. 
Rheumatic pains in limbs : Merc. sol. 
CEdema of lower extremities, which are 

cold: Colchic. 
Cold hands and feet: Canthar. 



Fever, begins with violent : Ferr. 
Chill, high fever, dry skin : Aeon. 
Skin dry, tongue coated: Thrombid. 
Cold, dry skin, or else cold perspiration : 

Arsen. 
Coldness : Laches. 
Chilliness : Ipec. 

Shuddering after drinking: Capsic. 
from abdomen, rising over the body: 

Coloc. 
Typhoid tendency : Baptis. 



Starting in sleep: Bellad. 
Petechial, miliary, and nettle-rash erup- 
tion: Arsen. 
Restlessness : Arsen., Rhus tox. 
General exhaustion : China. 



Collapse : Arsen., Carb. veg., China. 

Worse after drinking cold water: Staphis. 
when urinating urging to stool: 

Aloes. 

from any motion : Bryon. 

from currents of air, though warm : 

Capsic. 

in the evening : Ipec. 

in the night : China, Merc, sol., Palsal., 

Rhus tox. 

about midnight : Arsen. 

in the morning, driving out of bed : 

Sidphur. 

during the day : Magn carb. 

day and night : Merc. subl. 

Caused by vexation or indignation: 

Coloc, Staphis. 

dentition : Magn. carb. 

eating unripe, sour fruit: Ipec. 

sudden check of perspiration : Aeon. 

getting wet : Rhus tox. 

hot weather, summer heat : Bryon., 

Magn. carb. 



Carb. veg., after Arsen., if there be cold 
breath, c'ool skin, terribly smelling dis- 
charges, general collapse. 

Kali bichr., after Canthar. 

Kali mur., in most cases. 

Nux vom., after previous abuse of diar- 
rhoea-mixtures. 

Sulphur, when other remedies have 
failed. 



Cholera. 

A case of true cholera exhibits the following symptoms : Being preceded 
in most cases by profuse diarrhoeic stools the bowels are quickly emptied of 
their contents. The discharges change to a rice-water-like fluid, and are 
accompanied by profound prostration. Upon drinking follows vomiting, at 
first of the contents of the stomach and afterwards of mere watery substances, 
slightly tinged yellow. The weakness of the patient increases rapidly and 
his voice becomes husky. The discharges now take place involuntarily, the 
secretion of urine ceases. To the insatiable thirst associate great anguish 
and oppression of the chest and in the pit of the stomach, and the most pain- 
ful cramps in the calves of the legs and in the bowels. The aspect of the 



CHOLERA. 513 

patient has by this time changed fearfully. The eyes have sunk into their 
orbits, the nose has become pointed and the cheeks fallen in. The skin on 
the fingers is wrinkled, like that of a washerwoman — and if a portion of the 
skin is pinched, it remains as a fold. The lips, extremities, genitals, assume 
a bluish, cyanotic color. The pulse is so faint, that it scarcely can be felt, 
and so is the impulse of the heart. The whole surface of the body becomes 
icy cold. 

There is no headache, but frequently the patient complains of darkness 
before the eyes, roaring in the ears and vertigo. 

All this may take place in a few hours and the patient be no more. If 
recovery takes place, all the symptoms may, by a perfect reaction of the 
system, be speedily extinct, but in case of imperfect reaction, the disease 
changes into a kind of typhoid fever, which is sometimes complicated with 
dhTerent local inflammatory symptoms, such as pneumonia, pleuritis, bronchi- 
tis, parotitis, splenitis, or diphtheritic exudation in the pharynx, intestines, 
vagina and bladder, so that even if the patieot lives through an attack of 
cholera itself, he may be carried off by its consecutive symptoms. All this, 
however, rarely takes place under homoeopathic treatment. 

The pathological changes, so far as they belong to the small intestines, 
are as follows: The serous (peritoneal) covering of the small intestines is, in 
consequence of capillary hyperseinia, of a rosy color and dry, or covered with 
a layer of sticky fluid; its mucous membrane is injected, and the solitary as 
well as Peyer's glands are swollen, and filled with serum or solid exudation. 
The villi — those minute projecting papilla? which are so abundant as to give 
to the entire surface a beautiful velvety appearance — have lest their epithe- 
lium, and the surface of the mucous membrane appears smooth, or covered 
with extensive extravasations. The colon presents at some epidemics diph- 
theritic or dysenteric signs of inflammation; at others no signs whatever. 
All other chaDges found post-mortem have not yielded any characteristic 
signs of cholera ; they must be considered merely as accidental lesions, from 
which to make deductions would be, according to Buhl, a wrong to science. 
Dr. Gaspard Guillot, of Lyons, draws attention to the fact, which he ob- 
served, that the teeth of patients who died suddenly of cholera, assume a 
brick-red, and of those who lingered several days, a bronze or cyanotic color. 

Xi'emeyer explains the whole row of fearful changes, which the entire 
system undergoes by this dreadful malady, in the following manner: 

Out of the villi, which are denuded of their natural protection, takes 
place a constant copious transudation of serum into the gut, therefore, the 
rice-waier discharges upward and downward, by which cholera is character- 
ized; but being deprived of their epithelium, these villi lose their capability 
of absorbing the fluid which the patient takes as a drink; consequently the 
patient constantly loses fluids, but gains none. The next natural consequence 
33 



514 INTESTINAL CANAL. 

of tins must be, that the blood becomes dark and thick, in later stages even 
black, tarry, ropy, semi-coagulated. Thus the blood, deprived of its natural 
amount of water, seeks for fresh fluid supply, and absorbs all the water con- 
tained everywhere in the tissues, in consequence of which all the tissues be- 
come dry and reduced in volume; the nose becomes pointed, the cheeks fall in, 
the eyeballs sink back into their orbits, the skin wrinkles on the fingers like 
washerwomen's, and remains, as a fold, wherever pinched, and even patho- 
logical exudations, which have resisted all medication — for example, serous 
exudations of the pleural cavities, or within the synovial membranes of the 
joints — are completely absorbed, and moist eruptions and ulcers become dry 
like parchment. And further, it explains the cessation of all natural secre- 
tions, such as saliva, tears, sweat, urine and bile, simply because there is 
nothing more contained in the blood to be secreted. 

Another consequence of the blood constantly losing its watery con- 
stituents is this : the circulation of the capillaries becomes impaired, if not 
entirely prevented. As soon, however, as this takes place in the capillaries 
of the heart muscle, it causes, according to physiological and pathological 
experience, a paresis of the heart, and thus that characteristic feebleness and 
faintness of the hearfs impulses and sounds, and the small, feeble, faint pulse 
of the radial and carotid arteries, in cholera; thus, also, the cyanotic symp- 
toms, the blueness of the skin everywhere, the blue tongue, by which severe 
cases of cholera are characterized. 

On the same condition of the blood, also, depends that anguish for 
breath and hunger for air — that deep inspiration and short moaning expira- 
tion-— which is always present in severe cases of cholera; for, in order that 
free expiration be possible, it is necessary, not only that there should be a 
free admission of air into the air-cells, but also that a corresponding change 
of blood in the capillaries of the lungs should constantly be going on. A 
retardation of this flow causes an imperfect purification of the blood from 
its carbon, which fact can be demonstrated by an analysis of the exhaled 
air, which contains less carbonic acid gas than it does normally. The air 
passes out nearly unchanged, causing thus the characteristic cold breath of 
cholera patients, and as the vocal organs partake of the universal drying 
process, they become rigid, and naturally cause the voice of the patient to 
become changed into the peculiar cholera voice, which is rough and coarse, 
with imperfect articulation. 

The very distressing and painful spasms or cramps, which contract the 
muscles into round, hard knobs, are doubtless caused by central irritation, and 
it is quite probable that this irritation originates in the same drying-out 
process which pervades the whole system. During the algid stage the 
temperature sinks to 93.5°, in rare cases to 88° F. ; the pulse is from the 
start feeble, and little or not at all hurried; exceptionally, only, it is as high 



CHOLERA. 515 

as 96 or 100; often it becomes thready and hardly perceptible; even the 
heart's diastole may, in bad cases, be no longer recognizable while its systole 
continues. 

Dr. Koch considers this complex of symptoms of the attack proper of 
cholera, and which has generally been looked upon as a consequence of 
loss of water and the inspissation of the blood, essentially as poisoning 
of a special poison, which he supposes is produced by the comma-bacilli. 
" For," he says, " it (this complex of symptoms) takes place also not un- 
frequently when comparatively very small quantities of fluid are lost 
during life, by vomiting and diarrhoea, and when, immediately after death, 
the intestine contains also only a small quantity of liquid. If, now, death 
follow in the stage of cholera poisoning, then the phenomena met with in 
post-mortem examinations correspond to those cases in which the mucous 
membrane of the intestine is little changed, and the contents of the intestine 
consist of a pure cultivation of comma-bacilli. If, on the contrary, this stage 
be prolonged, or if it be got over, the consequences of the mortification of 
the epithelium and of the mucous membrane show themselves; capillary 
haemorrhage in the mucous membrane takes place, and some of the component 
parts of the blood mix, in more or less abundance, with the contents of the 
intestine. The albuminous fluid in the intestine begins to putrefy, and under 
the influence of putrefaction, bacteria, other poisonous products are formed 
which are also absorbed. But these have an effect differing from that of the 
cholera poison; the symptoms caused by them correspond to what is gener- 
ally called cholera-typhoid" (Translated from the " Deutsche Medizinisohe 
Wochenschrift," in New York Medical Abstract.) To this, I have merely 
to observe, if an extra poison (produced by the comma-bacilli) be required to 
cause that peculiar complex of cholera symptoms, may not then the comma- 
bacilli themselves be a product or grow under the influence of that still 
unknown poison, just as, according to Koch, bacteria are formed when the 
albuminous fluid in the intestines begins to putrify? This seems to be alike 
probable, since comma-bacilli, cultivated in gelatine, have thus far failed to 
produce cholera in animals as well as in men. There is darkness all around 
yet. And we may well say that the Specific Cause of cholera is not posi- 
tively known yet. The mycetic theory, however, which ascribes the origin 
and development of cholera to parasites of the lowest form and smallest size, 
seems to be the one which no\v-a-days is most generally accepted, especially 
since Dr. Koch has found the same kind of bacilli in the dead bodies of nine 
cholera patients in Calcutta, which he had discovered the year previous in 
Egypt. "Minute observation of these bacilli," so says the report of Dr. 
Koch and his colleagues, "under our treatment, led to the discovery of some 
very characteristic qualities, as to their form and growth in gelatine, which 
enabled us with certainty to distinguish them from other bacilli. And now 



516 INTESTINAL CANAL. 

we had the means of definitely deciding the question whether these bacilli 
belonged to the regular inhabitants of the intestine, or whether they occurred 
exclusively in that of cholera patients. And first of all, with the help of 
our gelatine preparations, we demonstrated the existence of these bacilli in 
the evacuations of all the cholera patients we examined, as w T ell as in the in- 
testinal contents of those who had died from cholera in a similar manner. 'We 
then examined the intestines of other corpses, and in every case the bacilli 
in question were absent from the intestine. Thus far we have examined the 
bodies of eight persons, who died of pneumonia, dysentery, phthisis, and 
kidney disease, as well as of several animals, and other substances abounding 
in bacteria; but nowhere did we find in them anything like our cholera 
bacilli. Should this phenomenon prove constant in the course of the further 
investigation, a very important result will thus have been attained ; for if 
bacilli of a specific character are exclusively incident to the process of 
cholera, the original connection between the appearance of these bacteria of 
the disease would scarcely admit of any doubt, even if the reproduction of 
the disease in animals did not succeed. But, even in the latter respect, 
things seem to be in our favor, as some of the experiments made on animals 
have yielded results which allow us to hope for further success." 

Dr. Koch calls these bacilli. Comma-bacilli, on account of their resem- 
blance to a comma used in writing. 

The spread of cholera. Seeing that drinking water had a most potent 
influence upon the dissemination of the disease, Pettenkofer commenced in 
tne year 1854 his extensive and careful investigations as to the conditions of 
climate, weather and groundwater in their bearings to cholera. His re- 
searches established the fact that the conditions of climate and weather had 
little or no influence, but that porous soils, which permit the penetration of 
moisture and fluids, were the very breeding beds for the spread of cholera 
germs, especially if resting upon closely packed alluvial clay, which arrests 
the further escape of the groundwater downward, and collects it all in no 
great depth under the surface. Any well feeding of such groundwater, must 
necessarily become contaminated and be the source from which cholera will 
be further disseminated; for when drinking from such wells, the cholera 
germs would be transmitted to the very spot, the stomach and bow T els, where 
they could at once multiply aud cause the disease. This is in accordance 
with all the facts known. A large material of such observations has been 
collected by Frankland in his article "on the water-supply of London and 
the cholera" in the Quarterly Journal of Science, 1867. But this ground- 
water produces cholera only, when the disease exists already upon the soil ; 
it does not originate the seeds of cholera, but carries merely what it had 
received from the surface, and probably gives it a more or less favorable 
chance to multiply. 



CHOLERA. 517 

To this mode of propagation belong also the instances where wells and 
rivers become contaminated by privies or sewers containing cholera germs. 
Even milk if diluted with contaminated water or served in cans cleansed by 
such water will have the same effect. 

The air too is to a certain extent a carrier of the cholera germs, especially 
in the immediate presence of a cholera patient, and when being long exposed 
to its influence. But that air can carry the poison over large tracts of land 
has never been proved, and Hahnemann already has refuted this idea. 

Much more mischief is done by the adherence of the poison to solid 
bodies. Old clothing, linen, bedclothes, anything that has been soiled by 
the vomit or stools of the patient will surely disseminate the disease. The 
instances where it has been imported to distant countries by old rags thus 
contaminated are not rare. 

The Prognosis is very bad under allopathic treatment, 50 per cent, and 
more, as the last epidemic of 1884 in France and Italy has shown again. 
The deaths under the homoeopathic treatment amounted even under the most 
unfavorable circumstances to only from 8-12 per cent, at the highest! 
Four homoeopathic physicians in Naples, Dr. Rubini, Cigliano, Mucci and 
Orioli lost in the same epidemic but 0.15 to 1 per cent.! See a direct report 
of Dr. Tommaso Cigliano to the Allg. Horn. Zeitung in Leipzig, Vol. 109, 
Xo. 20, on the cholera epidemic of 1884 in Naples. 

THERAPEUTIC HINTS —For disinfection. These same physicians 
discarded altogether Carbolic acid, Chloride of lime, Sulphate of iron or green 
vitriol, Corrosive sublimate and all other from the allopathic school profusely 
employed disinfectants. They advised their patients to burn Sulphur in 
privies and dirty places and corners, in rooms where cholera patients had 
lived and articles remained which they had used. Persons who had been in 
contact with cholera patients were advised to remain for a while in the 
vapors of camphor which had been allowed to evaporate on a hot iron, ac- 
cording to Hahnemann's direction. The dejections of cholera patients were 
mixed with a few spoonfuls of spirit of camphor. 

As prophylaxis they recommended Pubini's solution of Camphor, which 
is made of 100 parts of camphor to 100 parts of spirits of wine; they advised 
it in doses of five, three or two drops twice or three times a day. 

In treating cholera patients they relied almost exclusively on Pubini's 
camphor solution, giving 4 or 5 drops on sugar, or more in bad cases, every 
10 to 15 minutes, until reaction set in, when the doses were decreased and 
given in longer intervals. They used also Ver. alb. and Cuprum and 
other remedies with good results, but their mainstay was Camphor in all 
stages. 

As drink they allowed fresh water, a little at a time, sometimes with a 



518 INTESTINAL CANAL. 

few drops of rum or cognac. If water would not stay on the stomach, they 
ordered small pieces of ice, although this only rarely. 

As nourishment they allowed, after perspiration and vomiting had ceased, 
meat broth, or water soup, or bouillion soup, also a little of watered wine. 
They never allowed any interference with any other drug, nor baths of any 
kind, nor change of bed or clothing until after perspiration had ceased. 

For injections Camphor is best applied in oil, or in warm water with 
some alcohol. 

I must here put in a word of warning against overdosing with Camphor. 
Camphor in an overdose will do harm and may even kill as well as cholera, 
and in a very similar manner, and just herein lies its homoeopathicity to 
cholera. If, when taken as a preventive or during reconvalescence, it causes 
stupefaction, somnolence, precordial anxiety, coldness and bluishness of the 
skin, its use must be discontinued at once, or the dose greatly diminished. 
Coffea or Opium are its antidotes. 

The best way of administering Camphor is on pieces of sugar; in water 
it causes often nausea and loathing to such an extent, that patients refuse to 
take it. 

Another prophylactic remedy which Dr. Hering recommended years 
ago, and which has proved equally successful in the several cholera epidemics 
of this country, is this : Take pulverized or precipitated Sulphur and put a 
pinch of it into each stocking or shoe you are wearing ; renew about twice a 
week. The sulphur will be absorbed by the skin and disinfect the body of 
any cholera germs that might chance to enter it, just as burning sulphur 
will disinfect rooms and clothing. 

The linen, bed sheets, etc., should always, before they are given to the 
washerwomen, be thoroughly disinfected by exposure to the fumes of burning 
sulphur in a suitable room. 

As regards public sanitary measures, such as: the removal of filth from 
the streets, the abatement of nuisances, the filling up of wells in the city which 
may become contaminated by privies, sewers or ground water, the purifying 
of our rivers from which we draw our drinking water, the prevention of 
importing the cholera germs from abroad, we must necessarily leave to the 
proper authorities. 

As there is, before and during an epidemic of this kind, generally a 
prevalence of bowel complaints (cholerine), it is quite important that these 
incipient symptoms should at once be attended to. We shall frequently 
find indicated : 

Aloes, constant rumbling in abdomen with a feeling as if he must have 
a stool, but no evacuation following. (C. C. Smith.) 

Asar. Eur., in nervous and timid persons, who constantly feel chilly, 
or complain of cold hands, feet, knees or abdomen, even the hottest room or 



CHOLERA. 519 

warmest covering does not relieve this chilly feeling ; constant nausea, with 
loss of appetite or loathing of food without any gastric derangement; per- 
fectly clear tongue; rumbling and gurgling in the abdomen, likewise at- 
tended with nausea. 

Bryon., diarrhoea in the morning after getting up, with previous cut- 
ting pain in the bowels. 

Carb. veg., after exposure to heat of sun or fire (cooks, blacksmiths, 
masons, etc.), ushered in by haemorrhage from bowels; associated with flatu- 
lence. 

Chin, sulph., for the following precursory symptoms: great sensitive- 
ness against external influences; general weakness; internal bad feeling as 
of coming illness; anxiety, down-heartedness, moroseness, despondency, lazi- 
ness and lassitude; aversion to all kind of work; chilliness, especially in the 
back, alternating with flashes of heat ; heaviness in head as from a cold ; 
loss of appetite, loathing and nausea; pressure in stomach worse after drink- 
ing water ; pressure in pit of stomach up into the throat ; pain in the bowels, 
especially after eating; constipation or soft stools followed by weakness; 
heaviness and aching in all the limbs, especially in the joints. For this pre- 
cursory stage, which, in the different single persons, of course, consists only 
in part of these symptoms, I gave Chin, sulph., 0.01 to 0.06, one dose every 
evening, for eight days. None of the persons thus treated were attacked by 
cholera. If I ever should live to see another cholera epidemic, I would give 
Chin, sulph. and ozonized water. (Aegidi, A. H. Z., Band 85, S. 191. 

Coloc, bloody diarrhoea, with violent pain in the bowels, extending 
down into the thighs. 

I pec, nausea and vomiting predominating without, or at least always 
previous to, an alvine discharge. 

Iris vers., violent pain at the pit of the stomach or around the navel, 
or in some cases still lower down in the abdominal region, at or before every 
fit of vomiting and purging. 

Mercur., bloody, slimy discharges, with tenesmus. 

Phosph. ac, especially in the summer season; painless, watery dis- 
charges; great rumbling in the abdomen; bloatedness; sticky tongue. 

Secale, painless diarrhoea, with tingling and numbness in the limbs. 

Veratr., diarrhoea, and vomiting of a turbid water, with cold perspira- 
tion on the forehead. 

The developed cholera may point to one of the following remedies. 

Camphora, Hahnemann's discovery: he says: "When cholera first 
makes its appearance, it usually attacks in the following way: great prostra- 
tion at once; the patient cannot stand; his features become distorted; his 
eyes sunken; his face and hands bluish and icy cold, with coldness of the re- 
maining parts of the body ; his features express despair, and his whole action 



520 INTESTINAL CANAL. 

anguish, as though he would suffocate ; half stupid and senseless, he moans 
and groans in a hoarse, husky voice, expressing nothing particular, unless 
questioned. He has burning in the stomach and oesophagus, and cramps in 
the calves of the legs and in other muscles; when touched in the pit of the 
stomach he screams out; he has no thirst, no nausea, no vomiting, no diar- 
rhoea. In such cases Camphora gives immediate relief; one drop of the tinc- 
ture on sugar every five minutes." These observations of Hahnemann have 
been verified since by hundreds of physicians, and in thousands of cases. 

As additional symptoms I might mention: vertigo, nausea, vomiting 
with cold perspiration, especially in the face; faintness, asphyxia; cramps 
everywhere; the upper lip is drawn up, exposing the upper teeth. It is also 
recommended after previous use of allopathic medicine. Its beneficial action 
is seen in a gradual glow and warm perspiration all over the body ; when of 
course its use must be discontinued. Overdosing calls for Coffea or Opium. 

Next to Camphora in frequency of its use stands — 

Ver. alb., anguish; fear of death, or indifference; vertigo; eyes 
sunken ; nose cold ; face cold, pale, distorted, bluish, bloated ; great thirst 
for cold water, and vomiting after drinking, with great debility or diarrhoea 
at the same time; the discharges are gushing, profuse, rice- water-like, with 
cramps and colic in the bowels ; cold feeling in the abdomen ; tongue pale or 
bluish ; dry or yellow-coated ; cold ; voice feeble and husky ; very anxious 
oppression and constriction of the chest ; tonic cramps commencing in hands 
and feet, gradually spreading all over; pulse very small, thread-like; cold- 
ness all over ; cold perspiration. 

Cuprum, Hahnemann says; "If, after Camphora, there should not 
soon be a change for the better, apply at once Cuprum x." Its sphere of 
action is the following : very painful clonic spasms in different parts of the 
body, so that the patient cries out; great pressure in the pit of the stomach, 
worse from contact; constriction of the chest; great thirst; for a wdiile after 
drinking cold water vomiting and diarrhoea not very prominent ; anxiety ; 
cold face; blue lips; coldness all over; skin inelastic; urine suppressed. 

Besides these compare the following remedies: 

Aeon., restlessness; coldness externally, but to the patient a sense of 
burning heat through the whole system ; excessive thirst, but cannot retain 
anything; vomiting and purging of green, watery fluid; collapse. Two 
drops of tincture in half a tumblerful of water, two teaspoonfuls every half 
hour. (W. Boyce.) 

Arg. nitr., during the height of the disease, when the respiratory 
muscles are attacked with spasms, so that the patient can scarcely breathe, 
neither speak ; to drink a swallow of water, or the approach of a handker- 
chief to the nose, causes a feeling of suffocation, with terrible anxiety and 
thoughts of self-destruction ; during the oppression severe stitches in the pit 



CHOLEEA. 521 

of the stomach; after taking any fluid it appears as though it were running 
straight through the intestinal canal without stopping. 

Arsen., great anguish, indescribable, with constant restlessness; fear 
of death; sudden prostration; eyes sunken; nose pointed; face pale, cold, 
distorted ; tougue dry, brown, or black ; excessive thirst for cold water, but 
drinking little at a time, which is immediately thrown up; violent burning 
in the stomach and bowels, worse after throwing up ; urine suppressed ; voice 
hoarse ; great oppression and constriction of the chest ; skin wrinkled, dry, 
cold, blue; cramps, clonic and tonic, in different localities; cold, sticky per- 
spiration. May be indicated in all stages of the disease; best sign of its 
proper choice is the reappearing of urinary secretion. 

Bryon. 30 , a few globules each time after vomiting alone, or after vomit- 
ing and purging ; it cured even the worst cases with loss of consciousness, 
inability to speak, icy-coldness of the skin, wrinkled skin; pulselessness. 
(Haynel.) 

Carb. veg., in the last stage; when already the discharges up and 
down, the cramps, and general reaction have ceased; when the patient lies 
in a sopor, and is pulseless, with cold breath, cold tongue, or coldness all 
over, a picture of perfect collapse. 

Cicuta, violent cramps; tonic spasms of the muscles of the chest; loud 
hiccough; eyes turned upwards; soporous condition. 

Laches., vomiting renewed by the slightest motion, and nausea attended 
by a great flow of saliva. 

Crot. tigl., gushing out of watery discharges mixed with whitish flakes, 
with rumbling, griping in the bowels, and afterwards burning in the anus; 
discharges always brought on after drinking and motion ; great exhaustion ; 
faintness and dizziness. 

Hydr. ac, when there is a rapid progress of the disease towards as- 
phyxia; marble coldness of the whole body; pulselessness; cessation of diar- 
rhoea and vomiting; hiccough; paralysis of the oesophagus; when drinking, 
the fluid runs gurgling down the oesophagus; long fainting spells; trismus; 
tetanus. 

Jatropha, violent vomiting of a whitish, jelly-like substance, resembling 
the white of an egg ; discharges from the bowels in gushes ; gurgling noise in 
the abdomen, sounding as if a bottle were being emptied ; cramps in the 
calves of the legs, drawing them flat; at the same time the mind is in a kind 
of ecstasy and takes little notice of these painful spasms; or anxiety and fear, 
as though cramps in the calves would set in; burning of the abdomen; belly 
drawn in; marble coldness of the body; pulselessness; cold, sticky per- 
spiration. 

Ipec, in light cases, where the vomiting predominates over the alvine 
discharges ; vomiting mostly of a sour fluid, without diarrhoea. 



522 INTESTINAL CANAL. 

Phosphor., tongue coated white; excessive thirst ; vomiting after the 
water has become hot in the stomach ; hiccough after eating ; belly bloated ; 
rumbling and rolling in the abdomen; the rice-water evacuations contain 
grains like tallow ; oppression; great sinking of strength. 

Secale, dizziness, deafness; painful retching; profuse diarrhoea; un- 
successful urging to urinate ; skin wrinkled ; tingling in the limbs ; cramps 
and coldness; aversion to heat and being covered. 

Sulphur, first recommended by Dr. Hering, because it corresponds to 
its commencement in the morning, its cramps in the calves of the legs, its 
indifference of mind, and lastly its red spots, furuncles, etc., during con- 
valesence. Diarrhoea and vomiting at the same time, wakens the patient 
after midnight; the body grows cold and blue, with intense cramps in the 
calves of the legs and soles of the feet; pain in the region of the liver. 

Tabac, cold perspiration, with constant, deadly sickness and vomiting 
now and then; cramps and tearing in the limbs. 

Consecutive symptoms may call for — 

Aeon., if there be high, inflammatory fever; hard, strong pulse; con- 
gestion of the head or lungs; great restlessness; fear of death. 

Bellad., congestion of the head with violent delirium; visions and 
illusions of senses. 

Bryon., typhoid symptoms; pain in all the limbs on moving. 

Canthar., excessive sensitiveness of the abdominal walls; burning in 
umbilical region and deep in the pelvic cavity; rumbling in the abdomen 
and tenesmus followed by bloody evacuations ; urination drop by drop, with 
great burning; suppression and retention of urine. 

Mur. ac, difficult speech ; moaning and groaning during sleep; sliding 
down in bed. 

Phosph. ac, indifferent; without pain; delirium; drowsiness; sopor. 

Rhus tox., typhoid condition; red tip of tongue; pain in all the limbs 
on lying quiet. 

Tereb., if Canthar. has failed. 

Dr. J. Buchner's therapy is the following: Cholerine: Ipec, Phosph. 
ac, Veratr. Cholera: Amm. sulph., Camphora, Cuprum, Cupr. ac, Ipec, 
Veratr. Cholera paralytica: Nicot. Typhoid ex diphtheride: Nitr. 
ac Typhoid ex morOO Brightii: Arsen., Cupr. ac, Phosphor. Other 
remedies which may be indicated : Carb. veg., Cicuta, Ox. ac, Jatropha, 
Crot. tigl., Opium, Plumbum, Secale, Tabac. Tart, emet., 

Dr. Schiissler recommends : Kali phosphoricum. 



CHOLERA MORBUS. 523 

Cholera Morbus or Nostras or Europaea. 

' The attack conies on almost always suddenly, and frequently in the 
middle of the night. It consists of vomiting and purging, spasmodic pain in 
the abdomen, sometimes cramps in the legs, rapid loss of strength, and cold- 
ness of the skin. The thirst is great, the vomiting constant, and the purging 
consists of fetid fluid discharges containing a large quantity of bile at first, 
which, however, gradually diminishes, until, at last, the discharges approach 
the rice-water appearance without smell. The rapid and great loss of fluid 
will naturally cause similar symptoms as we observe in cholera Asiatica, and 
especially in children, old people or debilitated persons it may reach even a 
fatal termination. Then the intestines become paralyzed, vomiting and 
purging cease, yet the transudation continues ; the pulsations of the heart 
grow fainter and the radial pulse ceases altogether ; the sensorium becomes 
clouded and the patient sinks from sheer exhaustion. Yet such are only ex- 
ceptional cases ; as a general event the patients soon revive again. It prevails 
mostly during summer heat, although there are cases in other seasons ; and it 
seems to be excited especially by exposure, checked perspiration, drinking 
large quantities of ice water, or imprudence in eating. It differs from Asiatic 
cholera in not being caused by a specific poison — in not being to such a de- 
gree epidemic, violent and fatal. It differs from poisoning with arsenic by 
its purging and vomiting setting in at the same time ; while in cases of poi- 
soning the vomiting almost always precedes the purging. 

THERAPEUTIC HINTS.- Compare Cholera and Cholerine. Be- 
sides the remedies there characterized may be indicated: 

Ant. crud., vomiting and diarrhoea, watery or slimy; great thirst for 
cold water, especially at nigh^; tongue coated white; after sour wine. 

Chamom., after sudden taking cold; severe, cutting pains in the ab- 
domen ; vomiting of bile; painful, bilious evacuations; great irritability of 
mind; impatience; restlessness; child wants to be carried about; also after 
chagrin. 

China, discharges mostly painless, containing undigested food ; worse 
in the night, with great fermentation in the bowels, which are bloated; fulness 
of the bowels; sour eructations, and better for a while afterwards; especially 
after new or sour beer. 

Diosc, vomiting and purging of watery stools, with painful cramps in 
the stomach, bowels, and extremities. 

Euphorb. cor., forcible vomiting and diarrhoea of watery fluid, with 
sinking, anxious feeling at the stomach; faintness; slow and weak pulse; 
cool skin, feet, and hands, which become affected with painful cramps; pain- 
ful spasms in the intestines; cold sweat on the body and extremities; death- 



524 INTESTINAL CANAL. 

like sensation with anxiety of mind; no desire to live unless relief comes 
soon. 

Ipec, if the vomiting is predominating; from sour, unripe fruit, etc. 

Iris vers., vomiting and diarrhoea tinged with bile, with violent pain 
in the pit of the stomach, or around the navel, or still lower down in the ab- 
dominal region, at or before every fit of vomiting or purging ; burning in the 
rectum and anus; periodical spells of aggravation about two or three 
o'clock A.M. 

Veratr. is the most important and the most frequently indicated remedy. 
Purging predominates over vomiting; the stools follow in quick succession, 
become watery, lose all coloring matter and are gushing out, with violent 
pain in abdomen, or absence of pain; cold feeling; great thirst; nausea and 
anxiety. Drinking increases the symptoms. 

Summer- Complaint. 

Under this title two different affections of early childhood are frequently 
mixed up, namely, Cholera infantum and Catarrhal inflammation of 

the intestines. Both are most prevalent during the heat of the summer, 
and both show a high death-rate of infantile life. 

Cholera infantum corresponds to cholera morbus, and is characterized 
by severe vomiting, purging, rapid prostration and collapse. In consequence 
of the rapid loss of fluids through the intestinal canal and the consequent 
suppression of urine, ancemia and urcemia soon result with symptoms similar 
to hydrocephalus. The child grows restless, utters plaintive cries, rolls its 
head, commences to squint and falls into stupor — a state of things which 
Marshall Hall has designated with the name of " Hydrocephaloid," in con- 
tradistinction to hydrocephalus acutus, which is of an inflammatory nature. 
Compare Anaemia. 

Its Causes are : Extreme summer heat, 90° F. and above, for a great 
length of time; crowded cities with their pestilential influences of impure 
air, unclean streets, etc., improper alimentation, the combined influence of 
which the tender age of infants up to two years is frequently not capable of 
resisting. 

Cholera infantum often associates with intestinal catarrh, and this is no 
doubt the reason why in. common practice both forms are frequently con- 
founded. Still we ought to distinguish those cases with severe vomiting, 
profuse watery evacuations, rapid prostration and collapse, as cholera in- 
fantum. 

The Intestinal catarrh of infants during summer heat, the true 
Summer-complaint, is an inflammatory disease of the intestinal tract, but 
preponderantly an inflammation of the large intestines, though both the 



SUMMER-COMPLAINT. 525 

small and the large may be affected at the same time, hence it is also called 
Elltero- colitis. Its pathological changes correspond to those described 
under Intestinal Catarrh. 

Its Causes are the same as those of cholera infantum, to which we must 
add dentition. For it is not without good reason that mothers most dread 
the second summer of their infants, and are loath to wean them, if possible, 
before that period has passed. 

The most persistent of its Symptoms is diarrhoea. The evacuations, 
however, vary greatly. From feculent masses at first, the dejections become 
more liquid, of a whitish or ash-colored, or yellowish tint, changing to green 
or greenish, or leaving a mere greenish or dirty stain on the diaper ; or they 
are slimy, at times mixed with streaks of blood. As long as the dejections 
contain feculent matter, they mostly have a very penetrating smell, after- 
wards they assume a peculiar, sweetish, fleshy odor, sui generis of summer- 
complaint. 

Vomiting is a frequent symptom, but it comes and goes. There is gen- 
erally a great deal of thirst, but the liquid taken is not retained. There is 
always more or less fever, and the pulse rises to 120 and 140 or higher. 

Acute cases generally run their course in about two weeks, when con- 
valescence gradually sets in, or they assume a chronic nature with occasional 
improvements and relapses. Unfavorable symptoms are : continued gagging ; 
great frequency of the stools and the appearance of hydrocephaloid symptoms. 

THERAPEUTIC HINTS.— The large majority of people can not 
afford to escape the continued and excessive summer-heat by going to the 
seashore or to the mountains. For them it will be well to at least avail 
themselves of the few cool morning and perhaps evening hours, to take the 
child out riding, either in the cars or in a children's carriage, or where a 
river is near, on a steamboat. The riding motion, as Dr. Wm. B. Chamber- 
lain has truly remarked, is certainly of great benefit to the patient, and, in 
conjunction with the breathing of a purer atmosphere, will surely produce 
gratifying results. The high temperature may also be lowered by sponging 
the child all over with lukewarm water several times a day, and if there be 
excessive thirst without the ability to retain any drink, it will be well to 
apply a wet compress over the epigastrium. 

Alimentation. — The mother's milk is absolutely the best, provided the 
mother be well herself. If the child has been weaned, resort must be taken 
to cow's milk, thinned by adding two-thirds of boiling water. The boiling 
water is, at least, partially freed from disease-germs; it raises the tempera- 
ture of the milk to a desirable degree of warmth, and indicates at once 
whether the milk to be used is already undergoing the process of sour fer- 
mentation or not. A little salt may be added. If milk is always rejected, 



526 INTESTINAL CANAL. 

barley well boiled and strained may be tried. Of all the artificially pre- 
pared children's food (prepared, of course, always according to some scientific 
reasons, a la retort), I am no great friend. According to recent microscopic 
examinations, assisted by such simple tests as Iodine, which turns starch-cells 
blue, and gluten or (albuminous) granules yellow, Dr. Ephraim Cutter, of 
Cambridge, came to the following results: "There was scarcely a single one 
of the so-called infant foods that contained a quantity of gluten as large as 
that contained in ordinary wheat flour. That is to say, a well compounded 
Avheat gruel is superior to any of them, particularly when boiled with a little 
milk; and mothers are in error who place the slightest dependence upon 
them. As respects one very expensive article, professing to possess 270 parts 
in every 1,000 of phosphatic salts in connection with gluten, Dr. Cutter was 
unable to find any gluten at all. The thing was nearly pure starch, sold at 
an exorbitant price as a nerve and brain food and a great remedy for rickets. 
So all through the list. Sometimes a trace of gluten was present; more 
frequently none at all. In one case there were 90 parts of starch to 10 of 
gluten; but this was exceptional, and the majority were less valuable, ounce 
for ounce, than ordinary wheat flour. Considering the semi-philanthropic 
pretensions that have been put forth by the manufacturers of these foods, 
some of them sustained by the certificates of eminent physicians, the report 
of Dr. Cutter is one of the dreariest comments upon human nature that has 
recently fallen under the notice of the journalist. But if the revelations he 
has made of fraud and pretense on the part of manufacturers in this field 
shall serve to protect mothers from further betrayal and to rescue infant life 
from quack articles of nutriment, his work, though giving a tremendous 
shock to our sensibilities and to our faith in medical certificates, will not 
have been done in vain." {Medical Advance, June, 1882, p. 384.) 

Sometimes I have found that a little red wine in water remained in the 
stomach, when nothing else would. Beef-tea I abominate, and for reasons 
already given elsewhere. Simple mutton or beef-broth may be recommended ; 
but at times solid food is absolutely necessary, especially in weaned children 
w T ho have already some teeth. It is the process of mastication which here 
comes into play and which excites the necessary mixing of saliva with the 
food. A mutton chop sprinkled with a little salt and roasted quickly on a 
gridiron, and a pretzel, crisp and fresh from the baker, often do wonders. 

Cholera infantum. — Ver. alb. and Ipec. are undoubtedly the most 
important of all remedies, but compare also Arsen., Camphora, Cuprum, 
Phosphor., Secale, Sulphur and Tabac. The special indications for each are 
given under Cholera and Cholera Morbus. 

Summer-complaint, proprie sic dictu. 

Aeon., teething children w T ith high fever, restlessness, crying, biting 
fists, and frequent green or mucous stools. 



SUMMER-COMPLAINT. 527 

iEthusa, stools watery, greenish, without smell; milk disagrees, is 
thrown up at once, at times in coagulated lumps ; vomiting of white, frothy 
matter ; after stool and vomiting the child dozes, utters plaintive cries, now 
and then, and again commences to doze ; its face is pale, with a painful 
expression around the mouth; great prostration; eyes fixed and staring; 
convulsions with clenching the thumbs and turning the eyes downward. 

Ant. crud., child cannot bear to be touched or looked at; tongue 
coated white; violent vomiting, renewed after taking food or drink; diar- 
rhoea profuse. 

Apis, stools of various colors, offensive or odorless, painful or painless, 
usually worse in the morning. Stupor interrupted with shrill shrieks; head 
hot; eyes red; tongue dry; skin dry; hands cold and blue; abdomen 
tender, sunken; urine suppressed; pulse thread-like; impulse of heart 
violent. 

Arg. nitr., stools green, like spinach; diarrhoea after fluids, after 
sweet things which he craves. Sopor ; large pupils ; periodical trembling of 
the body. 

Arsen., stools green, watery, offensive; vomiting immediately after 
drinking ; great thirst, but drinks little at a time ; great restlessness ; great 
prostration ; all worse after midnight. Sopor, or coma vigil, with staring, 
spasmodically moving eyes ; dilated pupils ; difficult hearing and speaking 
or swallowing; dry tongue; sooty nostrils; sunken abdomen; involuntary 
stool and urine ; stiff neck ; palsy of the extremities. 

B apt is., very offensive diarrhoea, day and night; the child can only 
swallow fluids, no solids, even after it has learned to eat. 

Bellad., stools green, with hot head and cold feet, profuse micturition ; 
white tongue with red margin ; dry mouth and lips ; drowsy with frequent 
starting during sleep. 

Benz. ac, extremely copious watery stools, flooding everything about 
the child ; fetid urine. 

Borax., constant vomiting and gagging; painless stools, at first frothy, 
thin and brown, later cadaverously smelling, with little bits of yellow feces, 
or colorless and slimy ; belly soft, flabby and sunken in ; general emaciation ; 
Bopor; child makes an anxious face when carried down stairs, or put from 
the arms into the cradle. 

Bryon., any motion brings on diarrhoea; a sudden change to hot or 
cold weather aggravates the symptoms. Great thirst, with drinking large 
quantities ; hot head and soporous condition ; very fretful and irritable. 

Calc. carb., stools whitish, watery, most frequent in the after part of 
the day, often of a sour smell ; sour vomiting ; open fontanelles ; sweat of the 
head during sleep; old, wrinkled face; cold face; cold arms up to the 



528 INTESTINAL CANAL. 

elbows; retarded dentition; emaciation; bloated, big belly. The child 
makes an anxious face when being lifted up from the cradle, or being car- 
ried up stairs. 

Calc. phosph., scrawny children, with dirty white or brownish com- 
plexion ; skull soft and thin, crackling like paper when pressed upon ; old, 
wrinkled looks of the face; dry skin, diarrhoea with much flatulence during 
dentition ; greenish thin stools ; longing for bacon or ham fat. Hydrocepha- 
loid conditions. 

Camphora, the skin is cold as marble, and yet the child will not 
remain covered; half stupid and senseless; utter prostration. Vomiting 
and diarrhoea may be present or absent. Choleraic symptoms. 

Chamom., stools watery, green or like chopped eggs, often from any 
motion of the child, with crying, colicky pains and drawing up the legs. 
Teething ; often one cheek red and the other pale ; hot perspiration about 
the head. The child is very cross, wants to be carried about. 

China, painless and often undigested discharges, worse in the night, and 
after eating. Also attended with colicky pains and fermenting in the bowels. 
When the looseness has been brought on by eating fruit ; also when the pa- 
tient has become very weak from profuse and long-continued diarrhoea. 

Coffea, during dentition diarrhoea watery and painless, with sleepless- 
ness and threatening convulsions. 

Coloc, colicky pains relieved by lying on the stomach. 

Crot. tigl., sudden forcible discharges, after drinking, while nursing 
or eating, during summer. 

Cuprum, stools green with painful vomiting; spasms preceded by 
violent vomiting of mucus; convulsions. 

Dulcam., stools green with mucus from catching cold during hot 
weather. 

Ferr. phosph., frequent stools, green, watery, or hashed, mixed with 
mucus, scanty; straining at stool, also retching. Child rolls its head, moans; 
eyes half open; face pinched; urine scanty; pulse and respiration acceler- 
ated; starting in sleep. (J. C. Morgan.) 

Helleb., loose, watery, or jelly-like stools; scanty, dark urine; hydro- 
cephaloid symptoms. 

Ignat., "sudden metastasis from bowels to the brain during dentition; 
sudden paleness of face, with rolling-tossing motion of the head ; difficulty 
of swallowing; delirium, with convulsive motion of the eyes and lips." 
(Lilienthal.) 

Ipec, nausea and vomiting predominate; stools green like grass, or 
fermented like yeast. 

Iris vers., nausea and vomiting of sour fluid; stools thin, watery, 
copious, tinged with bile; boils about the child's head. 



SUMMER-COMPLAINT. 529 

Kali brom., frequent, green, watery discharges, with violent abdominal 
spasms, during which the abdomen gets hard ; thrush in the mouth ; convul- 
sive motions of eyes and limbs. (C. Mohr.) 

Kreos., constant vomiting and greedy drinking; stools grayish or 
white, chopped, very fetid ; belching or hiccoughing, especially when being 
carried; the child moans constantly, or dozes with half-open eyes; face cold, 
with a pale bluish tinge, especially on the temples and around the nose and 
mouth ; rapid emaciation ; quick, scarcely perceptible pulse. 

Laches., most important when the discharges have a penetrating, fetid 
smell and assume a purulent character. Great heat of the abdomen. 

Lycop., "stool of green, stringy, odorless mucus." 

Magn. carb., sour-smelling discharges up and down; pain in the 
bowels. 

Merc, sol., dark green stools, slimy, sometimes bloody with tenesmus; 
cannot get done. 

Natr. mur., vomiting and diarrhoea, worse during the day; great 
thirst ; general emaciation, most conspicuous around the neck, which appears 
thin and shrunken. (Hering.) 

Nux vom., stools early in the morning; after errors in diet. 

Phosphor., vomiting as soon as the water has become warm in the 
stomach. (Lippe.) The anus remains open all the time the child is strain- 
ing. (Boyce.) Hydrocephaloid symptoms from great exhaustion. 

Phosph. ac, painless, profuse, watery, or whitish stools, not weakening 
for a while, but being followed at last by great exhaustion. 

Podoph., the stools frequently change in character, and are usually 
most frequent during the early part of the day; prolapsus ani during stool. 
Dentition, head hot, rolling head from side to side, moaning; flushed cheeks; 
gagging, retching or vomiting of frothy, green mucus, or of food. 

Psorin., thin, watery stools, smelling like carrion; fretful, sleepless; 
the entire child has a disagreeable smell. 

Rheum, griping, sour stools, the whole child smells sour. 

Sepia, stools green, smelling putrid or sour; "boiled milk particularly 
disagrees." 

Silic, in thin and scrawny children with sweaty head (Boyce), and 
sweaty, offensively smelling feet. 

Stanum, "the child will not be quiet in any other position than carried 
over the point of its mother's shoulder." (Boyce.) 

Sulphur, stools worse in the morning; psoric patients prone to erup- 
tions here and there, and to excoriations behind the ears and between the 
legs. Hydrocephaloid symptoms. 

Sulph. ac, "excessively restless children, when Chamom. was of no 
service; aphthous condition; mouth generally dry." 
34 



530 



INTESTINAL CANAL. 



Ver. alb., vomiting and purging, the latter predominates ; great thirst, 
but drinking increases nausea and diarrhoea. After vomiting or purging 
great exhaustion, cold sweat on forehead ; and cold tongue. One of the most 
important remedies in cholera infantum. 

Zincum, "on awaking the child appears frightened and its head rolls 
from side to side; during sleep it cries out, starts and jumps; feet constantly 
fidgety." Hydrocephaloid. 

Hydrocephaloid. Compare: iEthusa, Apis, Arg. nitr., Arsen., 
Bellad., Borax, Bryon., Calc. phosph., Camphora, China, Cuprum, Ferr. 
phosph., Helleb., Ignat., Laches., Lycop., Magn. phosph., Phosphor., Po- 
doph., Silic, Sulphur, Veratr., Zincum. 



Digest to Summer-complaint 

COLOR OF DISCHARGES. 

Green : Bellad. 



or mucous : Aeon. 

, like grass : Ipec. 

, like scum of a frog pond : Magn. carb. 

, like spinach : Arg. nitr. 

, watery, offensive : Arsen. 

, with painful vomiting : Cuprum. 

, with mucus : Dulcam. 

, watery, or hashed, mixed with mucus, 

scanty : Ferr. phosph. 

, watery: Kali brom. 

, , or like chopped eggs : Chamom. 

, stringy, odorless mucus: Lycop. 

, dark, slimy, sometimes bloody, with 

tenesmus: Merc. sol. 

, putrid or sour smelling : Sepia. 

Greenish, watery, without smell: JEthusa. 
Of various colors, offensive: Apis. 
Change color frequently : Podoph. 
Grayish or white, chopped, fetid: Kreos. 
Whitish, watery: Calc. carb., Phosph. ac. 

SMELL OF DISCHARGES. 

Odorless : JEthusa, Apis, Lycop. 

Fetid, offensive: Apis, Arsen., Baptis., 

Kreos., Laches. 
Cadaverously: Borax. 
Carrion-like: Psorin. 
Putrid: Sepia. 
Sour : Calc. carb., Chamom., Magn. carb., 

Rheum, Sepia. 



NATURE OF DISCHARGES. 

Copious, profuse: Ant. crud., Iris, 

Phosph. ac. 
, flooding everything about the child : 

Benz. ac. 
Jelly-like : Helleb., Rhus tox., Sepia. 
Mucous: Aeon., Borax, Dulcam., Ferr. 

phosph., Lycop. 
Purulent: Laches. 
Thin and watery : JEthusa, Arsen., Benz. 

ac., Borax, Chamom., Coffea, Helleb., Iris 

vers., Kali brcm., Phosph. ac, Psorin. 
Tinged -with bile: Iris vers. 
With little bits of yellow feces : Borax. 
Undigested : China. 
Like yeast, fermented: Ipec. 
Frothy: Borax. 
With much -wind : Calc. phosph. 

MANNER OF DISCHARGES. 

Painless: Apis, Borax, China, Coffea, 

Phosph. ac., Sulphur. 
Griping: Rheum. 
Painful : Apis, Merc, sol, Sulphur. 
Colicky, with drawing up the legs: 

Chamom. 
Sudden, forcible: Grot, tigl. 
Involuntary stool and urine: Arsen. 

DURING STOOL. 
Colic and fermenting in bowels: China. 

and drawing up limbs: Chamom. 

Straining, with prolapsus ani: Merc, sol, 

Podoph. 



DIGEST TO SUMMER-COMPLAINT. 



531 



Straining, amis remains open : Phosphor. 

, retching: Ferr. phosph. 

Much flatulence : Calc. phosph. 

AFTER STOOL. 

Great exhaustion and cold sweat on 

forehead : Ver. alb. 
Dozing, with plaintive cries: JEihusa. 

SYSTEMIC SYMPTOMS. 
Half stupid and senseless: Camphora. 
Stupor : Borax. 

, interrupted with shrill shrieks: Apis. 

Delirium, with convulsive motions of 

eyes and lips : Ignat. 
Moaning : Ferr. phosph., Kreos., Podoph. 
Crying: Aeon. 
Biting fists: Aeon. 
Rolls head : Ferr. phosph., Ignat., Podoph., 

Zincum. 
Makes anxious face when being carried 
down stairs and put from the arms into 
cradle: Borax. 

when being taken up or carried up 

stairs: Calc. curb. 
Will not be quiet unless carried over 
the point of the mother's shoulder : Stan- 
nuru. 
Cannot bear of being touched or looked 

at: Ant. crud. 
Wants to be carried about: Chamom., 

Bhus tox. 
Fretful: Psorin. 

and irritable: Bryon. 

Cross : Chamom. 

Appears frightened on awaking: Zin- 
cum. 



Sudden metastasis from bowels to 
brain during dentition: Ignat. 

Hydrocephaloid: JEthusa, Apis, Arg. 
nitr., Arsen., Bellad., Borax, Bryon., Calc. 
phosph., Cunphora, China, Cuprum, Ferr. 
phosph., Ilelleb., Ignat, Laches., Lycop., 
Phosphor., Podoph., Silic, Sulphur, Ver. 
alb., Zincum. 

Head hot : Podoph. 

and cold feet : Bellad. 

and remaining body cool: Arnica. 

and soporous condition: Bryon. 



Sweat on head in thin, screaming chil- 
dren: Silic. 

during sleep: Calc. carb. 

hot : Chamom. 

Open fontanelles : Calc. carb. and phosph. 

Skull soft and thin, crackling like paper 
when pressed upon : Calc. ph 

Boils about the head : Iris vers. 



lips: 



Eyes red : Apis. 

fixed and staring: JEthusa. 

half open : Ferr. phosph. 

Pupils dilated: Arg. nitr., Arsen. 
Convulsive motion of eyes and 

Ignat. 
Eruption behind ears and between legs : 

Sulphur. 
Difficult hearing : Arsen. 
Nostrils sooty: Arsen. 
Face, cheeks flushed: Podoph. 
One cheek red, the other pale : Chamom., 

Ignat., Sulphur. 
Dirty white or brownish complexion, 

scrawny children: Calc. phosph. 
Sudden paleness, with rolling, tossing 

motion of head : Ignat. 
Paleness, with a painful expression 

around the mouth: JEthusa. 
Face cold: Calc. carb. 
, with a pale bluish tinge on temples 

and around nose and mouth: Kreos. 
Anxious look when being lifted up: 

Calc. carb. 

carried down : Borax. 

Old, wrinkled face : Arg. nitr., Arsen., 

Calc. carb. and phosph. 
Face pinched: Ferr. phosph. 
Convulsive motion of eyes and lips: 
Ignat. 



Mouth generally dry : Sulph. ae. 

and lips dry : Bellad. 

, thrush in: Borax , Kali brom. 

aphthous condition: Sulp't.ac. 

Tongue dry: Apis, Arsen. 

coated white: Ant. crud. 

white, with red margin: Bellad. 

cold: Ver. alb. 



532 



INTESTINAL CANAL. 






Speaking and swallowing difficult: Ar- 
sen. 

Dentition, during: Aeon., Cede, carb., Cole, 
phosph., Chamom., Coffea, Podoph. 

, , sudden metastasis from bowels 

to brain : Ignat. 



Swallowing difficult: Arsen., Ignat. 

, can swallow only liquids, no solids : 

Baptis. 

Thirst : Laches., Natr. mur. 

, but drinks little at a time : Arsen. 

, drinks large quantities : Bryon. 

■ , drinks hastily and greedy: Kreos., 

Sulphur. 

, drinking increases nausea and diar- 
rhoea: Ver. alb. 

Longing for bacon or ham-fat: Calc. 
phosph. 

boiled eggs : Calc. carb. 



Milk disagrees and is thrown up in coag- 
ulated lumps : JEthusa. 
, boiled, disagrees: Sepia. 



Belching or hiccoughing, especially when 
being carried : Kreos. 

Nausea and vomiting predominates: Ipec. 

Gagging, retching or vomiting: Borax, 
Podoph. 

Vomiting sour : Calc. carb., Iris vers. 

of frothy, green mucus or food : Po- 
doph. 

, white matter, or coagulated 

lumps of milk : JEthusa. 

— — of mucus, followed by spasms: Cu- 
prum. 

immediately after drinking: Arsen. 

as soon as the water has become warm 

in the stomach : Phosphor. 

after taking food or drink: Ant. crud. 

and greedy drinking: Kreos. 

after drinking milk which comes up 

in coagulated lumps : JEthusa. 

and purging, the latter predominat- 
ing: Ver. alb. 

may be present or absent : Cam- 
phor a. 



Pain in bowels : Magn. carb. 

Griping: Rheum. 

Colic, relieved by lying on the stomach: 

Coloc. 
Violent abdominal spasms, during which 

the abdomen gets hard : Kali brom. 
Abdomen sunken: Apis, Arsen. 

, soft and flabby: Borax. 

and tender: Apis. 

big and bloated : Calc. carb. 

hard: Kali brom. 

hot : Laches. 



Urine profuse : Bellad. 

scanty : Ferr. phosph., Helleb. 

and stool involuntary: Arsen. 

suppressed: Apis. 

fetid : Benz. ac. 

dark : Helleb. 



Respiration and pulse accelerated : Ferr 

phosph. 
Pulse quick, scarcely perceptible : Kreos. 
— ■ — thread-like: Apis. 
Impulse of heart violent : Apis. 



Neck stiff: Arsen. 

emaciated: Natr. mur. 

Arms cold up to elbow : Calc. carb., 

Hands cold and blue: Apis. 

Feet cold, head hot : Bellad. 

Body cool, head hot: Arnica. 

Skin cold as marble, yet the child will 

not remain covered : Camphora, Secale. 
Feet sweaty, offensively : Silic. 

fidgety: Zincum. 

High fever and restlessness : Aeon. 

Skin dry: Apis, Calc. phosph. 

, eruption behind ears and between 

legs: Sulphur. 
Whole child smells sour: Rheum. 
disagreeably: Psorin. 



Sleep with starting: Bellad., Ferr. phosph., 
Zincum. 

with crying out: Apis, Zincum. 

Drowsy: Bellad. 
Sopor: Arg.nitr. 
, with hot head : Bryon. 



CONSTIPATION. 



533 



Sopor, or coma vigil, with staring, spas- 
modically moving eyes: Arsen. 

Sleeplessness : Aeon., Bellad., Chamom., 
Psorin., Sulph. ac. 

Restlessness : Aeon., Arsen , Chamom., 
Rhus tox. 



Trembling of whole body, periodically : 
Arg. nitr. 

Convulsions: Cuprum. 

with cleaching the thumbs and turn- 
ing the eyes downward : JEthusa. 

Convulsive motions of eyes and limbs : 
Kali brorn. 

of eyes and lips : Ignat. 

Palsy of the extremities : Arsen. 



"Weakness and prostration : JEtkusa, Ar- 
sen., Camphora, China. 

Exhaustion follows after some time: 
Phosph. ac. 

Emaciation : Borax, Culc. carb., Kreos. 



Worse after midnight : Arsen. 
early in the morning : Nux vom. } Sul- 
phur. 



"Worse during early part of day : Podoph. 

after part of day : Cole. carb. 

the day : Natr. mur. 

the night: China. 

day and night: Baptis. 

after eating: China. 

and drinking, or while mov- 
ing: Crot. tigl. 

after drinking: Veratr. 

milk: JEthusa, Sepia. 

fluids and sweet things which 

he craves : Arg. nitr. 

from motion : Bryon., Chaniom. 



Caused by heat of summer: Crot. tigl. 
catching cold during hot weather: 

Dulcam. 
sudden changes to hot or cold 

weather: Bryon. 

errors in diet : Nux vom. 

eating fruit: China. 

or sour things : Ipse. 



Sulph. ac. is indicated when Chamom. 
has not relieved the excessive restless- 
ness. 



Constipation. 

Constipation has a relative meaning. Some persons feel perfectly well 
if they have a stool in two or three days. I know women who, in perfect 
health, have not more than one evacuation in a week. With most people 
one discharge every day seems to be the norm. Retarded action of the 
bowels is frequently accompanied with dizziness, headache, palpitation of the 
heart, hypochondriacal symptoms, haemorrhoids and flatulency. If long 
continued it may lead to dilatation and hypertrophy of the intestine and in 
some rare cases, where actual impaction of hardened and dried feces ensues, 
to inflammation, ulceration, and even perforation of the gut. 

Constipation may be brought about: by a diet containing too large an 
amount of undigestible matter (beans, corn and the like coarse food), which 
forms dry feces difficult to evacuate ; by diseased conditions of the mucosa in 
consequence of chronic catarrh, which diminishes the peristaltic action of the 
bowels; by muscular weakness of the intestines in consequence of anaemia, 
chlorosis, long-continued diarrhoea, the use of purgative medicines, or the im- 
proper suppression of the desire for stool at regular hours; by paralytic 
affections of the intestines in consequence of opium, lead or other poisons, or 



534 INTESTINAL CA.NAL. 

cerebral or spinal diseases; by abnormal losses of fluids in diabetes, profuse 
lactation or sweats; by mechanical obstructions outside the intestines from 
tumors, the enlarged or displaced womb; or by the presence of foreign bodies 
within the intestines, such as biliary stones, fruit stones, etc. 

Retarded action of the bowels in acute diseases, such as typhoid fever, 
scarlatina, measles, etc., is always of benefit to the patient, and ought never 
to be interfered Avith in any crude manner. 

THERAPEUTIC HINTS —If frequent resort has been had to pur- 
gative remedies, this bad habit must at once be stopped. A careful regula- 
tion of diet, drinking of cold or hot water before retiring and after rising in the 
morning, a strict adherence to the rule: "try to have the bowels moved at a 
regular hour every day or every other day"; the administration of injections 
of lukewarm water, and the occasional kneading of the abdominal walls by 
the fist will go a good way in helping to improve many cases of habitual con- 
stipation. But all this will not do in all cases; remedial agents will often 
be required, as may readily be inferred from the numerous causes" by which 
constipation may be induced. For lazy chaps and wise ones, who either do 
their w T hole business with Nux vom. and castor oil, or sneer at the symptom 
under Alumina: "the rectum is inactive," because they imagine that in con- 
stipation the rectum must necessarily always be inactive! — the following 
special hints are not written : 

^sc. hipp., dry, uncomfortable feeling in the rectum, as if it were 
filled with small sticks; very painful haemorrhoids, with little bleeding; 
aching and lame feeling in the small of the back, extending to the sacrum 
and hips; worse when getting up after sitting. 

Alum., the rectum is inactive, there is no desire for stool; the evacua- 
tion can be effected only by straining the abdominal muscles, even when the 
stool is soft; stools hard, knotty and scanty, or sticking to the anus like putty ; 
ailments from lead. 

Amm. mur., hard stools, crumbling to pieces when evacuated, re- 
quiring great effort to expel them, followed by soft stools; feces covered by 
glairy mucus. 

Anac, urging without being able to expel anything; the rectum feels 
as if stopped up with a plug ; the expulsion not taking place immediately, 
he experiences a painful twisting and turning in the intestines across the ab- 
domen. 

Bryon., hard, dry stools, as if burnt; of large size and passed with 
difficulty; rheumatic tendency; irritable and prone to fits of anger; after 
castor oil ; during hot weather. 

Calc. carb., hard, large, partially undigested stools; after stool feeling 
of faintness; oozing of a fluid from the rectum, smelling like herring-brine; 



CONSTIPATION. 535 

too early and too profuse menstruation ; restless sleep after three o'clock a.m. ; 
scrofulous diathesis. 

Capsic. , after drinking, urging to stool, but only slime is passed ; feeling 
of heat in the abdomen. 

Carb. veg., urging with tingling in the rectum and pressure on the 
bladder; labor-like pain; discharging feces in fragments, which are tough 
and scanty ; burning in bowels ; tympanitis. 

Caustic, frequent and unsuccessful urging, causing a good deal of paiu, 
anxiety and redness of the face; stool comes off in pieces; at last soft, and of 
the size of a goose-quill ; stool passes better while in a standing position. 

Chelid., stools like sheep's dung; pain in liver and csecal region; 
gurgling in abdomen, which is distended; crawling and itching in rectum, 
and reddish urine. 

China, large accumulation of feces in the intestines, with dizziness and 
heat in the head ; difficult stool, even when soft. 

Conium, frequent urging without stool, or a small quantity being ex- 
pelled at a time ; chilliness during stool ; palpitation of the heart and tremu- 
lous weakness afterwards; the flow of urine suddenly stops and continues 
after a short intermission; dizziness when turning in bed. 

Ferrum, flushed head and face with cold hands and feet; anaemia. 

Graphit., hard, knotty stools, with tenesmus and stitches in the rectum ; 
sometimes the stool is only of the size of lumbricoides ; a quantity of mucus 
is expelled with the stool, or the hard feces are covered with mucus; itching- 
blotches about the body, which emit a glutinous fluid; erysipelatous or ulcer- 
ative processes of the legs. 

Hepar, sluggishness and inactivity of the bowels, in consequence of 
which the abdominal muscles must bear down in order to effect an evacuation, 
which is hard or not, but insufficient; after mercurial dosing. 

Hydrast., constipation, headache and piles; after stools, for hours se- 
vere pain in the rectum and anus; colic pains with fainting turns and heat 
in the bowels; amernia; remittent fever; "after purgative medicines." 
(Goodno.) 

Iris vers., constant nausea, bitter eructations and vomiting; burning 
in epigastrium; colic with cutting pains and piles; hemicrania. 

Iodium, desire for stool, without evacuation; it takes place with great 
facility after taking some cold milk ; discharges of thick mucus, or purulent 
matter; part of the feces being retained. 

Kali bichr., stools dry, scanty, knotty; painful retraction of the anus; 
debility, headache, coldness of the extremities ; tough secretion from any of 
the mucous membranes. 

Kali carb., too large-sized feces; inactivity of the rectum; severe Ian- 



536 INTESTINAL CANAL. 

cinating, tearing and cutting in the anus; violent pain in the small of the 
back, as if broken. 

Laches., constipation of years' standing; the anus feels closed; the 
feces press against it all the time without passing; only single flatus are 
passed; the feces have a cadaverous smell; haemorrhoids, with stitching pain 
in the varices when coughing or sneezing. 

Lycop., ineffectual urging, owing to contraction of the rectum (sphinc- 
ter ani) ; distressing pain in the rectum for hours after evacuation ; excessive 
and painful accumulation of flatus in the abdomen; red, sandy deposit in the 
urine. Irritable and restless in the afternoon. 

Magn. mur., stools hard and in large lumps; urgent pressure in the 
rectum, the stool comes out in small pieces and seems as if burnt ; shudder- 
ing for a short time after stool. Pain and distress every few days in the hy- 
pogastric region. 

Natr. carb., insufficient stool, with tenesmus, followed by burning in 
the eyes and urethra, with great sexual excitement. 

Natr. mur., pressure from the navel downwards into the pelvis, or a 
leaden heaviness through the pelvis and across the bladder, worse when walk- 
ing, and better when sitting in a bent forward position ; hard, dry stools As- 
suring the anus, make it bleed; a number of bad feelings in the anus after 
stool; also cutting in the urethra after micturition. 

Nitr. ac, hard, scanty stools ; long pressing when going to stool; pain- 
ful burning in the rectum, especially after stool; urine emitting an intolerably 
strong smell. 

Nux vom., constant, ineffectual urging to stool; large, hard feces; 
piles; headache; unrefreshing sleep; after previous use of purgative medi- 
cines; coffee and liquor drinkers; use of high-seasoned food; sedentary 
habits. 

Opium, stools in hard, black, round balls; decided torpor and inertia 
of the rectum ; vomiting of stercoraceous substances in consequence of intus- 
susception; incarcerated hernia ; lead poisoning. 

Phosphor., stools narrow, dry, long, and difficult to expel; exceed- 
ingly painful cramps in the rectum after stool. 

Phytol., "constipation of long standing; pain shooting from the anus 
and lower part of the rectum along the perineum to the middle of the penis. 

Platina, difficult expulsion of scanty stool ; adhering to the part like 
soft clay; after poisoning with lead; traveling in the cars. 

Plumbum, stools consisting of small, hard balls; constriction and 
drawing up of the anus; frequent, violent colic; drawing in of the abdomen 
in the region of the navel; numb extremities; knife drops from his hands. 

Podoph., constipation with great difficulty; prolapsus ani; frequent 
micturition; weakness and soreness of the back; especially after washing. 



CONSTIPATION. 537 

Prun. spin., hard stool ; intermitting stool, looking like the excrements 
of dogs, in small lumps, with stitches in the rectum, extorting cries. 

Pulsat., with menstrual disorders, or after suppression of intermittent 
fever by quinine. 

Ratan., urging sensation in the small of the back, as if there would be 
stool; hard stool with straining; and sudden stitches in the anus; fissures of 
the anus. 

Ruta, scanty, hard stool; frequent urging to stool, with protrusion of 
the rectum, also during stool ; the rectum protrudes when stooping ever so 
little, and especially when squatting; a considerable quantity of flatulence is 
emitted whenever the urging takes place. 

Sabad., violent urging to stool, with noise like the croaking of frogs; 
necessity of sitting a long while, then passes an immense quantity of flatu- 
lence, which is followed by an enormous evacuation, after that, burning pain 
in the abdomen. 

Sarsap., obstinate constipation, with violent urging to urinate; urging 
to stool, with contraction of the intestines, and excessive pressure from 
above downwards, as if the bowels would be pressed out; during stool vio- 
lent tearing and cutting in the rectum ; afterwards a repetition of the same 
symptoms. 

Selen., stool so hard and impacted that it has to be removed by 
mechanical aid ; the feces contain threads of fecal matter like hair. 

Sepia, unsuccessful urging to stool, only wind and mucus being passed, 
with sensation in the rectum as of a lump having lodged in it; contractive 
pain in the anus ; thence in the perineum and vagina ; oozing of moisture 
from the rectum. During pregnancy. 

Silic, stools composed of hard lumps; after long straining the protrud- 
ing feces sudddenly recede into the rectum. 

Sulphur, constant urging, pressing on the rectum as if it would pro- 
trude, with pressing on the bladder; prolapsus ani; palpitation of the heart; 
after stool excessive stinging and sore pain in the anus, preventing lying or 
sitting down; rush of blood to the head; cold feet; faintness regularly, 
towards 10 or 11 o'clock a.m. 

Sulph. ac, hard stool, consisting of small, black lumps mixed with 
blood, and with such violent pricking in the anus that she has to rise on ac- 
count of the pain; climacteric age; constant flashes of heat; tremulous 
sensation in the whole body without trembling. 

Tabac, constipation; tympanitic bloating of the abdomen ; dyspnoea. 

Thuja, obstinate constipation, fever, inactivity, or intussusception ; hard 
balls; violent pain in the rectum, which prevents the passage ; offensive per- 
spiration at the anus and in the perineum. 

Verbasc, scanty discharge of stool, like sheep's dung, with straining. 



538 



INTESTINAL CANAL. 



Ver. alb., chronic costiveness with heat and pain in the head; stools 
in black, round balls, or large and hard, or first portion of the stool of large 
size, the latter coming out in thin strings, although of the same consistence 
and color. During stool turning pale and faint, chilly with anxiety and cold 
sweat on forehead. 

Zincum, dry, hard, insufficient, and difficult stool; afterwards violent 
bearing down in abdomen, relieved by passage of flatus up or down. 



Digest to Constipation. 



Constipation of long standing: Laches., 

PhytoL, Sarsap. 
— — , with violent urging to urinate : Sarsap. 

, chronic: Ver. alb. 

, obstinate : Thuja. 

Sluggishness, inactivity, torpor of bow- 
els, abdominal muscles must bear down : 

Hepar. 

of rectum : Alum., Opium. 

, no desire for stool : Alum. 

Large accumulation of feces : China. 
Urging, ineffectual: Anac, Iodium, Nux 

vom. 
, causing pain, anxiety and redness of 

face: Caustic. 
, with contraction of sphincter ani: 

Lycop. 
, with pressing on rectum, as if it 

would protrude, and pressure on the 

bladder: Sulphur. 
, with contraction of intestines, as if 

the bowels would be pressed out: Sarsap. 
, only a small quantity being expelled : 

Conium. 

, only single flatus are passed : Laches. 

, only wind and mucus being passed, 

with a sensation in rectum as if a lump 

having lodged in it : Sepia. 
, large quantity of wind is emitted: 

Ruta. 
, followed by an enormous evacuation 

and burning in abdomen : Sabad. 

, in small of back : Ratan. 

, with tingling in rectum and pressure 

on bladder : Carb. veg. 
, with protrusion of rectum: Podoph., 

Ruta. 



Urging, with noise like croaking of frogs : 

Sabad. 

, with labor-like pain : Carb. veg. 

, pressure from navel downwards into 

pelvis: Natr. mur. 
, with sudden receding of feces into 

rectum : Silic. 
, after drinking, but only slime is 

passed : Capsic. 
Evacuation difficult : Amm. mur., Podoph. 
, with straining abdominal muscles : 

Alum., Hepar. 

, followed by soft stools : Amm. mur. 

, even when stool is soft : Alum., China. 

, stool sticks to anus like soft clay or 

putty : Alum., Platina. 

part of feces being retarded : Iodium. 

Stool passes easy after taking some cold 

milk: Iodium. 
in a standing position : Caustic. 



Before stool painful twitching and turn- 
ing in the intestines : Anac. 
During stool, violent pain in rectum, 

preventing passage: Thuja. 
, violent pricking in anus, must rise: 

Sulph. ac. 
, violent tearing and cutting in rectum : 

Kali carb., Sarsap. 

, painful retraction of anus : Kali bichr. 

, contractive pain in anus, in perineum 

and vagina : Sepia. 
, stitches in rectum, extorting cries: 

Prun. spin. 

, stitches in rectum : Graphit., Ratan. 

, anus feels closed, feces presses against 

it: Laches. 



DIGEST TO CONSTIPATION. 



539 



During stool, Assuring the anus and 

making it bleed : Natr. mur. 

, chilliness: Conium, Ver. alb. 

, pale, faint, chilly with anxiety and 

cold sweat on forehead : Veratr. 
After stool, burning in eyes and urethra 

with sexual excitement: Natr. carb. 
, stinging and sore pain in anus, pre- 
venting lying or sitting: Sulphur. 

, pain in rectum and anus: Hydrast. 

, burning in rectum : Nitr. ac. 

, cramps in rectum: Phosphor. 

, distressing pain in rectum for hours: 

Lycop. 
, number of bad feelings in anus : Natr. 

mur. 
, bearing down in abdomen, better 

from passage of wind up or down : Zincum. 
, palpitation of heart and tremulous 

weakness: Conium. 

, feeling of faintness : Calc. carb. 

, shuddering: Magn. mur. 

NATURE OF DISCHARGE. 
Stool of large size: Bryon., Kali carb., Ver. 

alb. 

, later in thin strings: Ver. alb. 

and hard: Calc. carb., Magn. mur., 

Xuz vom., Ver. alb. 
, dry and hard as if burnt: Bryon., 

Magn. mur. 
so hard and impacted that it had to 

be removed by mechanical aid : Selen. 
scanty, insufficient : Alum., Carb. veg., 

Hepar, Kali bichr., Natr. carb., Nitr. ac, 

Rata, Verbose, Zincum. 

knotty : Alum., Graphit., Kali bichr. 

hard lumps: Silic. 

small, black lumps mixed with blood : 

Sulph. ac. 

small hard balls: Plumbum, Thuja. 

round black balls : Opium, Veratr. 

like sheep's dung: Chelid., Verbose. 

, like excrements of dogs in small 

lumps: Prun. spin. 

narrow, dry, long: Phosphor. 

in pieces: Caustic, Magn. mur. 

, which are tough : Carb. veg. 

, crumbling to pieces when being 

evacuated: Aram. mur. 



Stool containing threads of fecal matter 

like hair: Selen. 
, feces covered with mucus: Amm.mur., 

Graphit., Lycop. 
, consists of thick mucus, or purulent 

matter: Iodium. 

of the size of lumbricoides : Graphit. 

a goose-quill: Caustic. 

, latter portion consisting of thin 

strings: Ver. alb. 
of cadaverous smell : Laches. 



Rectum feels as if stopped up with a plug : 

Anac. 
, as if filled with small sticks: ^Esc. 

hipp. 

, crawling and itching in: Chelid. 

Anus contracted and drawn up : Plumbum. 
, lancinating, tearing, cutting in: Kali 

carb. 
, shooting pain along perineum to 

middle of penis : Phytol. 
— ; — , prolapsed : Nux vom., Podoph., Sulphur. 
protrudes when stooping or squatting 

down: Ruta. 
Piles: JEsc. hipp., Hydrast, Iris, Nux vom. 
, stitch-pain in, when sneezing or 

coughing : Kali carb., Laches. 
Fissures of anus: Ignat, Nitr. ac., Nux 

vom., Patau. 
Oozing of moisture from anus: Sepia. 

, smelling like herring brine: Calc. carb. 

Offensive perspiration at anus and in 

perineum: Thuja. 

SYSTEMIC SYMPTOMS. 

Anxiety and redness of face from frequent 
and unsuccessful urging: Caustic. 

, cold sweat on forehead, face pale and 

faint during stool : Ver. alb. 

Irritable and prone to fits of anger : Bryon. 

and restless in afternoon : Lycop. 



Dizziness when turning in bed: Conium. 

and heat in head: China. 

Heat and pain in head: Ver. alb. 
Flushed head and face with cold hands 

and feet: Ferrum. 
Rush of blood to the head : Sulphur. 



;40 



INTESTINAL CANAL. 



Hemicrania : Iris. 

Headache : Hydrast., Kali bichr., Nux vom. 



Tough secretion from any of the mucous 

membranes : Kali bichr. 
Constant nausea, bitter eructations and 

vomiting : Iris. 
Vomiting of stercoraceous substances: 

Opium. 
Burning in epigastrium : Apis. 



Abdomen, bloating: Coirb. veg., Lycop., 
Tabac. 

, heat in : Capsic, Hydrast. 

, burning: Garb. veg. 

Colic : Plumbum. 

, with fainting: Hydrast. 

Drawing in of abdomen in region of 
navel: Plumbum. 

Leaden heaviness through pelvis and 
across bladder: Natr. mur. 

Pain and distress every few days in hypo- 
gastric region : Magn. mur. 

in liver and ceecal region : Chelid. 



Menstruation too early and too profuse : 

Cole. carb. 
Menstrual disorders: Pulsat. 



Frequent micturition : Podoph. 
Cutting in urethra after micturition: 

Natr. mur. 
Flow of urine stops and continues again 

after a short emission : Conium. 
Urine of intolerable strong smell : Nitr. ac. 

reddish : Chelid. 

makes a red, sandy deposit : Lycop. 

Dyspnoea: Tabac. 

Palpitation of the heart : Sulphur. 



Back, weakness and soreness, especially 

after washing : Podoph. 
Small of back, pain as if broken : Kali carb. 
, aching and lame feeling, extending 

to sacrum and hips : JEsc. hipp. 
Extremities, numb ; knife drops from his 

hands: Plumbum. 

cold : Kali bichr. 

Hands and feet cold : Ferrum. 
Feet cold : Sulphur. 
Rheumatic tendency : Bryon. 
Erysipelatous or ulcerative processes of 

legs: Graphit. 
Itching blotches about body, which emit 

a glutinous fluid : Graphit. 
Tremulous sensation in body without 

trembling: Sulph. ac. 



Sleep unrefreshing : Nux vom. 
restless after 3 a.m. : Cole. carb. 



Flushes of heat : Laches., Sulph. ac. 

Fever, inactivity: Thuja. 

Debility: Kali bichr. 

Faintness towards 10 or 11 a.m. : Sulphur. 



Nux 



After castor oil : Bryon. 

mercury : Hepar. 

lead: Alum., Opium, Platina. 

quinine: Pulsat. 

purgative medicines: Hydrast., 

vom. 
During hot weather: Bryon. 

traveling in the cars : Platina. 

pregnancy : Sepia. 

climacteric age: Laches., Sulph. ac. 

— — incarcerated hernia: Opium, Plumbum. 

intussusception : Thuja. 

Scrofulous diathesis: Calc. carb. 
Anaemia : Ferrum, Hydrast. 



Hernia; Internal and External Strangulation. 

Both consist of a "constriction or nipping of a portion of bowel by the 
edges of some natural or artificial orifice through which it protrudes, with 
consequent arrest of the circulation of blood in it, and impediment to the 
passage of fecal matters along it." (Bristowe.) 

Internal strangulation may take place in the foramen Winslowii or 






HERNIA. 541 

the foramen ovale, or in any abnormal fissure or opening which has been 
formed by inflammation and consecutive adhesion, and formation of bands 
and strings within the cavity of the abdomen. 

External Strangulation may take place in the inguinal or in the 
crural canal, in the opening which gives passage to the infra-pubic vessels, in 
the sacro-sciatic notch, and in the umbilicus. But it does not follow by any 
means, that the displacemeut of a portion of the bowel in any of these by- 
ways should always be followed by strangulation. If, however, strangulation 
does result, the symptoms are the same whether it be internal or external 
strangulation : there is acute pain in the region of the lesion, which is fol- 
lowed by obstinate constipation and vomiting at first of yellow and greenish 
and later of fecal matter — Miserere. 

The Diagnosis of internal strangulation is obscure, because its symp- 
toms are common to any kind of occlusion of the intestinal tract. External 
strangulation in case of ordinary hernia may always be detected by careful 
examination. 

THERAPEUTIC HINTS.— The first endeavor in any case of hernia, 
whether strangulated, incarcerated, or merely protruded, must be to reduce 
it. The manipulations used in this endeavor are called taxis, 1 and consist of 
various procedures. The patient is laid on his back, low with the shoulders 
and high with the pelvis ; the leg of the affected side is flexed upon the thigh 
and the thigh upon the abdomen, and then by rotating the limb inward the 
columns of the ring are relaxed. 

Or the patient is raised by his feet, so that by its own gravity the pro- 
truded bowel is retracted into the abdominal cavity. 

Or the patient is placed in a semi-prone position towards the affected 
side with the thigh flexed upon the body; his eyes are covered with a towel, 
and then some cold water is suddeuly dashed upon the chest and epigastrium, 
which causes by its shock a quick and deep inspiration, in consequence of 
which the hernia slips back. 

Or, according to Baron Sentin's method, "seek with index-finger for 
aperture giving issue to hernia, pushing up skin sufficiently from below in 
order not to be arrested by its resistance. Pass the end of the finger slowly 
between viscera and herniary orifice, depressing the intestine or omentum 
with the pulp of the finger. This stage demands perseverance. Now curve 
the finger like a hook, exerting enough traction on the ring to rupture some 
fibres, causing a cracking very sensible to the finger, sometimes to the ear. 
When this crack is not produced, submit the fibres to a continuous forced 
dilatation." 

Or place a jar filled with hot air over the abdomen, when, by cooling, 



542 INTESTINAL CANAL. 

the contents of the abdomen are drawn up into the jar and the hernia out of 
its enclosure — dry cupping. 

Or draw the hernia gently outwards with the right hand in order to dis- 
engage it from the neck of the sac, and then push gently with left thumb and 
index-finger upon the upper part of the tumor, thus emptying its upper por- 
tion first, when the rest will follow. A gentle, but persistent, pressure is 
necessary. A peculiar gurgling noise in the abdomen pronounces the reduc- 
tion of the hernia. 

Next to taxis the emptying of the lower bow T els is of great importance, 
in order to restore the peristaltic motion of the intestines. Dr. Hensler 
recommends large and repeated injections of sugar-water, as not only soften- 
ing the impacted feces, but also as nourishing to the mucous membrane of 
the gut. 

Dr. Finkelnstein recommends the external application of oil and ether 
in the proportion of 20 parts to 100, every fifteen minutes, which in a number 
of cases will reduce the hernia in one hour. 

Any of these methods may succeed ; but the carefully selected remedy 
may do it without them, or at least facilitate our success greatly and diminish 
more and more the necessity of the knife. 

Aeon., soreness, burning and heat and throbbing in tumor; excessively 
sensitive to touch ; after fright and cold. 

Arsen., when the tumor assumes a dark red or livid appearance, with 
great restlessness and prostration. 

Aurum, the testicles are slow in lowering down into the scrotum; in- 
guinal and umbilical hernia in children from crying. 

Bellad., soon after strangulation, which is caused by spasmodic action 
of the muscular fibres, and before inflammation has set in. 

Borax, if in children the anxious face is present during any dowmvard 
motion. 

Calc. carb., rachitic children; big-bellied and prone to diarrhoea. 

Coccul., when the prostration takes place very slowly, as if from a 
paralytic state of the abdominal ring. 

Laches., livid appearance of the tumor; coughing or sneezing goes 
like a knife through the tumor. 

Lycop., has been very effective in hernia of right side, with rumbling 
in abdomen and great fulness ; also in women of a gentle disposition, 

Magn. carb., scrotal hernia. 

Nux vom., sudden violent pain in hernial region; drawing and tear- 
ing, and spasmodic constriction in the abdomen, with nausea, vomiting of 
sour mucus; constipation with constant ineffectual urging to stool; or, similar 
to Coccul., slow protrusion in aged persons, with squeezing pain in the hernial 
region, fulness in abdomen, periodical nausea; tumor not very sensitive, is 



TORSION OR TWISTING OF THE BOWELS. 5-13 

soft and doughy; later comes pinching and griping in abdomen, periodical 
nausea, gulping up of salty or bitter water, vomiting, etc. 2sux vom. is fre- 
quently indicated, and especially if errors in diet have preceded ; if it fails 
Coccul. follows well. 

Opium, soporous condition; red face; distended abdomen with flatus; 
antiperistaltic motion, belching and vomiting; bowels absolutely closed, with 
constant urging to stool and urine. 

Plumbum, has relieved strangulation where Aeon., Bellad. and Xux 
vom. failed, in many cases. (Baumann.) 

Rhus tox., after straining or lifting heavy loads. 

Silic, "frequent colic, relieved by the discharge of offensive flatus; 
tenderness about the hernial tumor; vomits much milk after nursing." 
(Guernsey.) Boils ; abscesses ; offensive sweat of feet. 

Stannum, "inguinal hernia; the child has curdy stools and much 
colic, which is relieved by laying its abdomen across the nurse's knee, or 
against the point of her shoulder." (Guernsey.) 

Sulph. ac, left side, in melancholic and phlegmatic persons; after 
carrying heavy loads. Yon Boenninghausen considers it as one of the most 
important remedies in inguiual hernia. 

Thuja, "sweat only on the uncovered parts, while covered parts are 
dry and hot. (Von Boeuninghausen.) 

Ver. alb., antiperistaltic action, hiccough, cold sweat, nausea, with 
sensation of fainting and violent thirst. 

Torsion or Twisting of the Bowels. 

This takes place most frequently at the sigmoid flexure when, by a dis- 
proportion (mostly congenital) between the length of the S-loop and the 
smallness of its mesenterial root, the overdistended sigmoid flexure, filled with 
gas and feces, is rendered liable of rolling about its axis, and by its own 
weight and inactivity is prevented from straightening or untying itself again. 
This occurs most frequently in advanced life. 

Twists also take place not unfrequently when by unusually long mesen- 
tery portions of the ilium are rendered freely movable and are thus made 
liable to twist arouud their own axis. Peritonic false ligaments or omental 
adhesions running directly across the pedicle of the twisted loop may fix it 
in its twisted position, causing, by degrees, a permanent occlusion of the 
bowels, which is often preceded for a long time by colics, meteorism and con- 
stipation. "Occlusion itself comes on acutely, with severe symptoms of in- 
ternal incarceration, rapid collapse, vomiting, meteorism, and usually violent 
tenesmus, with frequent, sometimes bloody diarrhoea, followed by death 



544 INTESTINAL CANAL. 

within the first twenty-four hours — on the average on the fourth day." 
(Leichtenstern. 

A lateral kinking, the result of dislocation, is seen most frequently in the 
caecum and ascending colon, when they are rendered movable by an unusually 
long meso-colon and become displaced inward or into the left hypochondrium. 
" But the kinking is, in itself, insufficient to produce definite impermeability, 
which requires the addition of some compressing cause, most frequently the 
mesentery of a convolution of the small intestine, which overlies the bent 
point and obstructs it by compression. (Leichtenstern.) 

Intussusception ; Invagination. 

By this is meant " the prolapse or slipping of a tuck of intestine into the 
cavity of the portion of intestinal tube immediatly below it, wherewith it is 
continuous." (Bristowe.) It takes place in consequence of paresis of a 
limited portion of the intestine associated with vigorous peristaltic action of 
the portion below, just as prolapsus recti may follow violent anal tenesmus. 
It has been observed at all points of the large and small intestine. The ileo- 
csecalis is the most common form in childhood; in adults, ilium and ileo- 
cecal invaginations occur nearly as often. The ilium invaginations are found 
most frequently in the lower and lowest part of the ilium, while colon invagi- 
nations are more frequent in the descending colon and sigmoid flexure. 

The length of bowel involved in an intussusception varies from two to 
three inches up to three or four feet. The course of these lesions is also va- 
riable. Invagination may be reduced spontaneously, or by suitable treat- 
ment; or the invaginated portion of the bowel, from being compressed, may 
inflame, die and slough off either entire, or what happens oftener, in pieces or 
in shreds. 

This separation occurs, in the majority of cases, from the eleventh to the 
twenty-first day after the production of the invagination ; in chronic cases it 
may not happen until after several months. Or, and this is by far the most 
frequent in chronic cases of ileo-csecal invaginations, the two cylinders be- 
come fixed by a solid union, when after the complete disappearance of the 
swelling the canal of the invaginated portion becomes again permeable; or 
in very acute cases the invagination leads to immediate and permanent oc- 
clusion. The patients die in from three to six days, with the symptoms of 
internal strangulation, with or without peritonitis or perforation. 

The Symptoms are ushered in suddenly with violent colic, which is fol- 
lowed by vomiting, especially in children if the lesion be situated high up. 
Now follows diarrhoea, which lasts at least until all the contents below the 
lesion are discharged. These evacuations are always mixed with blood, 
which oozes from the compressed and congested portion of the invaginated 



INTUSSUSCEPTION. 545 

bowel, and consist at last of mere bloody mucus with violent tenesmus, which 
appears earlier and is the more intense the nearer the intussusception is to 
the rectum. In this case there frequently follows a paralysis of the rectal 
sphincter and patulence of the anus, through which the bloody passages 
escape involuntarily, a symptom especially found in children. The next and 
quite important symptom is the usually cylindrical, sausage-like tumor, which 
can be felt in the abdomen almost always in colon and ileo-csecal invagina- 
tions, but seldom in those of the ilium. In some cases the intussusception 
extends so low down into the rectum that its lower extremity may be detected 
by the finger inserted into the anus, 

Invaginations, especially in the small intestines, are frequently found 
in the bodies of children, but unaccompanied by any inflammatory changes ; 
they seem to be produced during the last struggle, and must therefore be 
considered as mere cadaveric changes. 

IleilS or Miserere are terms which denote stercoraceous vomiting, in 
consequence of any kind of occlusion of the intestine. 

THERAPEUTIC HINTS —Ileus or Miserere hint to : Aeon., Arsen, 
Bellad., Chamom., Coccul., Coloc, Cuprum, Diosc, Lycop , Nitr. ac, Nux 
vom., Opium, Platina, Plumbum, Raphan., Rhus tox., Sambuc, Silic, 
Sulphur, Thuja, Ver. alb., Zincum. 

Aeon., inflammatory symptoms; restlessness and impatience. 

Alum., pinching pain in the bowels; obstruction from inactivity and 
dryness of rectum; dry retching, or mucous vomiting; low-spirited, weeping, 
hopeless mood. 

Arsen., burning pain; restlessness and prostration; better from hot 
applications. 

Bellad., pain in right ileo-csecal region; cannot bear any touch; 
clawing around the navel; vomiting, can keep nothing down, is pale and 
weak. Prolapsus ani ; paralysis of the sphincter ani. During teething. 

Carb. veg., in slow T cases, when other remedies have failed and the 
pulse is intermitting. 

Coloc., neuralgic pain in bowels; obstruction, as if from dryness of the 
bowels; serous, bilious vomiting without nausea; angry mood; throws things 
out of his hands; indignation. (Hayward.) 

Cuprum, violent pain in umbilical region; total obstruction of bowels; 
violent, continued, convulsive vomiting of blood and feces; singultus; great 
agony. 

Kali bichr., pain as in enteritis; vomits in rapid succession bilious, 
bloody matter; the blood is bright and clotted. Listless, indifferent, languid 
mood. (Hayward.) 

Nux vom., crampy, remittent pain in bowels; contraction or restric- 
35 



546 INTESTINAL CANAL. 

tion of bowels; sour, mucous and bloody vomiting; quick, spasmodic pulse 
and hot skin ; irritable, sullen, quarrelsome mood. 

Opium, constipation; vomiting of fecal matter; excessive thirst; dis- 
tended abdomen, painful to touch ; crampy motions of the intestine, at times 
like a rolling up of a hard body in right hypochondrium ; frequent hiccough ; 
small, frequent pulse ; cold extremities ; distorted face. 

Phosphor., paralysis of sphincter ani. 

Plumbum, violent colic in region of navel, with complete obstruction 
of bowels and stercoraceous vomiting ; anus feels as if drawn upward ; swell- 
ing in the ileo-csecal region ; depressed and restless disposition. 

Thuja, ileus; spasmodic stricture, as if something alive was pushing 
out; ineffectual urging to stool, with erections. Sweats only on the uncov- 
ered parts of the body, while the covered parts are dry and hot. 

Ver. alb., colic; burning, twisting, cutting pain, with nausea and 
vomiting, worse from food, better after wind passes; cold skin; cold perspi- 
ration ; small, spasmodic pulse ; restless and anxious. 

As mechanical means to reduce invaginations, injections of air have 
been used by means of an ordinary bellows attached to an oesophageal sound 
until a considerable abdominal tension and the desired effect was produced. 
Dr. W. Danforth procured, in a desperate case, the same effect by injecting 
one ounce and a half of soda, dissolved in a pint of water, and followed by 
the injection of a dessertspoonful of tartaric acid in a cupful of water. The 
thus suddenly generated gas untied the knot. 

Haemorrhagia Intestinalis, Intestinal Haemorrhages, Malaena, 

Takes place in consequence of either — 1. Obstructed circulation of blood 
through the vena porta, as in the case of cirrhosis of the liver, diseases of the 
heart and lungs, compressions of the blood-vessels by large abdominal 
tumors; or, 2. Erosions or degeneration of the blood-vessels from intestinal 
ulcers during typhus, yellow fever, scurvy, etc.; or, 3. Lesions caused by 
corroding or cutting substances, wounds, etc. ; or, 4. Suppressed normal, or 
habitual, bloody discharges, as menstrual or hemorrhoidal. A copious, 
internal haemorrhage is characterized by sudden paleness, coldness of the 
body, collapsed features, weak pulse, fainting, fits of chilliness, and dis- 
charges of blood from the bowels. The discharged blood, when it comes 
from the" upper portion of the intestines, is generally dark and mixed with 
intestinal contents like tar. It is generally red and fluid when it proceeds 
from the lower portions. The exact seat of the hemorrhage, however, can- 
not be determined, as physical examination gives no hint whatever in regard 
to it. The bleeding may occur even within the stomach, as I have men- 
tioned when I spoke of hsematemesis ; and a black, tar-like appearance of 



HEMORRHOIDS, PILES. 547 

stool is not a sign that it contains blood, as it may be colored by bile. This, 
however, may soon be settled. Throwing the passage into water, it colors 
the water red when it contains blood ; and when it contains bile the water is 
colored green or yellowish. 

THERAPEUTIC HINTS —Compare the above-stated morbid con- 
ditions, which are the causes of the intestinal haemorrhage. 

As generally indicated, the most important remedies are Alum., Arsen., 
Carb. veg., China, Eriger., Hamam., Ipec, Nitr. ac, Sulphur. 

Haemorrhoids, Piles, 

Consist of a dilatation of the hemorrhoidal veins, to which belong chiefly the 
plexus of veins lying in the submucous tissue of the lower part of the rec- 
tum, and in the adjoining subcutaneous connective tissue, also the venous 
radicles in the mucous membrane, the perirectal plexus, and the adjoining 
venous plexuses of the bladder, uterus, vagina, and the sacral canal. These 
dilated veins form tumors of different sizes, according to the amount of 
venous turgescence, from the size of a pea to that of a cherry or walnut, 
which sometimes encircle the entire anal opening like a bunch of grapes. 
When thus situated outside the anal margin they are called external, when 
within the anal margin internal hcemorrhoids. 

There are usually longer or shorter intervals between these spells of 
turgescence, during which the patient feels comparatively free from hsemor- 
rhoidal inconveniences. However, repeated attacks of turgescence will 
gradually change either the mucous membrane or the submucous tissue, and 
produce catarrhal swelling of the mucous membrane, or hyperplasia of the 
connective tissue, or atrophy of these tissues under the influence of the press- 
ure of the varices. The natural rugosities of the rectal mucous membrane 
become permanently thickened and inflamed, polypous growths are formed 
and associated with more or less pedunculated tumors, resulting finally in 
suppuration and consequent purulent discharges— white or slimy hcemor- 
rhoids. 

The principal predisposing cause of the piles seems to be the position of 
the hemorrhoidal veins, as the lowest branches of the abdominal vessels, and 
in their want of valves to sustain the return column of blood in its course 
towards the vena porta. When a retardation or stagnation by some means 
or other in this backward moving column takes place, it is obvious that its 
whole weight must press downwards upon its lowest branches, overfilling and 
dilating them. Such retardation of the refluent stream of blood may arise 
from different conditions : 



548 INTESTINAL CANAL. 

1. From tumors within the abdominal cavity, which press upon the 
veins of the rectum ; a gravid uterus, etc. 

2. From diseases of the liver, which obstruct the vena porta. 

3. From diseases of the lungs, by which its capillaries become either 
obstructed or destroyed. 

4. From diseases of the heart, by which the veins become overfilled 
with blood. 

5. From a general relaxation of the abdominal veins, in consequence of 
using too much wine, coffee, tea, or leading a sedentary life. 

The fact, however, that frequently all members of the same family suffer 
with this complaint, seems in favor of the assumption that piles are of a 
hereditary nature, probably consisting of a congenital weakness or yielding 
of the walls of the hemorrhoidal veins. 

Symptoms. — As forerunners to their local appearance we observe: ful- 
ness and pressure in the epigastrium, disturbed digestion, bloatedness of the 
abdomen, costiveness, dull pain in the small of the back, also in the head 
and nape of the neck, hypochondriacal disposition, disinclination to work, 
and especially to mental occupation, all symptoms which denote a disturbed 
action in the abdominal organs. After a shorter or longer duration of these 
symptoms, we find a gradual development of the local symptoms at the 
anus — the beginning of varicose veins, their gradual growth, their tumes- 
cence and their collapse, alternating in longer or shorter intervals. Thus the 
whole complaint is of a slow and tedious nature, changing constantly from 
better to worse. The occasional spells of bleeding are frequently attended 
with a feeling of relief, though they do not better the morbid process itself 
in any way; they become in some cases habitual, assuming a regular type of 
from three to four weeks intervals. In such cases the organism becomes so 
much accustomed to them, that when they are suppressed in consequence of 
mental emotions, or taking cold, or by external medical applications, etc., 
other disturbances set in, such as congestion of the head, lungs, stomach, 
liver, kidneys, etc., which may result in nosebleed, haemoptysis, bloody urine, 
apoplexy, etc. 

In consequence of the stagnation of the refluent stream of blood, which 
is caused by liver, heart or lung diseases, may arise, also, especially in older 
individuals, a varicose state of the veins of the neck of the bladder, of the 
uterus or vagina, causing haemorrhages from these organs, or slimy discharges, 
painful micturition, etc. 

" Dilatation of the sacral plexus is revealed by pain and a feeling of 
weight in the sacral region. When the communicating plexus of the spinal 
canal is affected, it may, by compressing the roots of the nerves, give rise to 
sensations of weight, numbness, formication and pain in the lower extremi- 



HAEMORRHOIDS, PILES. 549 

ties, or in the lumbar region, so as to simulate sciatica or a lesion of the cord 
itself." (Quinke.) 

The Prognosis depends upon its predisposing and proximate causes. 
Actual danger can only exceptionally arise from its local manifestations. 

THERAPEUTIC HINTS.— Aeon., bleeding piles; stinging and 
pressure in anus; abdomen feels full, with tensive, pressive and colicky 
pains; bruised feeling in back and sacrum, inflammatory stage. 

^scul. hipp., protruding piles, purple, bleeding slightly, attended 
with constipation and a sensation as if sticks were in the rectum ; severe ful- 
ness and bearing down; aching pain and lame feeling in the back. 

Aloes, protruding piles, like bunches of grapes; hot and sore; relieved 
by cold water ; when urinating he has a feeling as though some liquid dis- 
charge from the bowels Avould take place at the same time; much flatus 
with stool. 

Alum., stool hard, and of the shape of laurel-berries, attended with 
cutting pain in the anus, as if it were too narrow; succeeded by a jet of blood 
from the rectum, followed by soreness in and along the rectum; perineum 
sweats and is tender to the touch. 

Amm. carb., varices protrude during stool, and without stool; they 
are moist, and with a pain as from excoriation ; discharge of blood during 
and after the evacuation; burning pain in the rectum, itching of anus. 

Ant. crud., tingling, itching and burning of the varix; mucous secre- 
tion from the rectum, staining the linen yellow ; alternate constipation and 
diarrhoea. 

Apis, small protruding varices, which sting, burn and smart intoler- 
ably, making one very irritable and fidgety ; stool constipated, urine scanty. 

Arsen., varices, which burn like fire, particularly at night; fissures of 
the anus, with impossibility of voiding urine; urine bloody; small of the 
back feels as if broken ; impossibility of stooping; burning in the skin and 
veins ; great weakness and restlessness ; useful in cases of drunkards. 

Bellad., bleeding piles with severe pain in the small of the back, as if 
it would break; incarcerated varices from spasmodic constriction of the 
sphincter ani, with great pain from the slightest touch ; on this account the 
patient must lie with nates separated; dysuria; congestion of the head; fever- 
ish restlessness. 

Calc, carb., profusely bleeding piles; protruding; painful when walk- 
ing, better when sitting; too early and too profuse menstruation; habitually 
cold, damp feet; after suppression of the hemorrhoidal flow, constant giddi- 
ness, especially on going up stairs ; heaviness and fulness of the head ; swelling 
of the pit of the stomach ; palpitation of the heart ; offensive sweat of the 
feet, making the soles raw. 



550 INTESTINAL CANAL. 

Capsic, the varices bleed a long time; the flowing blood causes a 
burning pain in the anus; the stool is mixed with bloody mucus; there are 
drawing, pains in the back and cutting pains in the belly. 

Carb. veg., protruding piles, blue, even suppurating, emitting a ter- 
rible smell ; burning in the rectum ; oozing of humor from the rectum ; flat- 
ulence ; congestion of tl e head, and nosebleed; after high living. 

Cascar., frequent and excessive bleeding from the rectum during and 
after hard, brown stool in large lumps, and without stool. 

Caustic, varices large, painful, stinging; burning when touched, hin- 
dering stool ; increased by walking and reflection ; fistula ani. 

Chamom., bleeding haemorrhoids with colic; frequent urging and 
diarrhoea; pain in the back, worse at night; ulcerating fissures at the anus; 
great restlessness, crying, screaming, tossing; sweating; angry, peevish and 
ill-humored. 

Colchic, with spasms of bladder and discharge of blood from it. 
(Stens, Sr.) 

Collin., flowing piles, incessant, though not profusely, or protruding 
piles with bleeding ; sensation in the rectum as if sticks, sand or gravel had 
lodged there ; growing worse as evening approaches till late at night, better 
in the morning ; constipation of the bowels and pain in the epigastrium, with 
loss of appetite; or diarrhoea. 

China, bleeding piles; burning and burning-itching; tingling in the 
anus, with creeping and itching extending into the urethra, attended with 
burning in the glans. 

Eriger., bleeding piles; hard, lumpy stools. 

Ferr. phosph., with catarrh of stomach and bowels. 

Graphit., varices and prolapsus of the rectum, even when there is no 
desire for stool, as if the rectum had lost its contractile power and had be- 
come paralyzed; painful, burning cracks (rhagades) between the varices; 
chronic constipation with hardness in the region of the liver; stool hard, 
knotty with blood and slime; scanty and delayed menses; leucorrhoea like 
water. 

Hamam., profusely bleeding haemorrhoids, characterized by burning, 
soreness, fulness, and weight; at times rawness of the anus; the back feels as 
if it would break off; pricking pain, worse from pressure, from the wrist to 
the shoulder along the course of the superficial veins; the same pricking pain 
in the region of the heart ; scanty menses. 

Hepar, inflammation and suppuration of the hemorrhoidal tumors. 

Hydrast., when a small loss of blood is followed by excessive weak- 
ness. (H. F. Hunt.) 

Ignat., bleeding piles; violent, shooting pains high up into the rectum ; 
prolapsus recti during stool; cutting, tearing in the rectum, continuing for 



HEMORRHOIDS, PILES. 551 

hours after stool ; for quiet people, or such as get easily excited and easily 
depressed. After confinement. 

Kali carb., in consequence of constipation with too large stools; the 
hemorrhoidal tumors swell and become large and very painful ; they bleed, 
especially during micturition, and emit slime afterwards; riding on horse- 
back ameliorates the pain considerably for the time being. After confine- 
ment. 

Laches., protruding haemorrhoids, very painful; a stitching pain is 
felt to go through the haemorrhoidal tumors, especially during coughing or 
sneezing ; also at the critical age, with scanty menstrual flow. 

Leptand., frequently bleeding piles; constipation and distressing pain 
beneath the sacrum. 

Lycop., protrusion of varices; painful when sitting; distention of the 
whole abdomen, and rumbling after stool ; cutting in the rectum and bladder ; 
long-continued pain after stool ; itching eruption around the anus, painful to 
touch ; grayish-yellow color of the face ; depressed spirits ; frequent urging 
to urinate ; slimy or reddish-sandy sediment in the urine. 

Mercur., large, bleeding piles during stool, which is watery; haemor- 
rhage from the rectum during micturition; falling of the rectum, which is 
black and bleeding; inflammation and suppuration of the haemorrhoidal 
tumors. 

Mur. ac, largely protruding piles, which look bluish and are exceed- 
ingly painful to contact— even the sheet is insupportable; prolapsus ani on 
passing loose stool during micturition. 

Natr. mur., varices, painful, stinging and humid; protrusion of the 
rectum; smarting and beating in the rectum; burning at the anus; herpes 
about the anus; herpes on the boundaries of the hair in the nape of the 
neck ; cutting pain in the urethra after micturition. 

Nitr. ac, bleeding piles, protruding after each stool ; the sharp-cutting 
pain in the rectum lasts four hours after an evacuation, and is much worse 
after a loose stool. 

• Nux vom., all sorts of piles after purgative medicines and external 
and internal allopathic treatment ; in persons of sedentary habits, or addicted 
to the use of coffee, wine, liquors, spices, etc.; ineffectual urging; constipa- 
tion; headache; sleeplessness early in the morning; hypochondriac mood; 
fissures of the anus, with great sensitiveness of the rectum. 

Petrol., burning and stitching in the anus and rectum; scurf on the 
border of the anus; titillating and smarting; itching herpes on the peri- 
neum. 

Phosphor., varices protrude during emission of flatus; mucous dis- 
charges from the anus, which is constantly open; discharge of dark, coagu- 
lated blood ; vertigo, especially on looking up or down. 



552 



INTESTINAL CANAL. 



Phosph. ac, bleeding piles, with intolerable pain in sitting. 

Podoph., piles and prolapsus ani, with diarrhoea of long standing; 
worse in the morning; or constipation with flatulence and headache. 

Pulsat., blind and flowing haemorrhoids; discharge of blood and slime 
with the stool; colicky pain; painful pressure upon the hsemorrhoidal 
tumors; backache; fainting spells; mild, gentle and tearful disposition; dry- 
ness and bad taste in the mouth every morning; no thirst. 

Ratan., protrusion of the varices after hard stool, with straining and 
violent pressing in the rectum; burning at the anus before and during a 
diarrhoeic stool; fissures of the anus, with great sensitiveness of the rectum. 

Rhus tox., sore, blind haemorrhoids protruding after every stool; 
drawing in the back from above downwards, with tension and pressing in the 
rectum, as if everything would come out; labor-like drawing towards the 
uterus, when standing; pain in the small of the back, as if bruised, when 
lying or sitting still ; going off when moving about. 

Sepia, protrusion of piles and rectum, even after soft stool ; worse after 
drinking milk; continual straining pain in the rectum; difficulty of urinating, 
especially in the morning; a feeling as if drops came out of the bladder, 
which is not the case ; heat, burning and swelling of the anus ; the varices 
become hardened; oozing of moisture from the rectum; soreness between the 
buttocks. 

Staphis., intense pain in the back and through the whole pelvis; en- 
largement of the prostate gland. (Preston.) 

Silic, inflammation and suppuration of the hsemorrhoidal tumors. 

Sulphur, all sorts of piles; constant ineffectual urging to stool; or thin, 
bloody stool, worse in the morning, with soreness of the anus, or single vio- 
lent stitches in the rectum, also between stools, arresting the breathing and 
causing him to start; prolapsus ani during stool, particularly when hard; 
tensive pain and stiffness in the small of the back, as if the parts were too 
short; inability to stand erect; burning micturition. After suppression of 
habitual bleeding: congestion of the head; dizziness; palpitation of the 
heart; pain in the pit of the stomach, with difficulty of breathing; loss "of 
appetite ; sudden hunger, with faintness before dinner ; sleepiness through the 
day, and sleeplessness at night. 

Thuja, the hsemorrhoidal tumors are painful when touched ever so 
slightly; sycosis. 



Digest to Haemorrhoids, Piles. 



Bleeding : Aeon., JEsc. hipp., Amm. carb., 
Bellad., Gale, carb., Capsic., Chamom., 
China, Collins., Eriger., Hamam., Hy- 
drast., Ignat., Kali carb., Leptand., Mer- 



cur., Nitr. ac, Phosph. ac, Pulsat, Sul- 
phur. 

Bleeding frequently: Leptand. 

during stool, which is watery : Mercur. 



DIGEST TO HAEMORRHOIDS, PILES. 



553 



Bleeding during stool, and slime: Pulsat. 

and after: Amm. carb., Cascar. 

during micturition, and emit slime 

afterwards : Kali carb. 

, with colic: Chamom. 

, with pain in small of back, as if it 

would break: Bellad. 

, with shooting pain up into the rec- 
tum: Ignat. 

, with burning, soreness, fulness in 

rectum : Hamam. 

, with burning in anus : Capsic. 

, with burning and burning-itching: 

China. 

, with stinging and pressing in anus: 

Aeon. 

is followed by excessive weakness : 

Hydrast. 

Suppression of bleeding is followed by 
giddiness, worse on going up-stairs: 
Calc. carb. 

Blind or flowing: Nux vom., Pulsat., Sul- 
phur. 

, sore, protruding after every stool : 

Rhus tox. 

Moist, with pain as from excoriation: 
Amm. carb. 

Protruding: JEsc. hipp., Aloes, Amm. 
carb., Apis, Calc. carb , Carb. veg., Caus- 
tic, Collins., Kali carb., Laches., Lycop., 
Mur, ac, Nitr. ac, Phosphor., Ratan., 
Rhus tox. 

, like bunches of grapes : Aloes. 

, blue, even suppurating, terrible 

smell: Carb. veg. 

, bluish, painful to slightest contact: 

Mur. ac. 

, purple, bleeding slightly : JEsc. hipp. 

during and without stool: Amm. carb. 

after each stool: Nitr. ac, Rhus tox. 

even alter soft stool: Sepia. 

after hard stool, with straining: Ra- 
tan. 

during emission of flatus : Phosphor. 

Inflamed: Aeon., Ferr. phosph. 

and suppurating: Carb. veg., Hepar, 

Mercur., Sepia, Silic. 

Incarcerated from spasmodic constric- 
tion of the sphincter ani : Bcllad. 



The varices become hardened : Sepia. 
Cracks between the varices: Graphit. 
Painful: Kali carb., Laches., Pulsat. 

, hindering stool: Caustic. 

, from slightest touch : Bellad., Thuja. 

in sitting : Lycop., Phosph. ac. 

Hot and sore : Aloes. 

Burning when touched : Caustic. 

like fire, worse in night : Arsen. 

Stinging, burning and smarting: Apis. 
Titillating and smarting: Petrol. 
Tingling, itching and burning: Ant. 

crud. 
Stinging: Caustic. 

and humid : Natr. mur. 

Stitching when coughing or sneezing: 

Laches. 

ACCOMPANYING SYMPTOMS. 

Crying, screaming, tossing, restless : Cha- 
mom. 

Depressed spirits: Lycop. 

Hypochondriac mood : Nux vom. 

Quiet nature, or easily excited, or de- 
pressd: Lgnat. 

Mild, gentle, tearful : Pulsat. 

Irritable and fidgety : Apis. 

Angry, peevish and ill-humored: Cha- 



Vertigo: Sulphur. 

, worse looking up or down : Phosphor. 

Congestion to head: Bellad,, Carb. veg., 

Sulphur. 
Heaviness and fulness: Calc. carb. 
Headache : Nux vom., Pulsat. 
Herpes on boundaries of hair in nape of 

neck : Natr. mur. 
Grayish-yellow color of face: Lycop. 



Dryness and bad taste in mouth every 

morning: Pulsat. 
No thirst : Pulsat. 
Loss of appetite : Sulphur. 
Sudden hunger, Avith faintness before 

dinner: Sulphur. 
Pain in pit of stomach, with difficulty of 

breathing : Sulphur. 
Swelling of pit of stomach : Calc. carb. 



554 



INTESTINAL CANAL. 



Catarrh of stomach and bowels: Ferr. 

phosph. 
Colicky pain : Puisat. 

and feeling of fulness : Aeon. 

Flatulency : Carb. veg. 

Distention of abdomen and rumbling 

after stool : Lycop. 
Fulness and bearing down : JEsc. hipp. 
Ineffectual urging : Nux vom., Sulphur. 
Frequent urging and diarrhoea: Cha- 

mom. 
Constipation: Apis, Kali carb., Nux 

vom. 
, with flatulence and headache: Po- 

doph. 
and pain in epigastrium, and loss of 

appetite: Collins. 
, with hardness in region of liver: 

Graphit. 
and feeling as of sticks in rectum: 

jEsc. hipp. 

and alternate diarrhoea: Ant. crud. 

, and pain beneath the sacrum : Lep- 

tand. 
Stools hard, lumpy: Cascar., Eriger. 
, knotty, with blood and slime: 

Graphit. 
, like laurel-berries, with cutting 

in anus, followed by a jet of blood and 

soreness in rectum : Alum. 
thin, bloody, with soreness of anus, 

or stitches in rectum, also between stools, 

arresting breathing and causing him to 

start: Sulphur. 
Diarrhoea : Ant. crud., Collins. 
Flatus with stool : Aloes. 
After stool, cutting, tearing in rectum 

for hours : Ignat. 
, , worse after a loose stool : Nitr. 

ac. 
, cutting pain long continued : Lycop. 



Anus, burning in: Natr. mur. 

, and swelling: Sepia. 

, before and during diarrhoeic 

stool: Patau. 
Rectum, burning in : Carb. veg. 
and anus, burning and stitching in: 

Petrol. 



Rectum, burning in, and itching of anus: 
Amm. carb. 

Cutting in rectum and bladder : Lycop. 

Smarting and beating in rectum: Natr. 
mur. 

Sticking pain in rectum as of sticks or 
gravel : JEsc. hipp., Collins. 

Straining, continual, in rectum : Sepia. 

Tingling in anus, creeping and itching 
extending into urethra, with burning in 
glans: China. 

Prolapsus recti: Nat. mur. 

during stool: Ignat, Sulphur. 

, with diarrhoea: Podoph. 

during loose stool and during mictu- 
rition : Mur. ac. 

, rectum is black and bleeding: Mer- 

cur. 

, without desire for stool, as if rectum 

had become paralyzed: Graphit. 

Oozing of moisture from rectum: Carb. 
veg., Sepia. 

mucus from rectum : Ant. crud. 

Discharge of mucus from anus, which is 
constantly open : Phosphor. 

, mixed with blood : Capsic. 

dark, coagulated blood: Phosphor. 

Fissures of ani, ulcerating: Chamom. 

, with great sensitiveness: 'Nux vom., 

Patau. 

, with impossibility to void urine: 

Arsen. 

Cracks between varices, burning: Gra- 
phit. 

Eruption around anus, itching, painful: 
Lycop. 

Rawness of anus : Hamam. 

Fistula ani : Caustic. 

Herpes about anus: Natr. mur. 

Scurf on the border of anus: Petrol. 

Sweat on perineum ; tender to touch : 
Alum. 

Itching herpes on perineum: Petrol. 

Soreness between buttocks : Sepia. 

Spasms of bladder, with bloody dis- 
charge: Colchic. 

Urging to urinate, frequent : Lycop. 

Urination difficult : Sepia. 

impossible : Arsen. 



FLATULENCY, BLOATEDXESS, METEOMSM. 



555 



Dysuria: Bellad. 

Burning during micturition : Sulphur. 

Cutting in urethra after micturition: 
Natr. mur., Sepia. 

Discharge from bowels, feeling of, during 
micturition: Aloes. 

Haemorrhage from bowels during mictu- 
rition : Mercur. 

Feeling as if drops came from bladder: 
Sepia. 

Urine bloody: Arsen., Colchic. 

scanty: Apis. 

Sediment slimy or reddish-sandy: Ly- 
cop. 

Prostate gland enlarged: Staphis. 



Small of back, as if bruised, when lying 
or sitting still: Bhus tox. 



Labor-like drawing towards uterus, 

when standing: Bhus tox. 
Scanty menses : Hamam. 
and delayed, leucorrhoea like water: 

Graphit. 
Too early and too profuse menses : Calc. 

carb. 



Palpitation of heart : Calc. carb., Sulphur. 

Pricking pain in region of heart: Ha- 
mam. 

Back, pain in, worse at night : Chamom. 

feels as if it would break oft : Bellad., 

Hamam. 

, pain in and through pelvis: Staphis. 

, , and cutting pain in bowels : 

Capsic. 

, drawing in, from above downward, 

with pressing in rectum: Bhus tox. 

, bruised feeling in, and sacrum : 

Aeon. 

, aching pain and lame feeling in: 

jffisC. hipp. 

Small of back, as if broken: Arsen., 

Kali carb. 
, as if parts were too short : Sulphur. 



Pricking pain in superficial veins from 

wrist to shoulder : Hamam. 
Burning in skin and veins: Arsen. 
Sweat, offensive, of feet: Calc. carb. 
Habitual cold, damp feet : Cak. carb. 
Cannot stand erect: Sulphur. 



Feverish restlessness : Bellad. 

Sweating: Chamom. 

Sleepy through day, sleepless at night: 

Sulphur. 
Sleepless early in morning: Xux vom. 
Weakness and restlessness : Arsen. 
Fainting spells : Bidsat. 



After constipation with too large stools: 

Kali carb. 
purgative medicines, highly seasoned 

food, etc. : Nux vom. 

high living : Carb. veg. 

habitual drinking: Arsen. 

confinement : Ignat., Kali carb. 

scanty menses at critical age : Laches. 

suppression of habitual bleeding : 

Sulphur. 
sycosis: Thuja. 



Worse from evening till late in night : 
Collins. 

on stooping: Arsen. 

on walking : Calc. carb., Caustic. 

after drinking milk: Sepia. 

after reflection : Caustic. 

on lying, must lie with nates sepa- 
rated : Bellad. 

Better from cold water : Aloes. 

when moving about : Bhus tox. 

when riding on horseback : Kali carb. 

when sitting : Calc. carb. 



Flatulency, Bloatedness, Meteorism of the Abdomen. 

AVe mean by these terms an abnormal collection of gas in the intestinal 
canal. It may be caused: 

1. By certain kinds of food, such as not well- fermented beer, sweet cider, 
fresh bread, green peas, unripe fruit, cabbage and the like. 



556 INTESTINAL CANAL. 

2. By a morbidly changed condition of the digestive juices, which cause 
fermentation of the intestinal contents. 

3. By a relaxed state of the muscular coat of the intestines, in consequence 
of which the contents of the bowels are not properly moved forwards, and 
become decomposed into gaseous substances. For this reason we frequently 
observe meteorism in severe cases of typhus, pneumonia, acute exanthematic 
and puerperal fevers, peritonitis, after the abuse of purgative medicines, in 
diseases of the brain and spine, also in hysteria and hypochondria. 

4. By mechanical obstructions of the intestinal canal, like strangulated 
hernia, intussusceptions and twistings of the gut around its own axis. 

Symptoms. — The abdomen appears bloated, puffed out, feels either 
elastic, or more or less inelastic and hard, according to the degree of com- 
pression of the gas within. Percussion generally yields a tympanitic sound, 
unless there be a greater tension of the gas within than of the external air, 
in which case the percussion sound is not tympanitic, and may be even dull. 
Auscultation reveals here and there gurgling noises, and even the metallic 
tinkling may be heard when the fluid contents move within the expanded 
guts. 

Such abnormal expansion of the intestines forces the liver, stomach and 
lungs higher up into the thoracic cavity, causing oppression, dyspnoea, palpi- 
tation of the heart, anxiety, fainting and congestion of the head. The ex- 
pansion downwards causes pressure upon the bladder, difficult urination, 
pressure upon the rectum, and frequent desire for stool, and pressure upon 
the uterus. This abnormal collection of gas is frequently associated with 
spells of violent colic, loss of appetite, nausea, etc. Belching, or the passing 
off of flatus, often gives great relief. The gas generated consists mostly of 
carbonic acid, or hydrogen, or sulphuretted hydrogen gas. 

It is obvious that the Prognosis depends entirely upon the cause, of 
which meteorism is the consequence. It is of little consequence if produced 
merely by improper food, or the improper condition of the digestive juices. 
It becomes a more serious symptom when caused by a relaxed state of the 
muscular coat of the intestines, and is most serious in cases of intestinal 
obstruction. 

THERAPEUTIC HINTS.— Carb. veg., much belching, sour and 
rancid; bloatedness of stomach and bowels; oppression of the chest ; palpita- 
tion of the heart ; consequences of high living. 

China, distention of the abdomen; oppression of the stomach; eructa- 
tions, especially after eating; great fermentation in the bowels; after new or 
sour beer and fruit. 

Chamom., attended with severe colic; the abdomen is swollen like a 
drum; the gas passes off constantly, but in small and insufficient quantities. 



557 

Laches., eructations of air affording relief; distended stomach; incar- 
ceration of flatulence. 

Lycop., constant rumbling and gurgling of wind in the bowels, 
especially in the left hypochondrium ; incarcerated flatulence, which bears 
downwards upon rectum and bladder, causing a number of bad feelings. 

Nux vom., pressure towards the chest and head; oppression of the 
chest : constipation, with constant ineffectual urging ; after spirituous drinks, 
coffee, condiments, etc, in consequence of sedentary life. 

Pulsat., especially in consequence of spoiled stomach from eating fat 
things, pastry, warm cakes, fruits, etc. 

Besides, compare Gastric and Intestinal Catarrh, Constipation and Colic. 

Colica, Enteralgia. 

We understand by this term a paroxysmal pain in the abdomen of a 
purely neuralgic character, without any discoverable pathological change 
within the structure of the intestines, although it may attend different morbid 
processes which consist of such pathological changes. The Causes are 
numerous; they may be classed under the following heads: 

1. Such as are dependent upon anomalies of the intestinal contents: ab- 
normal quantity or quality of food, colica sabnrralis; or abnormal develop- 
ment of gas, colica flatulenta, wind colic ; or accumulation of hard feces, colica, 
stercoracea; or foreign irritating bodies, like worms, colica ferminosa; or 
metallic bodies, like lead, colica saturnina; or copper, colica aeruginosa. 

2. Such as are dependent upon a disturbed innervation, either — a. Prim- 
arily within the great centres of innervation themselves, from mental emo- 
tions, in case of hysteria or hypochondria and spinal diseases — colica nervosa; 
or, b. Secondarily, in consequence of diseases of other organs, which may 
cause a pain in the bowels sympathetically on the principle of "reflex action." 
Hence, authors speak of colica hepatica when the liver, of colica uterina when 
the womb, of colica renalis when the kidneys are thought to be the starting 
point of the colic. Still, we ought to remember, that in such cases the pain 
may not be an intestinal colic at all, but merely an irradiation from the 
primarily affected parts. 

3. Such as are dependent upon structural changes in the intestines, among 
which we may reckon colicky pains in dysentery, catarrhal affections, typh- 
litis, hernia, intussusception strangulation, twisting, etc. There is also a 
kind of colic produced by taking cold, especially of the feet and abdomen, 
and which is called colica rheumatica. 

Symptoms. — 1. Pain. It is of a crampy, severe griping, or twisting 
nature, coming and going in paroxysms, either in the umbilical region or in 
the side of the abdomen ; oftentimes shifting from one place to another. Ex- 



558 INTESTINAL CANAL. 

ternal pressure sometimes gives relief and sometimes aggravates the pain ; in 
other cases it shows no influence. External application of warm things re- 
lieves in a majority of cases, whilst cold things almost always aggravate the 
pain. 

2. Rolling and gurgling in the abdomen, occasioned by irregular con- 
tractions of the intestines and the moving of their fluid and gaseous contents, 
which may be felt by the examining hand. 

3. Bloatedness of the abdomen where there is a great collection of gas ; 
or contraction of the abdomen, especially in lead colic. 

4. Constipation; it is only in rare cases that colic is attended with 
diarrhoea. 

5. Nausea, vomiting and belching. 

6. Cold perspiration and extremities; small pulse. 

7. Anxious, frightened expression of countenance, contraction of eyebrows 
and compression of lips. 

8. Great restlessness; the patient tries all possible positions to obtain 
relief — now lying on the stomach, now drawing up the limbs, now bending 
and pressing the abdomen against a hard object, a chair, table or bed-post; 
now sitting down, now walking about, now trying to evacuate the bowels, etc. 
In some cases, however, the slightest motion increases the pain. 

The spells usually last some hours, in some cases longer. 

Wind colic ceases as soon as the incarcerated gas finds vent and 
passes off. 

Colic from indigestion is relieved by vomiting or diarrhoea; colic from 
hard feces by a sufficient evacuation from the bowels. 

Colic from taking cold is always relieved by a general warm perspira- 
tion. 

As there are so many causes for, and so many different affections with 
which colicky pains may be associated, it is absolutely necessary in each par- 
ticular case to make as close an examination as possible, in order to find out 
what lies at the bottom of the painful affection. 

Colic from indigestion, or colica saburralis, is brought on either from 
overloading the stomach, or from improper or unhealthy food. 

Here are indicated — 

Nux vom., after coffee, brandy, large meals. 

Pulsat., after fat food, pastry and flatulent food. 

Ipec, after sour and unripe fruits and salads. 

Arsen., after ice water and ice cream. 

Flatulent colic is characterized by distention of the abdomen, gurgling 
and rolling in the bowels, or pressure upwards towards the thoracic cavity, 
causing pain there and shortness of breath, or pressure downwards upon 
bladder and rectum. 



COLICA, EXTERALGIA. 559 

Here are indicated — 

Bellad., if associated with congestion of the head. 

Carb. veg., when there is a great deal of sour and rancid belching, 
without much relief. 

Chamom., when the abdomen is distended like a drum, and wind 
passes off only in small quantities without relief. 

Lycop., in cases of habitual costiveness and great pressure down- 
wards upon rectum and bladder, and gurgling under the left hypochon- 
drium. 

Nux vom., when there is great pressure upwards toward the thoracic 
cavity. 

Opium, when there is great pressure downwards upon bladder and 
rectum, without any passing off of feces, gas or urine. 

Rheumatic colic follows upon suddenly taking cold, getting wet, etc. 

Here are indicated — 

Aeon., after suppressed perspiration, exposure to sharp northwest 
wind. 

Coloc, cutting, pinching, contracting pain, with hot or cold skin, 
irritated pulse, and a disposition to double up and press hard upon the 
abdomen. 

Dulcam., after taking cold; the griping is attended with nausea in the 
stomach, and followed by diarrhoea. 

Pulsat., after getting the feet wet. 

Rhus tox., after getting wet all over. 

Nervous colic is a consequence of morbid innervation arising suddenly, 
sometimes without any known causes, showing no abnormity in the abdomi- 
nal cavity. 

Here are indicated — 

Bellad., clawing around the navel; better from pressure. 

Coloc., after indignation. 

I gnat., after grief and fright. 

Opium, after sudden fright. 

Plumbum, contracted abdomen. 

Lead colic — poisoning by lead. JBluish-gray line along the gums; 
retracted abdomen ; pain lessened from external pressure; obstinate costive- 
ness; slow pulse. 

ANTIDOTES.— Opium, Platina, Nux vom., Alum., Ant. crud., 
Coccul., Arsen., Bellad., Podoph., Zincum. 

Copper colic, poisoning by copper. Distended abdomen; pain worse 
from slightest touch ; nausea; vomiting; tenesmus. 

ANTIDOTES— Hepar, Nux vom., Bellad. 

All other secondary forms of colic are mere attendants upon other dis- 



560 INTESTINAL CANAL. 

turbances, which either have been considered already, or will be considered 
later. 

SPECIAL HINTS. — Aeon., intolerable, cutting pains in the belly, 
so violent that he screams, tosses about, and is almost beside himself; after 
taking cold; menstrual colic. 

Alum., lead colic, with dyspnoea, or pressing down in the groins like 
hernia. 

Arsen., pains in the whole abdomen, excessive; worse at night, after 
eating and drinking; better from warm application; with vomiting, or diar- 
rhoea, or costiveness; great anguish, lamentations, tossing about; internal 
restlessness, which does not allow one to lie still; despair of life; after the 
use of ice water, ice cream ; bad sausages, cheese; lead poisoning. In colic 
after severe burns. 

Asaf., distention of the abdomen, with severe pain and a feeling as 
though something were rising from below upward into the chest and throat ; 
during the height of the paroxysm, fainting; pain better from external press- 
ure; in hysteric and hypochondriac persons. 

Aurum, painful accumulation of gas below the left ribs, causing a 
stitching pain there; coming on even after eating the simplest food. 

Bellad., during the pain the transverse colon protrudes like a pad all 
the way across the belly ; while sitting or standing and walking, much worse, 
with a feeling as though the intestines were loose and dragging downwards ; 
external pressure and bending double relieves somewhat; protrusion in the 
inguinal region as thick as a finger, which, when pressed upon, disappears 
with a gurgling sound ; pain below the navel, as though a portion of the 
intestines were seized with the nails, clawing it together; thin purulent stool ; 
congestion of the head; copper colic. The pain comes suddenly and dis- 
appears suddenly. 

Bryon., after taking cold; cutting, lancinating pain in the abdomen; 
worse from motion and drinking cold water; bowels constipated; feces hard, 
as if burnt ; tongue coated, white, dry, without thirst ; or else great thirst. 

Calc. carb., severe spasms in the intestines, especially in the evening 
and at night, with coldness of the thighs ; feeling of coldness in the abdomen; 
enlargement and hardness of the abdomen, particularly in teething children; 
cliarrhceic, clay-like stools, smelling sour or fetid ; sweat on the head. 

Carb. veg., fulness and distention of the abdomen, with a feeling as 
though it would burst; squeezing and pressing in the left side of the epi- 
gastrium, or in the region of the bladder; oppression of the chest; belching, 
tasting sour and rancid; headache; chilliness over the back; hypochondriac 
mood; worse from eating, if ever so little; better from emission of flatus or 
hard stool ; colic from riding in carriage. 



COLICA, ENTERALGIA. 561 

Caustic, cranrpy colic of a chronic character; pain from the stomach 
through to the back, up into the chest, down into the abdomen; belching; 
rumbling in the bowels; obstinate constipation; tongue coated whitish on 
both sides. 

Chamom., flatulent colic; the abdomen is distended like a drum, or 
the wind presses here and there agaiust the abdominal walls, with a feeling 
as if it would pierce through ; or the patient has a feeling as if the whole 
abdomen were hollow, with continual rolling in the bowels and blueness 
around the eyes ; or the excessive paiu simulates a sensation as if the parts 
were rolled up into a ball ; vomiting ; diarrhoea, green and slimy ; or continual 
passing of small quantities of flatus without relief; great restlessness, anxiety; 
sticky or hot perspiration; after chagrin, or taking cold. Very irritable 
mood. 

China, distention of the abdomen, with pressing under the short ribs; 
rumbling and cutting j)ain in the bowels; worse at night; brought on by 
eating fruit or drinking new beer; after exhausting illness, loss of vital 
fluids, profuse perspiration ; gall-stones. 

Chin, sulph., flatulent colic of an intermitting type. 

Coccul., flatulent colic, about midnight, with incessant formation of 
flatulence, distending the abdomen, going off without relief, and obliging to 
turn from side to side; belching relieves; the pain is most severe in the epi- 
gastric, umbilical and right iliac region; nausea, vomiting; yellow face; 
cold perspiration, anxiety and restlessness. 

Coffea, excessive pains with anguish, great nervousness, loud crying 
and grating of teeth ; suffocative fits; coldness of limbs ; convulsions. 

Colonic, great distention of the abdomen; also when the abdomen is 
empty, aggravated by eating ; the stomach feels icy cold ; after flatulent food. 

Coloc, all sorts of violent pains, mostly in the umbilical region, or 
from the sides concentrating in the middle ; the patient doubles up or seeks 
relief by pressing the belly against the bed-post or any other hard object, or 
by lying on the belly ; likewise a tight, cramp-like pain in the left iliac and 
inguinal region, which is worse after (not during) external pressure, especially 
observed in women after excess in venere; after indignation; abuse of opium; 
a cup of coffee generally relieves the pain for a while. 

Cuprum, violent spasms in the abdomen and in the upper and lower 
limbs, in spells ; cutting pain in umbilical region, as if a knife were thrust 
through into the back ; screams as though he were being killed, throwing 
himself upon the floor; singultus and stercoraceous vomiting. 

Diosc, remitting, griping pain in the epigastric and umbilical region ; 

or severe pain in left iliac region, running upwards to left kidney, better 

from crouching together with the hands clasping the knees; or pain in a 

small spot which feels as if it were drawn forcibly upwards and backwards 

36 



562 INTESTINAL CANAL. 

towards the spine. Constant desire to defecate and urinate without accom- 
plishing much. 

Dulcam., colic when the weather changes suddenly from warm to cold ; 
griping in the bowels, with nausea, and coldness in the small of the back ; 
diarrhoea. 

Hyosc, colic as if his abdomen would burst, he presses his fists into his 
sides ; spasmodic cutting, vomiting, belching, hiccoughing and screaming. 

Ignat., periodical abdominal spasms, particularly at night, waking out 
of sleep, with stitches running up into the chest and to the sides ; in sensitive 
and hysteric women. 

Ipec, colic of children, with diarrhoea, uneasiness, screaming, and toss- 
ing about ; after acid or unripe fruit, beer, etc. 

Iris, colic of infants with flatulency and constipation, where Chamom., 
Coloc. and Nux vom. had failed. 

Kali carb., colic, as if the intestinal canal were full of water. 

Lycop., bloatedness in consequence of incarcerated flatulence and con- 
stipation, with urging to stool; a feeling as if the abdomen must burst; 
belching without relief; passing flatus downwards relieves; renal colic, 
where the pain is felt along the ureters into the bladder, especially in the 
right side. 

Magn. phosph., intermittent pain, relieved by bending double, by 
rubbing, and by external warmth and eructations. 

Mercur., colic occasioned by the cool evening air, with diarrhoea, 
chilliness and shuddering. 

Nux vom., flatulent distention of the abdomen, with pressure upwards 
into the chest, and downwards upon the rectum and bladder ; would like to 
belch, but cannot; constant urging to stool without effect, and frequent de- 
sire to make water; wind colic, hsemorrhoidal, renal and lead colic; "yellow 
color of face and more around the mouth ; pinched nose ; offensive breath ; 
tongue broad and soft, with a dirty white coat of a creamy consistence, and a 
very vivid scarlet redness around the edge of the tip. Thin, yellow, very 
badly-smelling stools." (J. C. Kilgour.) 

Opium, when flatulence accumulates in the upper portions of the 
bowels, causing a distention of the abdomen, especially in the umbilical re- 
gion, with antiperistaltic motion, belching and vomiting; the bowels seem 
perfectly closed, but there is a constant urging to stool and to urinate; the 
pain is cutting, pressive and twisting ; painter's colic. 

Oxal. ac, from eating sugar. 

Piper meth., agonizing pain, with tossing, twisting and writhing; pa- 
tient driven irresistibly to change position, without relief; better for a while 
when his attention is absorbed by something else. (Hiller.) 

Platina, painter's colic ; pain in umbilical region, extending through 



COLICA, ENTERALGIA. 563 

into the back ; the patient screams and tries to relieve the pain by turning in 
all possible positions. 

Plumbum, frightful pain, particularly around the umbilicus; the um- 
bilicus drawn in towards the spine ; obstinate constipation. 

Podoph., cramps in the bowels, with retraction of the abdominal mus- 
cles, or crampy drawing of the muscles into lumps and knots ; lead colic. 

Puis at., colic worse in the evening and at night; pale face; white 
tongue ; no thirst ; wants to uncover ; grayish diarrhoea ; tearful disposition. 
From eating fat and greasy food. 

Rheum, in infants with sour diarrhoea; the child smells sour all over. 

Rhus tox., worse at night, and when being quiet; better from moving 
about, or lying on the stomach. 

Sabad., sensation as if a ball of thread were moving and turning 
rapidly through it. "Oh, my bowels! it runs like a wheel!" 

Sepia, boring, burning pain, with great distention and sensitiveness of 
the abdomen; anxiety; typically recurring towards evening ; scrofulous per- 
sons. 

St annum, stitches from both sides through the abdomen and through 
the hips; worse from slightest motion or touch, and when lying on right side; 
vomiting of water when smelling any kind of cooking. 

Sulphur, spasmodically contractive colic, extending into the chest, the 
groin, and the genital organs; from piles; from flatulence; from eating- 
sweet things ; relieved by sitting bent ; psoric individuals. 

Tart, emet., violent colic, as if the bowels would be cut to pieces; 
violent cutting and labor-like tearing from above downwards; across the 
groin through the thighs down to the knees; nausea; accumulation of water 
in the mouth ; shifting of flatulence, with rumbling in the bowels and diar- 
rhoea. 

Thuja, hsemorrhidal colic, with very acute and violent pain in the 
lower bowels; much flatus, with or without stool; feces hard or fluid and 
scanty ; when fluid there is a sensation in the rectum as if boiling lead were 
passing through. 

Veratr., abdomen swollen and very sensitive; violent pinching pains; 
no discharge of flatus either up or downwards; the intestinal canal seems 
closed; nausea; inability to swallow; cold perspiration; anxiety; restless- 
ness ; after eating fruit or vegetables. 

Zincum, flatulent colic, worse from wine, towards evening, and when 
at rest; loud rolling and rumbling; retraction of the abdomen; hot, moist 
flatus passing off without relief; lead colic. 



564 



INTESTINAL CANAL. 



Digest to Colica, Enteralgia. 



Whole abdomen: Aeon., Arsen., Asaf., 
Bryon., Calc. carb., Carb. veg , Chamom., 
China, Colchic., Cuprum, Dulcam., Hyosc, 
Lycop., Nax vom., Podoph., Sepia, Tart, 
emet. 

Umbilical region : Bellad., Coeeul., Coloe., 
Cuprum, Diosc., Opium, Platina, Plumbum. 

Below navel, as though a portion of in- 
testines were clawed together : Bellad. 

Epigastric region: Caustic., Coeeul., Diosc. 

Below left ribs : Aurum. 

Sides of abdomen: Aurum, Carb. veg., 
Coloe., Stannum. 

Inguinal region: Alum., Bellad., Coloe, 
Sulphur, Tart. emet. 

Iliac region, left: Coloe., Diosc. 

, right: Coeeul. 



From navel to back : Cuprum, Platina. 

sides to navel: Coloe. 

, through abdomen and hips: Stannum. 

stomach to back, chest and down into 

abdomen: Caustic. 
a small spot which seems to be drawn 

upwards and backwards to spine : Diosc. 

up into chest and sides: Ignat. 

abdomen up into chest, down in groins 

and genital organs : Sulphur. 

, dragging downwards: Bellad. 

, downwards across the groin, into 

thighs to knees : Tart. emet. 

into groins like hernia : Alum. 

left iliac region to left kidney : Diosc. 



Pain agonizing, with tossing, twisting and 
writhing: Piper meth. 

, cutting: Bryon. 

, , screaming as if beside himself: 

A con. 

, , pressing and twisting: Opium. 

, , as if a knife were thrust through 

into the back: Cuprum. 

, , vomiting, belching, hiccough- 
ing and screaming: Hyosc. 

, and rumbling in bowels: China. 

, , and labor-like from above 

downwards to knees: Tart. emet. 



Pain, stitches, from both sides to abdomen 

and through hips : Stannum. 

— — , , up into chest and sides : Ignat. 

griping, remitting: Diosc. 

, , with nausea and coldness in 

back : Dulcam. 

, pinching: Ver.alb. 

, squeezing and pressing in left side: 

Carb. veg. 
, colic, as though bowels would burst : 

Carb. veg., Chamom., Hyosc., Lycop. 

, , would be cut to pieces: Tart. emet. 

, , were full of water : Kali carb. 

, crampy, chronic: Caustic. 

, , in left iliac and inguinal region : 

Coloe. 
, , as if clawed together with 

nails: Bellad. 
, spasmodically contractive, extending 

up and downwards: Sulphur. 

, spasms : Calc. carb. 

, spasms in spells in abdomen and in 

upper and lower limbs: Cuprum. 
, boring, burning with distention and 

sensitiveness of abdomen : Sepia. 
Feeling of coldness in abdomen : Calc. carb. 
looseness of intestines, dragging down- 
wards: Bellad. 
, as if parts were rolled up into a ball : 

Chamom. 
, as if a ball of thread were turning 

through bowels: Sabad. 
, as if abdomen were hollow, with 

rolling in bowels and blueness around 

eyes: Chamom. 
Pain comes suddenly and disappears sud- 
denly: Bellad. 
Umbilicus drawn in towards spine: 

Plumbum. 
Abdominal muscles retarded: Podoph., 

Zincum. 
Transverse colon protrudes like a pad: 

Bellad. 
Abdominal muscles are drawn into lumps 

and knots: Podoph. 
Protrusion in inguinal region, which dis- 
appears under pressure : Bellad. 



DIGEST TO COLICA, EXTERALGIA. 



565 



Distention of abdomen : Colchic.,Opium. 

, like a drum: Charnom. 

, with pressing and stitching under 

left ribs: Au.rum, China. 
, with feeling as though something 

were rising into throat: Asaf. 
, with pressure upwards into chest 

and downwards upon rectum and blad- 
der: Nux worn. 

, with urging to stool : Lycop. 

, with passing of flatus without relief: 

Coccul. 
, with rumbling and diarrhoea: Tart. 

emet. 
, with sensitiveness of abdomen: Sepia, 

Veratr. 
Enlargement and hardness of abdomen: 

Calc. carb. 
Feeling as if abdomen were hollow with 

rumbling and blueness around eyes: 

Chamom. 
"Wind colic: Chamom., Coccul., Xux vom., 

Sulphur, Zincum. 

, of an intermitting type : Chin. sulf. 

Heemorrhoidal: Xux vom., Sulphur, Thuja. 

Renal: Lycop., Xux vom. 

Gall-stone colic: China. 

Menstrual: Aeon. 

Lead, or painter's colic: Alum., Arsen., 

Xux vom., Opium, Platina,Podoph.,Zincum. 
Copper colic : Bellad. 

ACCOMPANYING SYMPTOMS. 
Fainting: Asaf. 
Screaming: Aeon., Hyosc. 

, throwing himself upon floor : Cuprum. . 

, tossing about : Ipec. 

, in all possible positions : Piper meth., 

Platina. 
Loud crying and grating of teeth: Coffea. 
Tearful disposition: Pulsat. 
Anxiety: Coccul., Chamom., Sepia, Ver.alh. 
Hypochondriac mood : Carb. veg. 
Despair of life, anguish, lamentations, 

tossing about: Arsen. 
Anguish, nervousness : Coffea. 
Irritable mood: Chamom. 
Restlessness: Arsen., Chamom., Coccul., 

Veratr. 



Head, congestion of: Bellad. 
, sweat on: Calc. carb. 



Headache : Carb. veg. 
Blueness around eyes: Chamom. 
Pale face : Pulsat. 

, yellow: Coccul., Xux vom. 

Nose pinched: Nux vom. 



Tongue white : Xux vom., Pulsat. 

on both sides: Caustic. 

, dry: Bryon. 

, broad and soft: Xux vom. 

Offensive breath : Xux vom. 
Accumulation of water in mouth : Tart. 

emet. 
Thirst great: Bryan. 
No thirst: Bryon., Pulsat. 
Inability to swallow: Veratr. 
Belching: Carb. veg., Caustic., Lycop. 

and vomiting: Opium. 

, cannot : Xux vom. 

Singultus and stercoraceous vomiting: 

Cuprum. 
Nausea: Coccul, Dulcam., Tart, emet., 

Veratr. 

and vomiting: Coccul. 

Vomiting and diarrhoea: Arsen., Chamom. 
of water when smelling any kind of 

cooking: Stannum. 
Stomach feels icv cold: Colchic. 



Gall-stones: China. 

Rolling and rumbling in abdomen: Oaus- 

tic., Zincum. 
Flatus, with or without stool: Thuja. 
, passes continually without relief: 

Chamom., Coccid., Zincum. 
— — , discharges neither up nor downwards : 

Veratr. 
Flatulence: Iris. 
Ineffectual urging to stool and to urinate : 

Diosc, Xux vom., Opium. 
Constipation: Bryon., Caustic, Iris, 

Plumbum. 
Feces hard : Bryon., Thuja. 
fliiid and scanty, with feeling as it 

melting lead were passing: Thuja. 
thin, purulent: Bellad. 



5G6 



INTESTINAL CANAL. 



Feces yellow, badly smelling: Nux vom. 
Diarrhoea: JDulcam., Ipec, Mercur. 

, clay-like: Calc. carb. 

, grayish: Pulsat. 

Feces smelling sour, or fetid : Calc. carb. 



Oppression of chest: Alum., Carb. veg. 
Suffocative fits: Coffea. 



Coldness in back : Dulcam. 

of thighs : Calc. carb. 

of limbs : Coffea. 

Chilliness over back : Carb. veg. 

and shuddering : Mercur. 

Perspiration hot and sticky: Chamom. 

cold: Coccul., Veratr. 

Wants to uncover: Pulsat. 
Child smells sour all over: Rheum. 
Convulsions: Coffea. 

CAUSED BY: 

Indignation, chagrin: Chamom., Coloc. 

Cold, taking : Aeon., Bryon. 

Cool evening air: Mercur. 

Sudden change of weather from warm to 
cold: Dulcam. 

Use of ice water or ice cream : Arsen. 

sweet things : Sulphur. 

sugar: Oxal. ac. 

acid or unripe fruit, beer : China, Ipec. 

fruit or vegetables: Veratr. 

flatulent food : Colchic. 

fat and greasy food : Pulsat. 

bad sausages, cheese: Arsen. 

Riding in carriage : Carb. veg. 

Exhausting illness, loss of fluids and pro- 
fuse perspiration : China. 

Severe and large burns: Arsen. 

Sensitiveness, hystery: Ignat. 

Hystery and hypochondriasis: Asaf. 

Excess in venere in women: Coloc. 

Scrofula : Sepia. 

Psora: Sulphur. 



Children : Ipec, Rheum. 
, teething: Calc. carb. 

WORSE. 

Eating ever so little, or simplest food 

Aurum, Carb. veg. 
Eating: Colchic. 

and drinking: Arsen. 

Drinking cold water : Bryon. 
wine: Zincum. 



Towards evening, typically recurring: 
Sepia. 

evening: Zincum. 

Evening and night: Calc. carb., Pulsat. 
Night : Arsen., China, Ignat., Rhus toz. 
Midnight: Coccul. 



At rest, or being quiet: Rhus tox., Zincum. 
While sitting, standing or walking : Bellad. 
Motion: Bryon. 
Slightest motion, touch, or lying on right 

side: Stannum. 
After (not during) external pressure : Coloc. 

BETTER. 

External pressure : Asaf., Bellad., Coloc. 
Bending double : Bellad., Magn. phosph., 

Sulphur. 
Crouching together with hands clasping 

the knees : Diosc. 
Lying on belly : Coloc, Rhus tox. 
Rubbing : Magn. phosph. 
Moving about: Rhus tox. 



Eructations: Coccul., 

Passing flatus downwards: Lycop. 

and hard stool: Carb. veg. 

External warmth : Arsen., Magn. phosph. 

Drinking coffee: Coloc. 

When attention is absorbed by something 

else : Piper meth. 
Iris helped where Chamom., Coloc. and Nux 

vom. had failed. 



Tuberculosis Intestinalis, Consumption of the Bowels. 

Tubercles form not only in the lungs ; they are as well deposited in the 
mucous and submucous membrane of the ilium, especially in Peyer's patches 



CANCER OF THE INTESTINES. 567 

and the solitary glands, in the colon, the csecum, rarely, however, in the 
jejunum and duodenum. The tuberculous material, wherever deposited, 
consists either of yellowish, cheesy masses, or of grayish, half-transparent, 
so-called miliary granules, which, by a gradual dissolving process, produce 
tuberculous ulcers. 

Intestinal tuberculosis is rarely a primary disease, but generally part 
and portion of — 

1. Pulmonary consumption, to which it adds the finishing blow. In 
some cases, however, intestinal tuberculosis seems to so predominate over the 
pulmonary complaint that the latter is concealed by the abdominal trouble. 

2. In other cases intestinal tuberculosis attends acute miliary tubercu- 
losis, a form of blood-poisoning, which, under the symptoms of typhus, 
deposits a great number of fine granules in different organs and tissues. It 
cannot be distinguished from typhus ; nor from tubercular meningitis, if its 
deposition inflames the pia mater. 

Lastly, intestinal tuberculosis may be part and portion of tubercular 
formations in the peritoneum, the mesenteric glands, and the retroperitoneal 
glands, all of which are difficult to define. 

The Symptoms are not all prominent or characteristic, only when the 
tubercles commence to soften in the last stage, an obstinate diarrhoza is one 
of the most prominent symptoms. With it are associated great loss of 
strength, night-sweats, and partial oedema; the patients finally die with the 
signs of marasmus. 

Obstinate diarrhoea, in conjunction with pulmonary tuberculosis, sug- 
gests the following remedies: Arg. nitr., Arsen., Bryon., Bar. carb., Calc. 
carb., Calc. phosph., Carb. veg., China, Ferrum, Hepar, Mercur., Nitr. ac, 
Phosphor., Phosph. ac. (Plumbum), Pulsat., Sulphur. Compare Consumption. 

Cancer of the Intestines 

Appears either in the form of scirrhus or fibrous cancer, or as medullary 
cancer (which is of a softer, narrow-like growth), or as alveolar cancer (which 
is of a jelly-like nature, but of rare occurrence). Compare Cancer of the 
Stomach. It originates primarily in the submucous and mucous coats of 
the intestines, or reaches over secondarily from a cancer of the stomach, or 
of the peritoneum, the liver, ovaries, uterus, or other neighboring organs. 

Primary cancer is found most frequently in the rectum, also often in 
the flexura sigmoidea, very rarely in the remaining parts of the intestinal 
tube. As it grows, it causes a swelling or tumor from the size of an egg to 
that of a fist ; and by its growth gives rise to intestinal obstruction. Never- 
theless its diagnosis may, in certain cases, be one of great difficulty. It may 
be suggested by partial intestinal obstruction; rarely by total obstruction; 



568 IKTESTINAL CANAL. 

also by the general symptoms of cancer cachexia. Or in younger indi- 
viduals it may cause intestinal obstruction alone, without these general 
symptoms of cancer-cachexia. Or it may produce merely the general cancer- 
cachexia without any sign of intestinal obstruction ; but in place of it diar- 
rhoea, colicky pain, flatulency, etc., the dejections containing blood, a gan- 
grenous, stinking fluid and pus. 

The main points of diagnostic importance are these: The presence of an 
uneven, potato-like tumor; the slow but steady development of intestinal 
obstruction ; the peculiar dry and ash-colored skin ; the fast wasting away in 
strength and. flesh ; and the age of the patient, as cancer very rarely appears 
before the age of forty. 

Cancer of the rectum is the most frequent in occurrence. At the 
beginning of its development, when it causes a pressure upon, and a con- 
secutive swelling of the hsemorrhoidal veins, with occasional bloody dis- 
charges, and pain from the os sacrum down into the thighs, it is most easily 
confounded with haemorrhoids. Later, however, the obstruction of the 
rectum becomes more apparent by the form of the discharged feces, which 
appear pressed, flattened, angular, or pass off in small, hard nuts, like sheep- 
clung. Manual examination reveals now a knotted tumor, which encircles 
the gut like a ring. In its still further advanced stage this tumor suppurates, 
and the bursting of blood-vessels may occasion profuse haemorrhages. "We 
sometimes observe in combination with it indurated inguinal glands; and I 
have seen a case where hard scirrhous infiltrations existed disseminated 
hrough the gluteus muscles. 

Its Prognosis is, like that of all cancers, very discouraging. Death 
occurs either in consequence of ileus, or peritonitis after perforation of the 
gut, or exhaustion. 

By means of the following remedies we may succeed in alleviating much 
suffering : 

Apis, Arsen., Bellad., Cannab., Carb. an., Carb. veg., Clemat., Graphit., 
Hepar, Hydrast., Kreos., Laches., Phosphor., Phosph. ac, Rhus tox., Sepia, 
Silic, Sulphur, Thuja. 

Polypus of Rectum. 

The follicular or soft 'polypus occurs generally in childhood, very rarely 
in the adult, is attached to the mucous membrane by a narrow peduncle 
and usually protrudes in children after a stool, resembling a small straw- 
berry ; it causes no pain but may produce bleeding sufficient to weaken the 
patient. 

The fibrous or hard polypus is pear-shaped, with a peduncle more or less 
long and thick, protrudes if low down or attached to a long peduncle, causes 



FISSURA ANI. 569 

some slimy discharge, but rarely bleeds, produces frequently the sensation of 
unrelief after stool, and its peduncle may become girt by the sphincter, which 
causes great pain. 

THERAPEUTIC HINTS.— Calc. carb. and phosph. are the main 
remedies. Ligature is the best surgical means. 

Fissura Ani. 

An anal fissure consists of an abrasion or ulcer usually at the posterior part 
of the lower circumference of the rectum, although it may occur in any other 
part of this portion of the anal mucous membrane, which here forms folds or 
pouches. AVhen looked at without distending the rectum, the lateral edges 
only being presented to view, the ulcer appears like a fissure, but is in reality 
an abrasion or a superficial ulcer. On defecation its surface is irritated, ex- 
citing spasm of the sphincter muscle, and causing sharp, cutting, burning 
and straining pains which last at times for two or three hours after stool. 
This trouble occurs usually in middle life and is more frequent in women 
than in men. 

THERAPEUTIC HINTS.— Aloes, when complicated with piles. 

Alum. P. S., ulceration of rectum, even fistula. 

Arum triph., with retention of urine. 

Coloc, burning, sticking and excoriated pain in the anus, with dis- 
charge of moisture from the rectum ; frequent pressure at the anal sphincter, 
which ceases on the escape of some mucus. 

Graphit., severe cutting pain during evacuation, followed by constric- 
tion and aching contraction for several hours, especially severe at night. 

Ignat., haemorrhoids ; moderate effort at stool causes prolapsus recti ; 
after stool stitching pain upward into the rectum; recurring pains in the 
anus of soreness and constriction. 

Nitr. ac, very painful, especially after loose stool. 

Nux vom., with constipation and great sensitiveuess of rectum. 

Paeon, off., burning and biting several hours after stool, preventing 
sleep ; must walk the floor nearly all night ; exudation of offensive moisture. 

Platina, with crawling and itching in anus every evening, frequent 
urging with scanty stool, paiuful sensation of weakness. 

Ratan., burning in ano before and several hours after stool with pro- 
trusion of varices; burning in urethra during urination. 

Rhus tox., with periodical profuse bleeding from arms. 

Silic, great pain half an hour after stool, lasting several hours. 



570 INTESTINAL CANAL. 

Besides compare: Amm. carb., Caustic., Gratiola, Mezer., Natr. mur., 
Phosphor., Plumbum, Sabad., Sepia, Thuja. 

Fistula Recti 

Is produced by the forming of an abscess in the loose areolar tissue around 
the lower part of the rectum. After bursting outside near the anus its walls 
contract and become fistulous, forming a blind external fistula. If the sup- 
purating process has at the same time opened a way through the rectal 
parietes into the bowel, it is a complete fistula. Blind internal fistula, in 
which an opening leads into the bowel without an external orifice, are rarely 
met with, though it may happen that the original ulcerated opening in the 
rectum is so large as to allow the matter from the abscess in the areolar tissue 
to escape readily into the bowel without the necessity of burrowing its way 
through to the outside. Sometimes the sinuses are tortuous or pass in differ- 
ent directions and there may be more than one internal opening. At other 
times there is an external orifice on each side of the anus which leads to the 
back of the rectum and communicates with the gut at this part by a single 
orifice, so as to form a sort of horse-shoe fistula. In phthisical subjects a 
fistula may originate in consequence of tubercular ulceration and perforation 
of the bowel. 

The forming of a fistula is always attended with pain, heat, redness and 
swelling before it breaks externally. Later, after the subsidence of inflam- 
mation and tenderness, it remains a constant annoyance by its discharging, 
more or less copiously, a thin purulent fluid when coming from a blind 
external fistula, or a brownish fluid from an admixture of feculent matter, 
when it issues from a complete fistula. At times the discharge becomes so 
thin and scanty that it appears as if the sinus were healing, when a fresh 
irritation again disappoints the sufferer. 

THERAPEUTIC HINTS —The old school knows nothing but the 
knife, and the modern view that all such affections are but of a local nature, 
does not make them hesitate in using it, notwithstanding the fact that a large 
percentage of those operated on in a short time after succumb to tuberculosis 
of the lungs. 

Many anal fistules have been cured by the sole use of internal remedies, 
and others have been so decidedly relieved, that so doubtful a relief as 
operation could afford, was never afterwards craved for. The remedies here 
needed are : 

Alum. P. S., ulceration of the rectum, with painful excrescences and 
fetid, ichorous discharges. 



PROLAPSUS RECTI. 



571 



Arsen., despondent; chilly up and down the back; relief from heat; 
large purple swelling on right gluteal muscle. 

Berber., great soreness and pain throughout the entire back, from the 
sacrum to the shoulders, worse from exertion. 

Calc. sulph. (Schiissler.) 

Hydrast., with constipation, piles and ulceration. 

Silic, aching, beating, throbbing in lumbo-sacral region; occasional 
swelling in perineum discharging blood and pus; constipation, stool slips 
back after much effort. 

Thuja, blind external fistula with cauliflower excrescences at the verge 
of the anus ; offensive perspiration around the parts affected. 

Besides, compare: Calend., Caustic, Ignat., Nux voni., Petrol., Sepia, 
Staphis., Sulphur. 

Prolapsus Recti. 

The protrusion of the hypertrophied mucous membrane, often observed 
in haemorrhoids, is not a true prolapsus. This, on the contrary, consists of a 
real falling down and out of all the coats of the rectum, is in fact an ever- 
sion of the gut, similar to intussusception, with this difference: that the 
falling portion of the intestine becomes uncovered and projects externally, 
while in intussusception it becomes invaginated into that portion of the 
intestine which is just below it. The extent of the protrusion varies greatly, 
from an inch to six inches, or even more. When not constricted by the 
sphincter it has the usual florid appearance ; when strangulated it appears 
livid, purple and tumid from congestion. After long exposure the mucous 
membrane becomes thickened, and granular and sometimes ulcerated. 

Prolapsus recti is most frequently observed in children in consequence 
of protracted diarrhoea; less often is it found in adults, and then oftener in 
women than in men, in consequence of a weakened state of the sphincter, 
after child-bearing, etc. The protrusion takes place usually during stool, 
sometimes after any movement, even when standing. The gut may remain 
constantly protruded, being fixed so as not to admit of replacement. In 
some cases the protruded portion has even sloughed off. 



THERAPEUTIC HINTS.— Bellad., the protruded bowel looks 
bright red ; during dentition. 
Ferrum. (K. T. Cooper.) 
Ignat., has helped most frequently. 
Indigo, I Schiissler.) 
Mercur., when there is great straining. 
Mur. ac, when urinating. 



572 INTESTINAL CANAL. 

Nux vom., frequently in children. 

Podoph., with morning diarrhoea. 

Ruta, frequent, lumpy, slimy stools, at times bloody; feces often escape 
while bending over ; much flatus ; prolapsus always at stool, sometimes with- 
out stool. (Mera.) When stooping or squatting down. 

Sulphur, worse on standing; morning diarrhoea; after easy stool; 
weak, scrofulous children. 

Besides: Apis, Arsen., Calc. carb., Carb. veg., Hamam., Lycop., Mezer., 
Phosphor., Sepia, Silic, Thuja. 

Proctalgia, 

Or neuralgic pain in the rectum, here oftentimes as violent as in other places, 
is relieved by Kali carb., when the pain is stitching and pressing. Phos- 
phor., in violent spasmodic pains, driving the patieut about. 

Intestinal Worms, Entozoes, Helminthes. 

Of the twenty-one intestinal parasites, three are infusoria, nine belong 
to the tape-worm class, two to the leech tribe and seven to the round worms. 
Of these only the following deserve a closer mention in this place : 

1. Oxyuris yermicillaris, the thread, seat, or pin-worm, is found in the 
intestine, from the jejunum down to the anus; the young animals in their 
various stages of development, and the mature males chiefly inhabit the 
small intestine; the pregnant females seem to prefer chiefly the csecum as 
their habitat, until their uteri are filled to bursting with eggs, when they 
gradually descend the large intestine and deposit the chief part of their eggs 
in the rectum, and occasionally even leave the latter and creep about on the 
moist skin around the anus. All, eggs, males and females, are finally ex- 
pelled mechanically with the feces. New crops of oxyu rides can originate 
only if ripe eggs are being introduced again into the stomach where, by the 
action of the gastric juice and the heat of the stomach, they are hatched in a 
short time, and the young, very small, fine delicate worms betake themselves 
at once to the upper portion of the small intestine, increasing rapidly in size 
to their full maturity. 

The ripe eggs may be brought to the mouth of infants even during birth 
and later, by the dirty hands of the mother or nurse, or in larger children 
and grown persons by their own hands, as a kind of self-infection ; they may 
be imparted by bakers, fruit dealers, cooks, waiters, etc. This is the view 
taken by Leuckart, Zenker and others, resting on numerous experiments, 
while Vix conceives "that all the transformations from the embryo to the 
adult form take place within the intestine of the infested persons without any 



INTESTINAL WORMS. 573 

necessary migration," a view which is not in accord with the general law of 
development in parasitic animals, nor does it explain all the known facts. 

Symptoms appear not until the oxyurides come down* to the rectum, 
where they, by their active boring movements, cause an intolerable tickling 
and painful itching just within the sphincter and within the folds of the anus, 
which sometimes, especially at night, becomes almost unbearable. In the 
female it is peculiarly distressing, from the habit which the worm has of 
wandering into the vagina; it may produce inordinate sexual excitement in 
both sexes by sympathetic irritation, and cause erections, pruritus, even 
nymphomania with consequent masturbation. 

Cleanliness of the most scrupulous kind, and injections of cold water 
are generally sufficient for the removal of these parasites, which have not a 
very long life. The nightly restlessness and intolerable itching which they 
produce as long as they exist, is most, always relieved by Aeon. 

2. The Ascaris lumbricoides, round worm, is of a cylindrical form, 
tapering at both extremities. The female reaches, according to Leuckart, 
15 inches in length by J inch to t inch in breadth, and the male 10 inches 
by i inch. It is of a light brownish or dirty reddish-yellow color. Its head 
consists of three semi-circular lips, the bases of which are separated from the 
remainder of the body by a well-marked circular furrow. The mouth con- 
sists of the triangular opening formed by the three lips. The tail of the 
male is always bent towards the abdomen like a hook, on which is seen the 
cloacal aperture with two spicube, which frequently project. The female 
sexual organs open in a vulva externally at the termination of the anterior 
third of the body. The ova have a conical form when unripe and are oval 
when ripe, and have a dark, tough, double shell, and very dark granular 
contents; they measure ^^ inch by ? J V inch, and their number has been 
calculated by Eschricht and Leuckart at about sixty millions in a single 
female, of which over 160,000 are daily discharged into the intestine of its 
bearer. If now a person is the possessor of several of these worms, it can 
easily be seen that his evacuations must become so thoroughly charged with 
these eggs, that their discovery by the microscope cannot be of any difficulty. 
But their further development is not yet fully understood. It may be that 
the ova hatch in the stomach after being conveyed there directly ; it may be 
that an intermediate host be necessary for their development. However this 
may be, the development of the worm, once introduced, must be very rapid, 
for it is quite seldom that very young animals are found in the intestine. 

The round worm normally inhabits the small intestine, but has a marked 
tendency to wander and creep into small apertures, so that it is led sometimes 
through fistulous channels to quite remote cavities or organs ; it has been 
found in the pleural sac, the gall-bladder, the biliary ducts, the spleen, the 
kidney, the bladder, the muscles of the loin or neck, the spinal cord, the 



574 INTESTINAL CANAL. 

lung, the glottis, the trachea and the Eustachian tube. In the Surgical 
Museum, at Washington, I have seen the preparation of a larynx, into which 
a round worm had entered and caused death by suffocation. 

Symptoms. — When this worm is present in moderate numbers, and oc- 
cupies its normal habitation in otherwise healthy persons, there is often no 
disturbance discoverable; but when present in greater numbers or infecting 
a delicate person it may give rise to abdominal griping, increased secretion of 
slime, diarrhoea, vomiting, irregular appetite; or, they cause reflex or sym- 
pathetic symptoms, as, itching of the nose, anus, genitals ; enlargement of the 
pupils, squinting, increased flow of saliva, restless sleep, with frequent starting 
and grating of teeth. 

Symptoms like the following: cachectic countenance; blue rings around 
the eyes; enlarged abdomen, fever, irritation of the brain, fits, convulsions, 
etc., which have been ascribed to worms, are rather doubtful. In such cases 
a careful examination will, no doubt, lead to other exciting causes. 

THERAPEUTIC HINTS— In the first place there is no need of 
disturbing the system with so-called vermifuges. Worms won't eat up a 
child, nor kill anybody, except in those very rare cases where "one of the 
critters goes into a wrong passage." 

Secondly, those symptoms of irritation are easily subdued if we choose 
homoeopathically between Bellad., China, Spigel., Sulphur, and other rem- 
edies. 

Tape-Worms. 

" The tape-worm must be looked upon as a colony of animals having an 
alternation of generation. The so-called head is the larva-like nurse ; the 
segments of the worm — the proglottides — are the animals with sexual organs. 
From the head (scolex), without any mingling of the sexes, are produced the 
segments by a process of budding. The segments remain joined together for 
a considerable time, but, after they have come to maturity, they separate 
from the rest of the colony. The head is provided with either two or four 
suckers, and very frequently with a circlet of numerous small hooks. By 
means of this apparatus it fastens itself to the mucous membrane of the in- 
testine of its host. As the segments of the chain, the sexual animals, increase 
the distance from the head, by the development and insertion of fresh seg- 
ments, they become sexually more developed, increasing at the same time in 
size. They are hermaphroditic, and generate eggs, in which a six-hooked 
embryo becomes developed. If eggs containing these embryos find entry into 
the stomach of a suitable animal, their envelopes become softened or undone, 
and the embryos are set free. By some way or other they leave the digestive 



TAPE WORMS. 



575 



canal and make their way to different parts of the body. If they now meet 
with conditions favorable to their further growth, " nurses " are developed in 
them. Should these again happen to be introduced into the intestinal tract 
of another animal, they fasten themselves on, and another tape-worm colony 
becomes developed by budding. The time required for the development of 
the tape-worm colony, viz., till the sexual organs are fully developed and 
segments are given off, is from eight to twelve weeks. The tape-worm in- 
habits the small intestine, where, folded into many coils, it lies surrounded 
with chyme ; it can move but little from its original position. Its muscular 
system seems, in the total absence of anything like an alimentary canal, to 
serve chiefly as a means of imbibing nourishment, the alternate contraction 
and relaxation of the several groups of muscles having an effect similar to 
that produced by a force-pump." (Heller.) This is characteristic of all 
kinds of tape-worms, of which we have separately to consider: 

1. Taenia solium, or the Armed tape-worm, which attains a length 





(After Kiichenmeister.) 
a. Taenia Solium, b. Natural size. 
c. Taenia Mediocanellata, or Saginata. 

of from 7 to 10 feet, seldom much more. Its head is about the size of a 
small pin's head, somewhat quadrilateral, owing to the four prominent suck- 
ing discs. On the top front is a moderately prominent rostellum, on which 
is placed a coronet of small hooks arranged in two circles, an outer and an 
inner one. Its slender neck is nearly an inch in length, but exhibits to the 
naked eye no segmentation, it only gradually passes into distinctly visible 
segments, which at first are so much shorter than broad, that one-half of the 
whole are found in the anterior ninth part of the entire worm. From this 
point the segments gradually increase in length more than in breadth, so that 
finally mature segments, Proglottides or Cucurbitina measure about one- 
half inch in length and one-quarter inch in breadth. From this point also 



57G INTESTINAL CANAL. 

the sexual organs are distinctly visible, and in about another ninth lower 
down, the impregnated eggs enter the uterus. The taenia solium being her- 
maphroditic, both male and female sexual organs are present in the same 
joint, and open by a common aperture on the margin and a little behind the 
middle of each segment, alternating irregularly from one side to the other. 
The uterus forms a straight line passing down the centre of the segment, 
' from which seven to twelve branches are given off on each side. Running 
along the whole length of each side of the worm is a vessel, with transverse 
communicating branches, which contains a liquid. 

The eggs are roundish, and measure when free about 7 J 7 inch. The 
ripe egg encloses the embryo, a delicate mass of protoplasm, armed with 
three pairs of fine, glistening hooks. After the ripe segments with their 
eggs have separated and been discharged with the feces — it has been calcu- 
lated that one moderate sized tape-worm contains about five millions of ripe 
ova — the free joints move about for a time, especially in moist and warm 
situations, and disseminate their ova widely. No doubt the vast majority of 
them perisheg, but those which happen to be taken with the food into the 
stomach of a pig, or much more rarely into that of a man, are hatched 
under the action of the stomachic juices, and the freed embryo (pro-scolex), 
by a diligent use of its armature perforates the tissues of its present location, 
and ultimately settles, most generally, in the cellular tissue of the muscles, 
or in rare cases in the liver or brain. Here it remains and gradually 
develops into the well-known cysticercus cellulosce of measly pork. This 
metamorphosis requires about two months and a half for its completion. In 
this condition the animal remains unchanged for a period not yet certainly 
known, but which has been estimated at from three to six years. If during 
this time one or several of the cysticerci happen to be transplanted into the 
stomach of man, which only can take place by the eating of raw or imper- 
fectly cooked measly pork, it or they are developed into the taenia solium, 
which takes its abode in the small intestine, and may infest the bearer for 
many years. 

2. Taenia saginata (Goeze), Taenia canellata (Kuchenmeister), the 
unarmed or fat tape-worm, is much larger, when fully developed, and much 
stronger, thicker, fatter and less transparent than the taenia solium. Its 
head measures about T ^ inch and has neither rostellum nor coronet of hooks, 
but four powerful and prominent suckers. Its larval form, the cisticercus 
taeniae saginatae, infests the flesh and organs of the ox, a fact which at once 
points out the chief difference between its life history and that of the taenia 
solium. It abounds in Abyssinia and South Africa, and is also common in 
Europe and in this country, and fully as frequent as taenia solium. 

3. Bothriocephalus latns (Bremser), the broad tape-worm, is the 
largest of all the tape- worms and commonly reaches a length of 17 to 26 



TAPE-WORMS. 577 

feet, and sometimes 60 feet or more. Its head is oblong, or club-shaped, 
measures T V iuch by ^V inch, and has on each side a fissure-like groove in 
which its suction apparatus is placed. When fresh, the worm has a dull 
bluish-gray color. Its joints are much broader than long, until towards the 
end of the chain they become square. The genital pores are situated in the 
centre of the segments, and all are on the same side. 

"The ovum, after a prolonged sojourn in water, develops a ciliated 
embryo, which escapes through the aperture in the shell, by forcing open 
the lid, and is furnished with three pairs of hooklets. On analogical 
grounds, it is very probable that it enters into the body of some aquatic 
animal, possibly a fish, but probably a mollusc, and then assumes the larval 
form, which is at present unknown. The intermediate bearer is probably 
eaten by man, and the larva assumes the adult form in his intestine. Of both- 
riocephalus latus there are usually several together; it has a somewhat limited 
geographical distribution; never having been found beyond the limits of 
Europe, in some countries of which only it is indigenous. It is common in 
the western cantons of Switzerland, Northwestern Russia, Sweden, Poland, 
Holland, Belgium and Eastern Prussia; it is less often met with in other 
parts of Germany, and has occasionally been imported into Britain. Low- 
lying damp regions near the borders of seas and lakes are those in which it 
is most often abundant. It is found in persons of all ages and sexes, even 
children at the breast are not free from it." (W. H. Ransom.) 

Symptoms. — Some individuals experience not the slightest inconveni- 
ence from tape-worm. Others complain of pain in the stomach and bowels, 
especially after certain articles of food, nausea, variable appetite, slight 
diarrhoea or constipation. As reflex phenomena are mentioned : itching of 
the nose, headache, dizziness, getting dark before the eyes, noises in the ears, 
palpitation of the heart, even chorea and epilepsy. All, or at least many of 
these symptoms may as well arise from some hysterical or hypochondriacal 
affection of the patient. However, in the case of taenia solium, which in its 
embryonic state may infest the most different organs of the human body, 
it is clear that such and other serious disturbances may arise from its 
presence. 

THERAPEUTIC HINTS.— If no offence is given, why should we 
use the cudgel. The above-mentioned symptoms are often relieved by a 
well-selected remedy, which may even cause the parasite to leave. But at 
times persons have made up their minds to get rid of the " critter," no matter 
what it costs. As the safest and most expeditious of all the numerous tape- 
worm remedies, many have recommended — 

Kousso, or the flowers of Brayera anthelmintica, 2 or 3 drachms put 
into a tumblerful of water well stirred, so that none of the flowers swim on 
37 



578 INTESTINAL CANAL. 

the top. This done in the evening, let it stand over night. Administer a 
cup of coffee before taking it in the morning, to prevent nausea. Then one- 
half of it is taken, and the other half, half an hour later. If inclination to 
vomit should set in, it is best subdued by lemon juice. The taenia saginata 
requires a larger dose. 

Often tape-worms have been removed by the seeds of the common pump- 
kin, mashed up to a mush, or by the use of the cocoanut. The male shield- 
fern (Aspidium filix mas), or the bark of the Pomegranate root (Punica 
granatum), are other remedies frequently and often successfully applied. 

The surest prevention consists in avoiding the use of raw or not well- 
cooked pork and beef. 



Tricocephalus Dispar, 

Or the whip-worm, is from one to two inches long, thin in front, like a 
thread, while its posterior portion is thicker. Its chosen residence is the 
caecum. There are no symptoms known by which it could be diagnosticated 
during life. Its life-history, as far as known, is similar to that of the seat- 
worm. 



Anchylostomum Duodenale, Dochmius s. Strongylus 
Duodenalis. 

It is a small, cylindrical worm, with its anterior portion, in which the 
head is situated, curved backwards. Its mouth is provided with a bell- 
shaped capsule and at its anterior margin with four strong, claw-like hooks 
and two smaller ones at the opposite side. The males measure T %- inch, and 
the females y 7 ^ inch in length. The tail of the male terminates in a three 
lobed bursa, in which are placed two thin spicula. The female's extremity 
is pointed, and their genital opening lies somewhat behind the centre of the 
body. The eggs are oval, and measure 5 J^ inch by T oW inch. They prob- 
ably under favorable circumstances hatch, and the embryo enjoys a free 
existence, for a time, in mud and muddy water. If taken into the stomach 
it grows and passes down to the duodendum or jejunum, and attaches itself 
by its powerfully armed mouth to the villi of the mucous membrane, and 
sucks the blood of its host. It has been found only in Italy, in Egypt, in 
the countries bordering the Nile, on the Comoro Islands, in Madagascar, in 
Brazil and Cayenne. It produces dangerous haemorrhages in the bowels, 
followed by an anaemic condition, which is often fatal, and is the cause of 
the so-called Egyptian chlorosis, the true nature of which was pointed out 
by Griesinger. Griesinger recommends turpentine against them. 



TRICHINA SPIRALIS. 579 

Trichina Spiralis. 

Only within the last twenty years trichines have become an object of 
pathological researches, although they had already been discovered by Hilton 
in the year 1821 as numerous white specks visible to the naked eye, in the 
muscles of a human body, but considered by him as cisticerci. Later, under 
the microscope, they proved to be calcified trichina cajisules, and about 1835 
Paget detected in them a minute round worm, which was accurately described 
and named by Owen : Trichina spiralis, on account of its form being like 
a hair and of a spiral shape. However, every thing concerning the life- 
history of these animals remained unknown until Zenker, of Dresden, in the 
year 1860, called public attention to the fact that this little parasite was the 
cause of a very painful and even fatal disease. Since then by the labor of 
numerous investigators the following has been brought to light : " The trichina 
spiralis is met with under two forms, the intestinal-trichina and the muscle- 
trichina. The former or mature trichina is an extremely fine, round, thread- 
like, slightly coiled worm, with a still finer head, which gradually decreases 
in thickness towards its point ; its hinder extremity is rounded off rather 
abruptly." (Heller.) The males are from one-half to one-third smaller 
than the females, and are furnished at the caudal extremity with two point- 
less, lobular appendages and a genital opening. The females have their vulva 
at about the termination of the anterior fourth part of their whole length ; 
their eggs after being fructified develop in the uterus to embryos which are 
born free and living. The birth of the embryos begins on the seventh dav 
after the introduction of rnuscle-trichinse into the stomach, and may continue, 
as it appears, for weeks. Soon after birth the embryos commence to migrate, 
piercing either, as some assume, through the intestinal wall and wandering 
from thence through the loose connective tissue towards the muscles; or they 
enter, as others suppose, the blood-vessels — either directly or by way of the 
lymph current, in which they are carried to the different muscular parts of 
the body. As soon as they reach the muscles they force themselves into the 
primitive fasciculi, cause disintegration of the same, increase in length and 
thickness, and finally roll up in coils of greater or less size and become en- 
capsuled. After a time a deposition of lime-salts takes place in the capsules, 
by which they become opaque and visible to the naked eye as little white 
specks; previous to this calcification only experienced observers can detect 
them. Under certain circumstances the muscle-trichinse die and may decay, 
or they petrify, break into pieces, and their former nature can be recognized 
only by the peculiar position occupied by the fragments. But as a general 
thing the vitality of the muscle-trichinae is almost unlimited and ends even 
not with the death of their host, while the intestinal trichinse very rarely 



580 INTESTINAL CANAL. 

live longer than from five to eight weeks, when their propagation has been 
finished. 

If it happens that the muscle-trichinae, by eating the meat of its host, be 
introduced into the stomach of man or a proper animal, they will be freed 
from their capsules, become sexually mature within about two and a half 
days, copulate, and after five days more the females will bring forth living 
embryos, which soon commence to migrate as above described. Trichines 




Trichinae. (After Heller.) 

a. Muscle-trichinae, magnified. 

b. Capsulated and calcified muscle-trichinae, slightly magnified. 
e. Calcified and broken. 

d. Capsulated, magnified. 

are found especially in swine, but have been observed also in the cat, rat, 
mouse, marmot, polecat, fox, marten, badger, hedgehog and raccoon, and 
have successfully been bred in rabbits and guinea-pigs, but exceptionally 
successful only in sheep, calves and dogs. 

From this it can be seen that the infection of man is principally carried 
on by the eating of raw or not thoroughly boiled pork. 

The disease caused by the propagation of trichines in man has been 
called 



TRICHINOSIS. 5S1 

Trichinosis, 

Which commences, as a rule, with disturbances of the digestive apparatus, 
sometimes a few hours, at other times not before several days after the in- 
fecting meal, with variable symptoms, such as: uneasiness, fulness, nausea, 
retching, vomiting, diarrhoea, or constipation. In most cases there is an un- 
pleasant and pasty taste in the mouth, and in many a loathsome, putrid odor. 
The muscular symptoms are the most important and painful. A constant 
symptom from the outset is a flabby condition of the muscles and painful 
sensation on motion, a muscular lameness. After the invasion of the muscles 
the symptoms may be trifling, even absent in light, and extremely violent in 
moderate and severe cases. Commencing seldom later than on the tenth day, 
they consist of various degrees of swelling and hardness and extreme sensi- 
tiveness to pressure of the muscles in general, or, a permanent contraction of 
the flexors of the extremities, or a difficulty of chewing and swallowing in a 
degree that only fluid nourishment can be taken, or a hoarseness when the 
muscles of the larynx, and a difficulty of breathing when the diaphragm and 
the respiratory muscles are invaded. The fever in light cases is insignificant, 
in severe forms resembles that of an ordinary case of typhoid fever, or pre- 
sents in lighter cases almost an intermittent type. There is seldom a chill 
at the onset, oftener slight shivering. The pulse varies at the beginning be- 
tween 80 and 90, and rises later to 100 or 120 beats in a minute. The tem- 
perature may rise to 105° F. Perspiration is usually very profuse, and 
continues throughout the whole disease. The nervous symptoms consist 
especially of sleeplessness, neuralgic attacks in the bowels, hyperesthesia of 
the skin in the form of pruritus or formication, either extending over the 
whole body or limited to single portions of the lower extremities, and in some 
cases of loss of hearing. The circulatory symptoms consist of oedematous 
swelling of the eyelids and face, which is the most characteristic sign of 
trichinosis, setting in most frequently on the seventh day, and at times dis- 
appearing after from two to five days, and reappearing again in some cases 
after a few weeks. (Edema of the extremities is often quite marked and 
lasting. 

The incubation varies from a few hours to several weeks, and it appears 
that some persons can tolerate a considerable number of trichines without 
experiencing any special disturbance. The muscle-trichinae must have 
attained a certain maturity in order to be capable of sustaining themselves 
in the stomach and of developing and reaching the muscles, their ultimate 
abode. If transplanted too young into the stomach, they will be either de- 
stroyed by digestion, or will have to make up their deficiency in the intestine 
and require therefore a longer time for the development of embryos. Also, 
if the capsulated trichime are much calcified, it will take a longer time to 



5S2 INTESTINAL CANAL. 

set them free. Just such uncertainty exists as to the duration of the disease 
itself. In some very light cases the whole course of trichinosis passes over 
in two or three weeks without even confining the patient to bed; while in 
somewhat severer cases convalescence begins in the fifth or sixth week, and 
grave cases take some four months and even then the convalescents frequently 
do not regain their full strength for a long time. A fatal termination occurs 
most frequently in the fourth, fifth or sixth week, and generally as a conse- 
quence of paralysis of the respiratory organs. The percentage of deaths has 
been as high as thirty in a hundred. 

The Diagnosis in single cases is very difficult in the beginning of the 
disease, easier when several persons become diseased at the same time. The 
onset resembles closely a gastro-intestinal catarrh, from which it differs, how- 
ever, by a constantly increasing perspiration. 

The oedema of the face and eyelids, appearing on the seventh day, is 
another important feature, inasmuch as other diseases in which this symptom 
occurs (morbus Brightii, diseases of the heart, lungs or pleura) can easily be 
excluded. The urine in trichinosis is always free from albumen. But the 
diagnosis becomes indisputable on the discovery of single trichinae in the 
stools, or upon the observation of muscle-trichinae in excised portions of 
muscle, or also in the proven fact that the patient has partaken of trichinous 
pork. 

THERAPEUTIC HINTS.— The best prophylaxis is not to eat any 

pork, ham, sausages, etc., which is not well boiled or roasted. The old school 
has ordered laxatives, turpentine, kali picrouiticum and benzine, but without 
any marked effect. 

Dr. Hering has recommended the Tellurite of Potassa in half grain 
doses. For in accordance with the provings of Hansen and Mohler, this 
substance caused at once such a strong, garlic-like odor of the breath, that 
the prover had to withdraw from society for several weeks. This odor is 
owing to a volatile organic compound, or perhaps telluretted hydrogen, into 
which the tellurite of potassa is converted, and may by its pervading the 
whole system, be likely the means of destroying the intruders. 

There are a few cases on record which have been treated homoeopath i- 
cally by Apis, Arsen., etc., but likewise without any striking effect. Al- 
though I never have seen a case of trichinosis, yet, considering the totality 
of the symptoms of trichinosis, I feel strongly inclined to recommend Ledum 
palustre. For in the first place the herb has been used successfully to 
keep insects away from clothing. Secondly, it has been given successfully 
for insect stings and wounds caused by needles, and what can the wandering 
tri chines be better compared with than millions of finest needles piercing the 
muscles? And lastly, Ledum has the following symptoms which correspond 



TRICHINOSIS. 583 

to trichinosis : Bloated face; want of appetite ; nausea; constipation; violent 
tension in the hypochondriac region during inspiration and retention of breath ; 
oppressed painful' breathing ; pain and drawing in the outer parts of the chest, 
especially during inspiration, accompanied with single stitches. Painful stiff- 
ness of the muscles; sensation as if the muscles had not their proper length, with 
pain as if sprained in every position, but especially when touching the parts and 
when walking. 

Swelling, with tension and stinging hardness of the whole leg. Swelling 
of the leg extending to beyond the calves, with tensive pains ; swelling of the 
feet ; inflammatory or oedematous swelling of the feet and legs. Pain in the 
soles of the feet when walking, as if ecchymosed. Pressure in the soles of the 
feet, more violent during a walk. Bruised pain in the heel when walking. 
The limbs of the whole body are painful, as if bruised and contused. Chilliness. 
Languor and weariness when sitting, standing or walking ; fainting. Pimples 
and boils, pustules on the forehead and other parts. (Edematous swelling, 
also of the skin of the whole body. 

SPECIAL HINTS TO HELMINTHIASIS.— Aeon., pain in the 
bowels; the umbilical region is hard and the whole belly bloated; urging to 
stool without discharge, or slime only; nausea; accumulation of water in the 
mouth ; or restlessness at night on account of intolerable itching and tingling 
at the anus, throwing the child into fever (seat-worms). 

Arg. nitr., periodical pain in the region of the liver and around the 
navel, with sickness at the stomach, retching, vomiting of tough mucus; 
menses irregular, but always discharge of thick, black, coagulated blood; 
gray-yellowish color of the face. 

Bellad., drowsiness; starting in sleep, grating of teeth, involuntary 
discharge of feces and urine, or dysuria; squinting. 

Calc. carb., headache, dark rings around the eyes; pale, bloated face; 
thirst; thick, bloated belly; aching about the navel; diarrhoea; easy per- 
spiration from motion ; scrofulous diathesis. 

China, pain in the belly worse at night, after eating; fulness of the 
abdomen, pyrosis, pressure in the stomach and retching; tremulous weakness 
all over. 

Cicuta, frequent hiccough and crying; pain in the nape of the neck; 
spasmodic drawing of the head backwards, and tremor of the hands. 

Cina, restless sleep with rolling of the eyes, dark rings around the 
eyes; squinting; enlarged pupils; constant rubbing the nose; bleeding of 
the nose; face pale, cold or red and hot; loathing of food, or great hunger; 
nausea; vomiting; pain in the umbilical region; belly hard and distended ; 
coastipation ; dry, hacking cough at night; feverishness ; convulsive motions 
of head and limbs. 



584 INTESTINAL CANAL. 

Euphorb., loss of appetite, or voraciousness at times; furred tongue, 
feverishness ; fetid breath ; bloated stomach ; constipation or diarrhoea ; ema- 
ciation, peevishness, wakefulness. 

Ferrum, pale, wretched complexion, easily flushing; itching at the 
anus from seat-worms at night ; involuntary micturition. 

Filix mas, frequent pain in the bowels, a kind of gnawing and boring; 
constipation ; loss of appetite ; furred tongue ; pale face ; blue rings around 
the eyes ; itching of the nose ; irritable and cross. 

Ignat., itching at the anus from seat-worms; convulsions, with loss of 
consciousness and temporary inability to speak afterwards. 

Kousso, indigestion; loathing; sleeplessness; weakness with fainting; 
profuse and cold perspiration ; emaciation ; dull pain in the bowels ; bloated- 
ness; constipation, tape- worm and other worms. 

Lycop., arthritic pain and stiffness; chronic eruptions; wretched, dirty, 
pale, earthy complexion; flatulence; bloating the stomach and abdomen; 
sensation of something crawling and moving in the bowels and stomach up 
and down; constipation. 

Mercur., continuous greediness for eating; he becomes weaker and 
weaker withal; bad smell from the mouth; itching of the anus; inflamma- 
tion of the vulva ; seat and round- worms. 

Punica granatum, vertigo, wavering before the eyes, enlarged pupils, 
yellow complexion; grating of teeth; accumulation of water in the mouth; 
changing appetite; gulping of watery fluid; vomiting; sensation of some- 
thing moving in the stomach; bloated bowels; colic; palpitation of the 
heart; spasms; syncope. 

Sabad., vomiting of round-worms, or nausea and retching, with a sen- 
sation of a worm in the pharynx ; or, in case of tape-worm, burning, boring 
and whirling in the umbilical region ; accumulation of water in the mouth ; 
chilliness and sensitiveness to cold ; sensation as if the abdomen were sunken in. 

Spigel., nausea every morning before breakfast, always better after 
breakfast ; dilated pupils ; squinting ; pale face ; smarting in the nose ; sen- 
sation of a worm rising in the throat, better after eating; or vomiting of all 
she takes, with sour rising like vinegar from the stomach ; pain in the bowels ; 
dry, hard cough at night ; palpitation of the heart. 

Silic, colic in children from worms. 

Sulphur, after Aeon, or Mercur. ; creeping in the nose ; creeping and 
biting in the rectum ; passage of lumbricoides, ascaricles and taenia ; nausea 
before meals and faintness before dinner; restlessness at night. 

Stannum, Hahnemann and others have mentioned it as palliating the 
symptoms caused by tape and round-worm. 

Tereb., burning and tingling in anus and rectum, lessened by applying 
cold water; hunger after a square meal; foul breath; choking sensation; 



PERITONITIS. 585 

dry, hacking cough; spasms and convulsions; wakeful at night; screaming 
as if frightened; staring look, clenching of fingers; twitching of different 
parts of the body. 

TeuCrium is said to be specific against the terrible itching in the anus 
from thread-worm. 

In addition the following remedies may be merely mentioned as vermi- 
fuges: Apocyn. andr., Asclep. syr. and tuber., Chelone, Dolich. pruriens, 
Gelsem., Gnaphal., Helon., Podoph/ 

Peritonitis. 

Its pathological character is like that of pleuritis or pericarditis — injec- 
tion of the capillary vessels followed by exudation. This exudation is either — 

1st. Of a serous nature, and then generally profuse, distending the ab- 
domen to a considerable extent. Owing to its serosity it is easily absorbed. 
Or the exudation is — 

2d. Of a fibrous nature, coagulable lymph, at least predominantly so. 
This is apt to cause adhesion, not only between the layers of the peritoneum 
at different places (thus forming sacs wherein the remaining fluid is retained), 
but it may create, also, strings or bands of fibrin, which fasten one portion of 
the intestine to another, and which may give rise to strangulation of a por- 
tion of the intestines. Or the exudation is — 

3d. More or less mixed with blood globules, called hemorrhagic, mostly 
found in diseases which predispose to bleeding in different organs, as for in- 
stance scurvy, typhus, delirium tremens, exanthematic fevers, etc. Or the 
exudation consists 

4th. Of pus or ichor, when it is called purulent or ichorous. The latter 
takes place only under the most unfavorable conditions, a generally depraved 
state of the blood, as in puerperal fevers, pyaemia, or Avhen urine passes into 
the cavity of the abdomen. 

It is thus clear that a peritonitis is not necessarily cured simply because 
the inflammation has passed away ; its product, the exudation, may yet give 
considerable trouble before it is removed. 

Peritonitis does not always involve the whole peritoneum, is not always 
general or diffused, but much oftener only partial or circumscribed, attacking 
only single portions, for instance those which, cover the liver, spleen, kidneys, 
uterus or some parts of the intestines, being more or less complicated with in- 
flammations of these organs. 

Its Causes are various. Primarily, it is most frequently brought on by 
external injuries: a blow, a fall, a penetrating wound, or by surgical opera- 
tions, or by exposure to cold and wet. 

Secondarily, it may be a mere continuation of an already existing in- 



586 PERITONEUM. 

flammatorj^ process of the liver, spleen, womb, bladder, csecum, etc., or it 
may arise in consequence of ulcerative processes within the intestines and 
subsequent perforations; also childbed-fever and menstruation are frequent 
causes of peritonitis. 

Symptoms. — Owing to these diverse causes peritonitis, considered as a 
general form of disease, exhibits a great variety of manifestations which will 
change in individual cases. Indeed, this is so with all forms of diseases. I 
can point out only those symptoms which are most apt to occur in all forms. 

1. Pain is never absent and always severe; it is described as sharp and 
lancinating, and is increased by the slightest motion or touch. Therefore the 
patient lies quietly on his back with his thighs flexed, breathing only with 
the thorax, instinctively avoiding all action of the diaphragm. The. slightest 
pressure increases the pain; even that of the bedclothes seems at times un- 
bearable — a distinctive sign between peritonitis and colic. 

2. Vomiting; at first, of the usual contents of the stomach, then of 
slimy and bilious, and lastly of green masses, as though verdigris had been 
taken into the stomach. It becomes stercoraceous only when peritonitis is 
associated with obstruction of the bowels. The vomiting never relieves, but 
increases the pain considerably. 

3. Singultus sets in especially when the serous covering of the diaphragm 
becomes involved in the inflammatory process. 

4. Constipation — owing to the paralyzed state of the intestines — is a fre- 
quent symptom ; but in cases of peritonitis puerperalis, or in combination 
with catarrhal inflammation, or ulceration within the intestines, there is 
almost always diarrhoea. 

5. Great distention of the abdomen in consequence of accumulation of 
gas and fluid. This causes the diaphragm to rise into the thoracic cavity 
and to compress the lungs, producing congestion, short breathing, 40 to 60 
times a minute, and a disturbance of the circulation which may bring on 
cyanosis of the face. 

6. Constant desire to urinate; painful micturition or retention of urine; 
always where the serous covering of the bladder is involved. 

7. Fever; more or less intense according to the extension of the inflam- 
mation. The temperature may rise to 104 or 105° F., and higher, and the 
pulse from 120 to 130 in a minute. Gradually, however, as the disease pro- 
gresses, the pulse becomes small and flickering; the extremities cool and 
covered with cold sweats; the features collapse. 

8. Physical signs are not very readily elicited, as the patient can bear 
neither touch nor motion; although, of course, we may expect a dull sound 
on percussion where there is effusion, and a tympanitic sound where there is 
meteorism. Auscultation gives no signs, except rumbling in the bowels, 
which may be heard a yard off. 



PERITONITIS. 587 

That it is a dangerous disease we may conclude, if we consider for one 
moment its nature, and again, that this danger varies according to cause, 
complication and extension of the disease. Simple cases, produced by bruises, 
taking cold, without other complications, are the least dangerous. Those 
caused by wounds are more or less dangerous, according to the nature of the 
wound. And the danger of those which are the secondary result from other 
inflammatory processes depends upon the nature of these processes. 

It is a good sign when, in the progress of the disease, the pain gradu- 
ally abates and the pulse rallies. It is a bad sign when the pain abates 
and the pulse gets weaker and quicker. It is a sign of imminent danger 
when the pain suddenly subsides and the pulse becomes flickering and the 
features collapse. 

Cases which have become chronic terminate frequently in marasmus and 
a variety of consecutive sufferings. It is possible that in such cases the puru- 
lent exudation perforates either some part of the intestine, or discharges out- 
side through the abdominal wall. 

THERAPEUTIC HINTS.— Aeon., hot, dry skin; quick, hard, small 
pulse; high, inflammatory fever; mouth and tongue dry ; great thirst; bitter 
taste; vomiting; no stool; urine scanty, red and hot; lower extremities cool ; 
short, quick breathing ; very restless; anxious expression in the face; burn- 
ing, cutting, darting pain in the bowels, worse from slightest pressure, motion 
and lying on the right side ; abdomen hot to the touch. After taking cold, 
drinking cold water when being heated. 

Apis, burning, stinging pain in the bowels, very sore to the touch; 
when exudation has taken place; urine scanty, dark; cedematous swelling of 
the feet; burning, stinging in the region of the ovaries; metritis. 

Arnica, after contusion. 

Arsen., later, when there is a sudden sinking of strength, cold, clammy 
perspiration, anxious, internal restlessness, insatiable thirst with drinking but 
little at a time; constant vomiting; burning in the bowels; all worse in the 
middle of the night. 

Bellad., after Aeon., great congestion to the head; strongly pulsating 
carotid arteries; light and noise unbearable; colicky pains in the bowels; 
painful retching and vomiting, worse from motion and contact ; great anxiety 
a:ul dyspnoea. Especially when in complication with metritis or perityphlitis. 

Bryon., stitching pain or pressing, lancinating in the bowels, worse 
from slightest motion; when exudation has taken place ; tongue white and 
dry ; great thirst ; bowels constipated ; the patient lies perfectly still, don't 
want to move. Especially in complication with diaphragmitis. 

Calc. carb., when about the seventh day a red rash appears; also 
when the pain is alleviated by cold water applications, so that the patient 
wants them renewed constantly. Abdominal tuberculosis. 



588 PERITONEUM. 

Canthar., abdomen burning hot; tympanitic distention in its upper 
region ; lower portion yields a dull sound ; bloody, slimy stools ; painful, ex- 
torting cries ; tenesmus of the bladder ; strangury ; great anguish and rest- 
lessness ; distressed face ; sunken features ; cold extremities. Especially when 
the serous covering of the bladder is the seat of inflammation. 

Carb. veg., excessive tympanitis with paralysis of the bowels. 

Laches., abdomen hot and sensitive to touch; painful stiffness from 
the loins down into the thighs ; scanty, turbid urine with reddish sediment ; 
strangury ; constipation ; necessity of lying on the back with drawn-up knees. 
Especially in complication with typhlitis. 

Lycop., in complication with diaphragmitis or hepatitis; when lying 
on the left side, a feeling as if a hard body were rolling from the navel to 
that side ; or when after three or four days the face assumes a yellowish 
color; troublesome flatulence and constipation; sleeplessness and constant 
loathing. 

Mercur., at a later period, if the exuded fluid becomes purulent, with 
frequent starts; creeping chills; perspiration without relief; pale, wretched 
complexion; foul smell from the mouth; vomiting of slime and slimy stools, 
with straining; oedematous swelling of the feet; great weakness and emacia- 
tion. Especially when in complication with typhlitis and the formation of 
abscesses. 

Nit rum, stitching and sticking pains; predominating coldness of the 
lower extremities ; kind of numb and stiff feeling in the affected parts, as if 
they were made of wood. 

Nux vom., belching, vomiting and constant pressure upon the rectum, 
as if urging to stool. 

Opium, distention of the abdomen ; anxiety, with a feeling of flying 
heat internally, and stupefaction of the head; somnolence; antiperistaltic 
motion of the intestines ; constant vomiting and belching ; retention of stool 
and urine; complete inactivity of the lower bowels. 

Rhus tox., great restlessness; changing position, notwithstanding the 
pain it causes ; tongue red at the tip ; pressive cutting pain in the abdomen ; 
typhoid symptoms ; febris lente ; metritis. 

Sulphur, after Aeon, and Bryon., or when the disease takes a protracted 
course. 

Veratr . , vomiting; and diarrhoea ; coolness of the skin ; sunken features ; 
pulse small and weak; thirst great; restlessness and anxiety. 

Ascites, Dropsy of the Peritoneum. 

Its pathological character is like that of hydrothorax, a collection of 
fluid within the peritoneal sac, which is of a yellow, or yellowish-green, or 



ASCITES, DROPSY OF THE PERITONEUM. 589 

(if blood be mixed with it) of a reddish color, and contains a great deal of 
albumen, saline constituents, and flakes of coagulated lymph. The quantity 
of fluid sometimes exceeds forty pounds. The peritoneum is opaque, without 
lustre, and thickened, but without any signs of inflammation. Liver and 
spleen are pale, sometimes smaller than normal; the kidneys appear anaemic, 
and the diaphragm is pushed upwards into the thoracic cavity. 

Dropsy of the belly is never a primary disease, but always the con- 
sequence of some morbid action, such as diseases of the lungs, heart, larynx, 
blood-vessels, liver, spleen, kidneys, of intermittent fever and cancer-cachexia. 

It may result from mere local troubles, such as impediments of circula- 
tion within the peritoneum by obstructions of the vena portas, cirrhosis, and 
tumors of the liver, tubercular and carcinomatous degeneration of the peri- 
toneum. Frequently several of these causes are in operation, and sometimes 
it may be difficult to find out the true cause. If it develops without any 
cedema of other parts, we may conclude that it is caused either by an ob- 
struction of the portal circulation, or by a degeneration of the peritoneum. 
If by disturbance of the portal circulation, we generally find signs of a dis- 
turbed action of the liver, and the urine containing bilious coloring matter ; 
if by degeneration of the peritoneum, there are signs of cancer-cachexia, or 
tumors in the abdomen, the urine usually retaining its natural color. 

Symptoms. — 1. Swelling of the abdomen. This alters its form according 
to the position of the patient. When standing, the hypogastric region swells 
out the most; when lying, the most dependent portion of the abdomen bulges 
out. This distinguishes ascites from any other swelling within the abdominal 
cavity. 

2. Fluctuation, which is easily discovered by palpation. 

3. Diminution of urinary secretion and alvine evacuations (the latter ex- 
cepted, where there is an intestinal catarrh co-existing). 

4. Dull percussion sound, also variable according to the patient's position. 

5. Pressure towards the thoracic cavity, with dyspnoea and palpitation of 
the heart. 

6. Enlargement of the veins in the lower extremities, and dropsical 
swelling of the external genital organs and lower extremities, in consequence 
of the pressure which the accumulation of fluid within the abdominal cavity 
exercises upon the vena cava and vena? iliacse, causing obstruction of circu- 
lation in these parts. 

The Prognosis depends entirely upon the nature of its cause. If that 
is not removable, it is hardly to be expected that its consequences will be. 
The patient does not die in consequence of dropsy, but in consequence of the 
primary disease, if that be fatal, although dropsy by impeding the respira- 
tion, or by excoriations or superficial gangrene may hasten this result. 

Ascites differs from dropsy of the ovaries by its causes, which close ex- 



590 PERITONEUM. 

amination must elicit; by its form, being a uniform distention of the lower 
abdomen, rising gradually upwards. In dropsy of the ovaries, the swelling 
is more on the one or the other side, extending gradually sideways over the 
whole abdomen ; by its changing form by change of position, which never oc- 
curs in dropsy of the ovaries, where the fluid is encysted. 

In our Therapeutic management of each individual case, therefore, we 
shall have to select remedies from those which are indicated for dropsical 
affections in general; as Apis, Arsen., Bryon., China, Dulcam., Ledum, 
Lycop., Phosphor., Pulsat., Rhus tox., Sepia, Strontian. 

Vomiting and diarrhcea suggest: Ant. crud., Apis, Apoc. cann., Ar- 
gent., Arsen., Asar., Borax, Chamom., Cuprum, Ipec, Mercur., Phosjmor., 
Senega, Sulphur, Tart, emet., Veratr. 

Ulcers on the legs: Arsen., Graphit., Helleb., Lycop., Mercur., Rhus tox., 
Scilla, Sulphur. 

(Edema of the lower limbs, with constant oozing out of the water from 
sore places without formation of pus : Rhus tox., afterwards Lycop. 

Cough, with dropsy: Amm. carb., Apis, Arsen., Col chic, Helleb., 
Nitr. ac. 

SPECIAL HINTS. — Apis, urine scanty, dark, like coffee-grounds; 
thirstlessness ; great soreness of the abdominal walls ; stinging, burning pains 
in different parts of the body; can't get breath, except when sitting; even 
leaning backwards causes suffocating feeling; in complication with scarlet 
fever, uterine tumors, and inflammatory processes of the bowels. 

Apoc. cann., has been given abundantly by western physicians for 
"dropsy" of all kinds; seems to be indicated by a sinking feeling at the pit 
of the stomach ; an irritable condition of the stomach, that cannot retain 
even a draught of water ; muddy urine ; diarrhoea ; bloatedness of the face 
after lying down, passing off after sitting up; dropsy after scarlatina. 

Arsen., complexion pale and earthy, or greenish; great weakness, ex- 
haustion; faint feeling from slight motion; tongue dry; great thirst, with 
frequent drinking, but only little at a time; suffocative spells, especially at 
night; great anxiety; must jump out of bed; skin cool; burning heat inside; 
post-scarlatinal dropsy ; in complication with heart diseases. 

Aurum, has been recommended when ascites is the consequence of 
functional disturbance of abdominal organs, in combination with albuminuria. 

Bryon., congestion of the head; giddiness when rising after stooping; 
loss of breath when moving in the least ; low T er eyelids cedematously swollen ; 
lips bluish ; great thirst and scanty urine, with burning in the urethra, pass- 
ing off drop by drop; obstinate constipation; after scarlet fever. 

Canthar., cured many cases according to Faivre. 



ASCITES, DROPSY OF THE PERITONEUM. 591 

China, indicated in organic disturbances of liver and spleen, and after 
loss of blood. 

Colonic, palpitation of heart, and dyspnoea from 11 to 3 o'clock in 
the night, burning in pit of stomach, afterwards nausea, finally vomiting with 
subsequent weakness and sometimes ravenous hunger. Skin dry and pale. 
(F. Pollock.) Urine scanty, looking like bits of decomposed blood, with 
offensive smell. (W. McGeorge.) 

Convulvulus arv., constipation; abdominal disturbances, weakness, 
appetite good ; he would eat more if there were more room, the abdomen 
being filled with water; urine almost entirely suppressed. 

Digit., difficult micturition; pale face; intermitting pulse; cold skin; 
doughy swelling, which easily yields to the pressure of the finger. 

Fluor, ac, enlarged and indurated liver, in consequence of drinking 
whiskey. 

Graphit., great oedema of lower extremities with profuse watery exu- 
dation below knees ; exudation gelatinous. (H. V. Miller.) 

Helleb., in acute cases; after scarlet fever; drowsiness; slow in 
answering questions; griping in bowels, with jelly-like discharges; frequent 
but scanty micturition; great thirst; fever; sympathetic neuralgia of face 
into teeth on left side; preventing chewing. 

Kali carb., in complication with liver and heart affections. 

Laches., in complication with liver, heart and spleen diseases, scarlet 
fever ; black, scanty urine. 

Lycop., liver affections ; abuse of alcoholic drinks; after venesection, or 
intermittent fever ; oozing out of water from sore places in the lower extrem- 
ities, without formation of pus; urine scanty, with red sediment; upper 
portion of the body emaciated, lower enormously swollen ; one foot cold, the 
other hot; restless sleep; cross when getting awake. 

Mangan. ox., intermittent fever; cachexia; palpitation of the heart, 
strong, irregular, tumbling, without abnormal sounds. 

Mercur., in consequence of organic lesions of the liver and other ab- 
dominal viscera; the swelling of the abdomen is tense, hard; thirst not 
prominent. 

Senec, abdomen very tense; lower extremities cedematous; urine 
scanty and high-colored, or alternating with profuse and watery discharge ; 
pain in the lumbar region and in the ovaries. 

Sulphur, after suppressed itch, rough skin; bluish spots; sleep, with 
moaning; quick pulse; cold feet; easily sweating, especially in the face; 
painless diarrhoea; drawing together of the fingers ; very forgetful; inclina- 
tion to sit still and to lie down. 

Paracentesis with the usual trocar causes adynamia, rapid return of the 
fluid and often peritonitis. 



592 LIVER. 

Capillary punction allows a slow withdrawal of the fluid, causes less 
adynamia and less frequently peritonitis. (Leudet.) 

Tympanites Abdominalis 

Corresponds to Pneumothorax, and consists of a collection of gas within the 
peritoneal sac. It is caused by ruptures or perforations of the stomach or of 
the intestines, in consequence of which the gas w T hich is contained therein 
diffuses itself within the peritoneal sac. More rarely the air finds its way 
into the abdominal cavity from out of the lungs (in consequence of abscesses 
and pneumothorax) ; and still more rarely it enters from the uterus or the 
vagina in consequence of destructive processes in these organs. Cases have 
been observed where the gas originates within the peritoneal sac itself, in 
consequence of a decomposition of ichorous fluids contained therein, especially 
in combination with puerperal peritonitis. 

Symptoms. — Swelling of the abdomen. Its development is rapid if it 
be caused by perforation; slower, if by gradual decomposition. 

Full tympanitic sound all over, even in the region of the liver. This or- 
gan is pressed backwards, if it be not adherent to the diaphragm ; this is 
quite characteristic and serves to distinguish tympanitis from meteorism, i. e., 
a collection of gas within the intestines. 

All signs of peritonitis, which develops itself soon after the entrance of 
air into the peritoneal sac. 

THERAPEUTIC HINTS— Compare Peritonitis and those other 
affections of which it is a mere consequence. 



DISEASES OF THE LIVER. 

Physical examination. — The upper part of the liver extends into the 
space between the fifth and fourth, sometimes even to the edge of the fourth 
rib. Being, however, overlapped here by the lower edge of the right lung, 
which reaches down to the sixth rib, we find on percussion the perfect, dull 
liver-sound commencing only from the sixth rib, while above it to the fourth 
rib the dull sound can be elicited only by hard strokes, sounding through 
the layer of the lung tissue that covers the liver. Inferiorly the liver reaches 
to the tenth rib in the right hypochondrium, whence it ascends in a some- 
what semi-lunar line across the epigastrium, midway (or often a little higher 
than midway) between the ensiform cartilage and the navel, towards the left 
hypochondrium. Percussion in a horizontal line from the ensiform cartilage 
towards the left, a little under the region where the apex of the heart strikes, 



PIGMENT LIVER. 593 

tells us how far into the left hypochondrium the left lobe of the liver 
reaches. 

This normal position, however, may be changed without indicating any 
disease of the liver itself. The liver is dislocated doivnwards by emphysema, 
pleuritic effusions, pneumo-, pyo- or hydrothorax of the right lung; it is dis- 
located upwards by fluid or gaseous collections, or tumors within the ab- 
dominal cavity, or in consequence of a shrinking of the right lung Its sur- 
face becomes grooved by tight lacing of corsets and waists of petticoats in 
females, and of pantaloons in males. Part of the right lobe may, by this 
long-continued process, be brought down to the anterior superior spinous 
process. 

Pigment Liver, Melanaemic Liver resulting from Malarial 

Fevers. 

The liver presents a steel-gray or blackish, or chocolate color, in con- 
sequence of an accumulation of pigment matter in its vascular apparatus. 
These deposits are either uniformly distributed, or limited only to certain 
portions. Similar appearances are constantly found, also in the spleen, fre- 
quently in the capillaries of the lungs, also in the brain, especially in its 
cortical substance, and in the kidneys. Even the other organs and tissues, 
such as the external integument, the mucous membranes, the muscular tissue, 
etc., remain by no means exempt, as may be seen by their gray tint. The 
pigment seems to be carried everywhere by the blood, and the effects upon 
the system of this morbid process in consequence of malarial fevers will, of 
course, vary according to the organs which are most specially attacked. We 
will find cases with predominant brain symptoms, others with predominant 
symptoms of the kidneys, others with predominant derangements of the 
gastro-intestinal tract and the liver, and others where ancemia and hydrcemia, 
resulting from affections of the spleen, constitute the most important morbid 
conditions. 



Hyperemia, Congestion of the Liver. 

One of the most frequent causes is obstruction to the circulation of 
blood in consequence of valular diseases of the heart, such as constriction of 
the left auriculo-ventricular opening, insufficiency of the mitral and still more 
of the tricuspid valves, and further, affections of the lungs, such as emphy- 
sema, extensive induration or atelectasis, great pleuritic effusions, etc., which 
all give rise to accumulations of blood in the venae cavse, by which the 
branches of the hepatic vein continue permanently distended, and cause a 
general enlargement of the liver. On section, the organ presents a nutmeg- 
38 



594 LIVER. 

like appearance. The dark spots correspond to the situations of the hepatic 
veins, and the light colored portions of the parenchyma, exhibiting upon 
closer inspection pale, delicate ramifications, correspond to branches of the 
portal vein, and constitute the so-called Nutmeg liver. From the persist- 
ence of this obstruction the hepatic parenchyma gradually atrophies and at 
last acquires a finely-granular structure, which frequently has been con- 
founded with cirrhosis of the liver. This is the atrophic form of nutmeg liver. 
Besides the symptoms of the cardiac or pulmonary disease, which constitutes 
the primary cause of the circulatory obstruction, we observe derangements 
of digestion, pains and tension in the epigastrium, nausea, etc., and occasion- 
ally haemorrhoids. Sooner or later it leads to death from pulmonary oedema, 
apoplexy, general dropsy, etc. 

Congestion of the liver may be induced also by rich living, especially 
in persons of a sedentary habit. Stimulants and irritants, such as alcoholic 
drinks, pepper, mustard, coffee, etc., in large quantities frequently give rise 
to this trouble, and quite marked is the influence of hot climates and of 
miasmatic effluvia. The hepatic hypersemias of the tropics are often associated 
with dysentery or malarious fevers. In the latter case there is also swelling 
of the spleen or kidneys. 

Its acute form is characterized by more or less painful distention of the 
region of the liver, with dyspnoea and pain stretching towards the right 
shoulder, by headache, nausea and vomiting of mucus or green matter; by 
constipation or diarrhoea, which is bilious or even bloody. This state of 
things, by proper treatment, may entirely subside; if neglected, it may give 
rise to a chronic form which shows more or less periodical exacerbations of 
these symptoms, and finally runs into structural changes of the liver, such as 
softening, or pale and jaundiced or fatty degeneration, or induration, cir- 
rhosis and abscesses. 

In temperate climates this affection is much less violent than in the 
tropics, but may also assume a chronic form and produce enlargement of the 
liver by fatty deposits, or infiltration of its parenchyma with albuminous 
substance, which gradually passes into colloid degeneration, and in rare cases 
becomes cirrhosed. 

A hyperemia of the liver in consequence of the suppression of habitual 
haemorrhages, for instance during the climacteric period of life, has frequently 
been observed; it usually does not give rise to any serious derangement in 
the nutrition of the liver. 

THERAPEUTIC HINTS.— In acute cases: 

Bellad., high fever; congestion of the head; severe headache; vomiting 
of the watery, slimy and bilious fluid ; great thirst ; region of the liver pain- 
ful and sore to the touch. 



HYPEREMIA OF LIVER. 595 

Bryon., bilious vomiting; bitter taste; white tongue; great thirst or 
only dryness in the mouth ; inclination to keep still ; soreness of the liver to 
pressure ; costiveness. 

Card, mar., when constipation frequently alternates with diarrhoea; 
liver sensitive to pressure; pressing? drawing, stitching pain in liver, worse 
on lying on left side; catarrh of gall-passages; swelling and induration of 
left lobe, with dyspnoea and cough ; jaundice. 

Chamom., after anger or chagrin; very annoying pressure in the 
region of the liver ; colicky pains in the bowels ; vomiting of bile ; feverish 
restlessness ; crossness ; icteric color of the face. 

China, pale, wretched complexion; diarrhoea, worse at night or after 
eating; sensitiveness to external cold; great weakness and lassitude; after 
severe illness, loss of vital fluids, or abuse of mercury. 

Ignat., after grief or fright, especially in the female sex; menstruation 
profuse and irregular; leucorrhoea, with bearing-down pain. 

Mercur., bad taste; bad smell from the mouth; tongue white, flabby, 
showing the imprints of the teeth; feverishness ; sweating without relief. 

Nux vom., fulness; pressure; stitches in the liver, worse from motion 
or contact; swelling of the liver; yellow color of the face, especially if the 
color of the face is florid with a yellowish tinge ; all worse in the morning ; 
great irritability and hypochondriac mood ; costiveness. 

Ptelia trif., "anorexia; sleeplessness; frequent emissions at night of 
small quantities of perfectly colorless urine; yellow coated tongue; nausea; 
sour taste and constant thirst ; constipation, the feces discharged every fourth 
day consisted of dark colored, hard, irregular lumps. Swelling of the liver, 
most exquisite tender to jar or pressure, which caused nauseating pains shoot- 
ing towards epigastrium. Worse from motion; cannot turn in bed, must lie 
on right side with abdomen supported by a pillow. Circumscribed flushing 
of checks in the afternoon ; no perspiration at any time. Jaundice sets in 
on second day of attack. Menstruation had ceased three years previous. 
Mental condition was one of quiet resignation. Has received at various times 
the following remedies : Arnica, Arsen., Bryon., China, Hepar, Kali carb., 
Laches., Lauroc, Nux vom., Sulphur, with rarely any relief of any of the 
symptoms. Ptelia trif. was given on account of the symptoms detailed in 
Allen's Materia Medica under Abdomen-Hypochondria, Nos. 471-486, with 
entire success. (F. Preston, Weekly Medical Counselor, May 31, 1882, p. 133.) 

In chronic cases: Calc. carb., Carb. veg., Graphit., Lycop., 
Magn. mur., Natr. mur., Natr. sulph., Sepia, Sulphur. 

Compare also the diseases of the heart and lungs, of which congestion 
of the liver is more or less a consecutive symptom ; also the chapters on acute 
and chronic catarrh of the stomach and intestines. Besides all this, the 
following require special study — 



596 LIVER. 

Card, mar., swelling and hardening of left lobe; sensitive to pressure; 
painful on lying on left side ; oj>pression of chest with cough and expectora- 
tion, sometimes bloody ; urine scanty, dark red and yellowish, with bile satura- 
ted; jaundice; dropsy. (Wolf.) 

Laches., cannot bear tight clothes around the waist; has even to 
loosen the night-jacket to relieve the oppression, which is occasioned even 
by laying the arm on the body ; tension ; contractive tightness in the region 
of the liver. 

Lauroc, distention of the region of the liver, with pain as from sub- 
cutaneous ulceration, or as if an abscess would burst; earthy complexion; 
yellowish spots in the face. 

Lycop., tension around the hypochondria as from a hoop; sore aching 
in the region of the liver, as if caused by a shock, worse from contact. 

Nux mosch., feeling of heaviness in the region of the liver; swollen 
liver; bloody stools. 

Podoph., fulness, with pain or soreness in the right hypoehondrium ; 
chronic hepatitis, with costiveness; the patient is constantly rubbing and 
stroking the region of the liver with his hands. 

Quassia, gastric catarrh and liver complaint with diarrhoea and dropsy ; 
spasmodic cough, like whooping-cough; rapid sinking of strength; spleen 
affection. (Wolf.) 

Peri-Hepatitis, Inflammation of the Capsule of the Liver 
and of Glisson's Capsule. 

It may be part of a general peritonitis, or the consequence of an abscess 
of the liver, of simple, or cirrhotic induration, of cancer, or of echinococci 
in the liver; it is at times the result of external violence, or a mere extension 
of an inflammatory process of some neighboring organs, such as right-sided 
pleurisy, and simple and cancerous inflammation of the stomach. 

Its most characteristic symptom is, tenderness of the hepatic region on 
pressure, motion and deep inspiration, without any change in the volume or 
situation of the liver. In itself it is not a dangerous disease, but may pro- 
duce thickening of Glisson's capsules and of the portal vein. Its treatment 
compare under peritonitis and the diseases of which it may be the conse- 
quence. 

Hepatitis vera circumscripta seu Suppurativa. 

This is an inflammation of the hepatic tissue limited to one or several 
isolated patches, without implicating the remaining portions of the gland to 
any great extent. In their centre these inflamed spots are soft and yellow- 



HEPATITIS VERA CIRCUMSCRIPTA SEU SUPPURATIVA. 597 

ish, at their periphery they show hyperemia, swelling and softening of the 
liver tissue. In the progress of the disease little pus globules form in the 
middle of the inflamed spot, they increase in number, unite and form a small 
abscess, which again unites with other small abscesses, and thus, in the course 
of time, the greater part of the liver may become an irregular cavity filled 
with pus. 

Such abscesses are found in the posterior portion of the right lobe. 
"When they reach the surface of the liver they break through and discharge 
their contents into the abdominal cavity; or, if the surface of the liver has 
formed adhesions, in consequence of previous inflammation, with neighboring 
organs — either with the abdominal walls, the diaphragm, the stomach, the 
gall-bladder, or a part of the intestines — it perforates these organs, and dis- 
charges itself either through the abdominal walls, or into the thoracic cavity, 
stomach, gall-bladder, or intestines, according to its situation and adhesion. 

Hepatitis is primarily a very rare disease, and is mostly brought on by 
external injuries— a fall, a blow, a wound, etc. 

Secondarily it is caused by the irritation of hardened concrements within 
the gall-ducts, or by ulcerative processes within the stomach and the intestines, 
which perforate and spread upon the surface of the liver. In tropical climates 
it has most frequently been found in connection with dysentery. Pyaemia, in 
consequence of wounds on the head or any other part of the body, is also a 
cause of it. 

Symptoms. — A primary hepatitis caused by a blow, fall, or other 
mechanical injury occasions pain in the right hypochondrium ; frequently 
very acute, as its lining portion of the peritoneum is likewise inflamed; it is 
worse from any motion. There is also a pain in the right shoulder, and on 
tension, in the right straight abdominal muscles. The liver is swollen ; the 
skin more or less yellowish discolored (icterus); fevers alternate with rigors. 

A secondary hepatitis, in the course of ulcerative processes in the stomach 
and intestines, manifests itself by shaking chills, pain in the liver, swelling 
of the liver and icterus, though the latter is not always present. 

Hepatitis in consequence of pysemia manifests itself likewise in swelling 
of the liver, icterus and shaking chills. Formation of abscesses on the con- 
vex portion of the liver often bulge out, and may be detected by palpation. 
Those on its concave side compress the portal vein, and cause swelling of the 
spleen and ascites. 

Small abscesses may pass over without any marked symptoms. Large 
abscesses cause fever, shaking chills, wasting away, cachectic appearance. 

Perforation through the abdominal walls, after previous adhesion of the 
inflamed portion of the liver with the abdominal parietes, is the most favor- 
able, as in this case, the pus is discharged outside. 

Perforation into the pleural sac causes p^euritis; a perforation into one 



598 LIVER. 

of the larger bronchi causes the pus to be expectorated ; a perforation into 
the ]5ericardial sac causes pericarditis, which is fatal. If the perforation 
takes place into the stomach, it is thrown up ; and if into the intestines, it is 
discharged through the bowels. A discharge into the abdominal cavity pro- 
duces fatal peritonitis. 

All this shows that hepatitis and its consequences must cause quite a 
variety of symptoms; that its prognosis generally is unfavorable; and lastly, 
that a successful treatment, without a close study of the individual case, is 
quite impossible. Still, I may mention the following remedies, which have 
proved themselves more or less beneficial in abscesses of the liver: Bellad., 
Bryon., China, Hepar, Kali carb., Laches., Merc, sol., Nux vom., Pulsat., 
Ruta, Sepia, Silic. 

SPECIAL HINTS. — Compare what has been said under the head of 
Peritonitis. 

Arnica, in traumatic cases. 

Arsen., painful bloatedness in the right hypochondrium, with violent 
burning pain; violent thirst; vomiting of black masses; black stools; burn- 
ing heat of the skin ; anxiety and restlessness ; very quick pulse ; perforation 
into the stomach or intestines. 

Bellad., especially with acute pain in the region of the liver, worse 
from pressure, breathing, coughing and lying upon the right side, extending 
upwards towards the shoulder and neck; congestion of the head; getting 
dark before the eyes; fainting and giddiness; bloatedness of the pit of the 
stomach; tension across the epigastrium; agonizing tossing about; sleepless- 
ness or wanting to sleep, with inability to go to sleep. 

Bryon., burning and stitching pain, worse from motion and contact; 
after chagrin or anger; fulness of stomach and abdomen; pain in the right 
shoulder; yellowish face; white tongue; great thirst; constipation. 

Chelid., crampy pain in the inner angle of the right shoulder-blade; 
shooting pain from the liver into the back; pressive pain in the back part of 
the head, towards the left ear ; pressure in the eyeballs ; bitter taste in the 
mouth; nausea; palpitation of the heart, with very quick and irregular 
pulsation and without abnormal sounds; constipation. 

China, pain as from subcutaneous ulceration, worse from touch; liver 
swollen; diarrhoea; distended veins on the face and head. 

Hepar, when suppuration takes place. 

Kali carb., pain through to the back; abscess; dryness of the skin. 

Laches., after Bellad. or Mercur., very sensitive to any pressure upon 
the hypochondriac region; much flatulence; palpitation of the heart; forma- 
tion of abscesses. 






CIRRHOSIS, HOB-NAIL LIVER. 599 

Leptand., yellow-coated tongue ; constant nausea and vomiting; ach- 
ing in the region of the liver; dark brownish urine; black stools. 

Lycop., in slow cases; complication with pneumonia; fan-like motion 
of the nostrils when breathing ; one foot hot, the other cold. 

Mercur., pressive pain and stitches in the liver ; inability to lie on the 
right side; when coughing or sneezing a stitch-pain through middle of the 
chest from front to back ; yellowish tinge of the face ; perspiration without 
improvement; during fever feels chilly when changing the feet to a cooler 
place in the bed. 

Nux vom., pain, stitch-like, or throbbing, or pressive, worse from ex- 
ternal pressure ; sour or bitter taste in the mouth ; nausea ; vomiting ; short- 
ness of breath ; the dress seems oppressive ; the removal of it, however, does 
not relieve ; great deal of headache. Previous use of allopathic medicines, 
coffee, liquor, etc. ; sedentary habits. 

Phosph. ac, pysemic symptoms. 

Pulsat., spells of great anxiety at night; green, slimy diarrhoea; thirst- 
lessness. 

Silic, hardness and distention of the region of the liver; throbbing, 
ulcerative pain, increased by contact and motion ; formation of abscesses. 

Sulphur, especially after Nux vom. and Mercur. ; red tip of the tongue; 
red lips; sleeplessness. 

w 

Cirrhosis, Hob-nail Liver, Interstitial Inflammation of the 
Liver, Granulated Liver, Gin-drinkers' Liver. 

It is a chronic inflammation of the areolar tissue, which, being of a 
fibrous texture, forms a capsule over the entire liver, enters as Glisson's 
capsule into the interior of the gland and accompanies the vessels, nerves 
and bile-ducts to their finest ramifications. The next consequence of inflam- 
matory action of this tissue is exudation of coagulable lymph, which forms 
new areolar tissue and adhesions between its ramifications, causing the se- 
creting cells of the liver to become isolated and compressed, and producing 
in this way larger or smaller granulations, which have been compared to 
hob-nails. In the further progress, the new formation compresses also the 
biliary ducts and blood-vessels, and the whole organ shrinks, becomes hard, 
tough, pale, anaemic, and, if cut, appears gray-yellowish, wherefore the name 
cirrhosis. Its most frequent Cause is the abuse of alcoholic drinks; still it 
has been observed in individuals who were not addicted to drinking, and 
where it seemed to be in connection with syphilis, intermittent fever, sup- 
pressed menstruation, poor living. 

Heart diseases, according to Bamberger and others, do not cause it. It 



600 LIVER. 

is much more frequently found in males than females, rarely in children, and 
most frequently in persons over thirty years. 

Symptoms. — 1. The liver is, during the stage of exudation, considerably 
enlarged, and, during the stage of granulation, loses quite considerably in 
bulk, so that the left lobe disappears entirely. If we have an opportunity 
to observe its progress long enough, we can witness this increase and gradual 
decrease of the liver, and in this way gain one of the most important aids in 
our diagnosis. 

2. Enlargement of the spleen is met in many, not all cases, in conse- 
quence of the obstructed circulation of blood within the portal vein and its 
branches, which impairs the free reflux of blood through the vena lienalis. 
This is an early symptom. 

3. Ascites appears later, but is a more constant accompaniment of 
granular induration, and depends upon the same obstruction of the portal 
circulation ; still later oedema of the lower extremities occurs. 

4. Meteorismus, if strongly developed, causes difficulty in breathing. 

5. Dilatation of the abdominal veins, caput medusae, appears not until an 
advanced stage of the disease. It. is caused by the obstructed portal circu- 
lation. The blood in its way from below, being stopped, forces its way 
through neighboring veins, widening and dilating them, and thus forms a 
collateral circuit around the liver, until it reaches the vena cava. These 
widened and dilated veins appear sometimes like a large network over the 
walls of the whole abdomen, and even above it. 

6. Functional disturbances of the intestinal canal are of a varied nature. 
The appetite is, in some cases, not altered till very late; in others, again, 
want of appetite, nausea, belching of wind and vomiting predominate. The 
bowels are either constipated or diarrhceic. In severe cases we find vomiting 
of blood and bloody stools. 

7. Loss of flesh and strength sets in quite early, as a necessary consequence 
of imperfect circulation. 

8. Jaundice is, according to Bamberger, a prominent symptom of cir- 
rhosis, other authors have not found it so frequent. It depends upon catarrh 
of the bile ducts, or upon compression of the hepatic duct, or upon constric- 
tion of the minute biliary ducts by the newly-formed connective tissue. 

If we consider these symptoms, together with the preceding abuse of 
spirituous liquors, we shall be enabled, in most cases, to make out a sure 
diagnosis. But for the sake of Differential Diagnosis I shall compare 
a few forms of disease which might be confounded with it. 

Stricture of the biliary duct is usually caused by gall-stones, and has its 
peculiar colicky spells, but no swelling of the spleen. 

Nutmeg liver is always the consequence of heart and lung diseases, and 
has no enlargement of the spleen. 



SYPHILITIC INFLAMMATION OF THE LIVER. 601 

Cancer and tuberculosis of the peritoneum, with highly-developed ascites, 
may be sometimes difficult to discern ; still we have here a quioker wasting 
away; perhaps also signs of cancer or tubercles in other organs, and a devel- 
opment of oedema of the lower limbs prior to the development of ascites ; 
whilst in cirrhosis we have first ascites and afterwards cedematous swelling of 
the lower extremities. 

Cancer of the liver distinguishes itself by the peculiarly potato-shaped 
surface of the enlarged liver and the normal size of the spleen. 

Hydatids of the liver give, on palpation, the sense of fluctuation ; they do 
not impair the general nutrition, nor do they cause an enlargement of the 
spleen. 

Inflammation of the portal vein, with coagula forming in it, is a much 
more rapid process, and is not caused by previous abuse of spirituous liquors. 

Inflammation of the areolar tissue surrounding the biliary ducts is char- 
acterized by the highest degree of icterus and the complete discoloration of 
the stools. 

Colloid or fatty infiltration of the liver never decreases in size, causes no 
icterus, and is found in scrofulous, rachitic, or syphilitic individuals, or as 
a consequence of mercurial poisoning. 

Prognosis is favorable as long as the disease is still in its first stage. 
After granulation has formed throughout the organ, I do not believe that its 
parenchyma can be reorganized. 

THERAPEUTIC HINTS— If the disease is brought on mainly by 
the abuse of spirituous liquors, especially whiskey and brandy, the first pre- 
scription, of course, must be, "stop drinking." And, in order to destroy the 
appetite for alcoholic stimulants, our second prescription should be, " drink 
milk," and nothing but milk; live on milk diet. After this we shall have a 
choice between these remedies, which are antidotes to alcohol: Arsen., 
Bryon., Carb. veg., Nux vom., Pulsat, Sulphur, etc. 

In its second stage we must be guifled entirely by the characteristic 
symptoms of the individual case, and may choose from the following : Arg. 
nitr., Aurum, Card, mar., Chelid., Cinchona, Conium, Iodium, Laches., 
Leptand., Lycop., Magn. mur., Mercur., Xatr. mur., Nitr. ac, Phosphor., 
Plumbum, Podoph., Quassia, Selen., Sepia, Tax. bacc. 

Syphilitic Inflammation of the Liver 

Manifests itself either as an interstitial hepatitis and peri-hepatitis, which leave 
white depressions, like cicatrices, consisting of fibrous tissue and extending 
from the thickened capsule more or less deeply into the interior of the gland, 
the secreting tissue of which is atrophied, thus producing an irregularly, 



602 LIVER. 

tabulated form of the liver ; or as hepatitis gummosa, when the tissue of the 
cicatrices just described is seen to contain whitish or yellowish nodules, which 
usually vary in size from a linseed or a bean up to a walnut, and resemble 
the nodes or gummata of syphilitic patients found in the subcutaneous areolar 
tissue beneath the peritoneum, in the testicles, etc. 

The symptoms during life of syphilitic hepatitis are not at all character- 
istic. A dull, temporary pain and tenderness in the region of the liver, in 
rare cases jaundice, also enlargement of the spleen and frequently co-existing 
albuminuria, may hint to this complaint, especially when other unmistakable 
signs of the secondary and tertian stage of syphilis are present. Its treat- 
ment belongs into the chapter of Syphilis. 

Acute Yellow Atrophy 

Is a rapid wasting of the liver in all its diameters, but especially in its thick- 
ness, sometimes preceded by a preliminary stage. Its capsule appears opaque 
and puckered; its parenchyma is flabby and shrivelled and of an ochre- 
yellow or rhubarb-like color; the blood-vessels, the gall-bladder and bile- 
ducts are empty in most cases, the gall-bladder containing only a small 
quantity of gray mucus or a turbid, pale yellow, rarely brown or greenish 
fluid. The spleen is frequently greatly enlarged and congested, and there are 
considerable extravasations of blood in various organs and tissues. The 
kidneys, especially in pregnant females, are in a state of fatty degeneration 
and their tissue flabby and shrivelled. The urine is characterized by the 
absence of urea, which has accumulated in the blood, and by temporary 
presence of albumen. 

The nature of this disease is still quite obscure; several theories have 
been advanced, but that which considers the whole process as one of diffuse 
inflammation is the one most generally accepted. 

The Precursory Symptoms usually resemble the symptoms of an 
acute gastro-enteric catarrh, whicfi sooner or later, sometimes not until after 
the lapse of several weeks, becomes associated with a slight jaundiced tint of 
the skin. Even this may exist from eight to fourteen days or longer before 
the characteristic changes in the liver and spleen, the haemorrhages and the 
nervous disturbances become apparent. However, in other cases, these symp- 
toms appear simultaneously with the jaundice, and as soon as they do appear, 
the progress of the disease is rapid and violent, terminating in the worst cases 
at the end of twelve or twenty-four hours, in other cases after two or five 
days, latest and in rare cases only, after a week. The disease sets in with 
vomiting first of ingesta and mucus, later of blood and ultimately of coffee- 
ground substances. This is attended with headache, which, as a rule, soon 
passes into delirium, followed by convulsions and a tremulousness of the muscles 



HEPAR ADIPOSUM, FATTY LIVER. 603 

of the extremities and trunk. Finally the state of excitement passes into stupor 
and deep coma ; the pupils enlarge, the respiration becomes sighing, inter- 
mittent and stertorous. The pulse, at first slow, rises with the nervous symp- 
toms to 120, or keeps at 70 or 80 as long as the patient is dozing, and rises 
to 120 or 130 when the patient is roused. The abdomen is tender, especially 
in the hepatic region. The extent of the hepatic dulness diminishes as the 
disease advances, while that of the spleen increases at the same time. The 
bowels are almost always confined ; the stools are dry and clay-like, later 
they become dark colored and tarry from the presence of blood. There ap- 
pear, as the jaundice increases, numerous extravasations of blood in the skin 
in the form of petechia? and ecchymoses, and haemorrhages from the nose, the 
vagina, the stomach and bowels, and the bronchi. 

The urine is brown and contains bile-pigment, at times small quantities 
of albumen. Its deposit, upon exposure to cold, is greenish-yellow, which 
differs greatly from all other kinds of deposits. The disease is most frequently 
observed in the female sex, and then especially during pregnancy. Further 
are mentioned as exciting causes: mental emotions, venereal excesses, syphi- 
lis, miasmatic influences and typhus. 

THERAPEUTIC HINTS.— Aeon., acute, feverish icterus, especially 
during pregnancy. 

Bellad., congestion to the head; headache; dizziness; sopor; pupils at 
first contracted, and afterwards dilated; spasmodic jerkings; grating of 
teeth, etc. 

Bryon., chill first and fever afterwards; .typhoid symptoms; bitter 
vomiting ; constipation. 

Crot. horr., yellow color over the whole body; convulsions with trem- 
bling of the limbs; haemorrhages from all the orifices of the body. 

Ipec, vomiting of blood, and bloody discharge from the bowels. 

Leptand., delirium; complete prostration; heat and dryness of the 
skin; coldness of the extremities; fetid and tarry stools; tongue thickly 
coated, with a black streak down the centre. 

Phosphor., ought to be compared. 

Compare also Haemorrhage from the Stomach and Bowels, and Jaundice. 

Hepar Adiposum, Fatty Liver. 

A fatty infiltration of the liver cells is found very frequently on post- 
mortem examinations without ever having shown its presence during life by 
any signs of diseased action of that organ. A diet of fatty substances, or of 
large quantities of food containing an abundance of carbo-hydrogens, pro- 
duces such infiltration, which, however, disappears again when the food is 



604 LIVER. 

changed. This accounts for the frequent occurrence of fatty liver in indi- 
viduals who have died suddenly in the bloom of good health. For this kind 
of infiltration there is no known line of demarcation between health and 
disease, inasmuch as the liver cells are not altered by it in their character, 
the fat being merely deposited therein. Altogether different is the fatty 
liver as found in connection with pulmonary tuberculosis, drunkard's dys- 
crasia, chronic dysentery, cancer and other wasting diseases. Here the liver 
cells cease entirely to perform their function, their nutrition becomes im- 
paired ; it is indeed a fatty degeneration of the liver cells. Its production is 
not fully explained, except by the broad statement that it is owing to ab- 
normal conditions of the metamorphosis of matter. But whether it be mere 
infiltration or degeneration, the blood is always loaded with fat and the 
sebaceous glands of the skin secrete abundantly, causing a greasy or velvety 
character of the cutis. 

The Symptoms of fatty liver are not very w T ell marked. Still, as a con- 
siderable accumulation of fat in the liver must impede the flow of blood 
through the portal vein, and the excretion of bile, we find fatty liver natu- 
rally associated with chronic congestion of the gastro-intestinal mucous mem- 
brane, which may be exaggerated by slight causes into catarrhs, derange- 
ments of digestion, diarrhoea, and haemorrhoids; and with stools more or less 
deficient in bile; but an intensely jaundiced color of the skin is never pro- 
duced by it and seldom a high degree of ascites. The liver is at first enlarged 
but gradually becomes reduced to even below its normal size; its outer 
surface is smooth. The general appearance of the patient gradually assumes 
the character of general cachexia, and there is usually an enlargement of 
the spleen attending it. 

Its Treatment will in the case of infiltration consist of a strict regula- 
tion of diet and habit, and in the case of degeneration will fall entirely under 
the treatment of those diseases with which it is associated. 

Colloid Liver, Lardaceous Liver, Waxy Liver, Amyloid 
Degeneration of the Liver. 

This is a degeneration of the liver cells Jinto a waxy, translucent mass, 
so that by degrees the parenchyma of the gland presents a uniform, smooth, 
yellowish-red, somewhat glistening surface, interrupted only by the patent 
orifices of the blood-vessels pouring out a little thin blood. This morbid 
change may occur sometimes only in isolated places, but is most frequently 
distributed more or less marked throughout the entire organ. The nature 
of this substance is thus far still unknown. From the blue color produced 
by a solution of Iodine in conjunction with Sulphuric acid, Virchow supposed 



CARCINOMA HEPATIS. 605 

it to be an "amyloid" body, but the proof from elementary analysis is still 
"wanting. 

Waxy degeneration is often found combined with fatty deposit in the 
liver, especially in cases of pulmonary tubercle, with cirrhotic induration, 
with syphilitic cicatrices and fibroid nodules (gummata), with simple atrophy 
of the liver. It is scarcely ever restricted to the liver, but is almost in- 
variably found also in the kidneys and spleen, and often likewise in the 
lymphatic glands and the mucous membrane of the gastro-intestinal canal. 
Moreover we can usually, at the same time, discover the remains of chronic 
diseases of the bones, the indications of constitutional syphilis, tubercle or 
cancer, etc. 

The injurious effects of this degeneration upon the elaboration of blood 
and nutrition causes, as a rule, a pale, cachectic appearance of the patient 
and symptoms of ansemia and hydremia. The symptoms vary, however, 
according to the cause which has excited the morbid process and the direc- 
tion in which it extends; they differ naturally in cases where the kidneys 
and the mucous membrane of the intestines are attacked at an early stage, 
and in other cases where the spleen and lymphatic glands are chiefly im- 
plicated, i • 

The liver is in most cases enlarged, at times very greatly, at others not 
at all, and in still others it is even reduced in size. There is usually an 
abnormal tenderness in the hepatic region, or a mere feeling of fulness; in 
rare cases of the syphilitic form an acute pain consequent upon an attack of 
peri-hepatitis. Jaundice and ascites are found only exceptionally. The 
spleen is commonly enlarged to a considerable size, though not always, and 
the derangement of the gastro-intestinal canal manifests itself frequently by 
loss of appetite, vomiting, with a clean tongue, diarrhoea with alternation of 
pale and dark stools. The same degeneration of the kidneys manifests itself 
in the majority of cases by enlargement and albuminuria. 

Mild cases, based upon chronic diseases of the bones, hint to: Calc. 
carb., Lycop., Silic, Sulphur. 

Syphilitic cases require: Iodium, Kali hydr. and the different Mer- 
curial preparations. Other cases will resist all treatment according to 
the base upon which they grow. 

Carcinoma Hepatis, Cancer of the Liver. 

There are three different forms of cancer of the liver. 

1. The carcinoma fasciculalum, a rare form, characterized by the pale, 
yellowish-red color, its glassy, transparent mass, which is enveloped in a bag 
of fibrous tissue. 

2. The alveolar cancer, the rarest of all, which is characterized by its 



600 LIVER. 

jelly-like substance, developing within the areolar tissue around the ramifica- 
tions of the portal vein. 

3. The medullary or encephaloid cancer, the most common form, is char- 
acterized by its marrow-like substance, which is mostly of a whitish color ; 
sometimes it is red from hemorrhagic effusion, and, at other times, dark, 
even black, from a deposition of pigment. The liver appears uneven from 
nodules of various sizes, w T hich, for the most part, feel hard to the touch, al- 
though, in some cases, the sense of touch may detect fluctuation. They in- 
crease more or less rapidly in size, and sometimes undergo changes of fatty 
degeneration, or, in still rarer cases, of softening and decay, or formation of 
ichor. 

We do not know any cause for this malignant disease. It is found 
sometimes as a primary affection of the liver, but more frequently it accom- 
panies cancerous deposits in other organs. Its most frequent occurrence 
and its most rapid development have been observed after extirpation of can- 
cerous growths from other organs, especially from the mammae. Persons 
between the ages of fifty and sixty are most liable to its invasion. 

Symptoms. — 1. Enlargement and uneven surface of the liver. Its size is 
sometimes enormous, reaching far over into the left hypochondrium and far 
down into the abdomen; in fact, no other disease except that of colloid liver 
causes such extensive enlargement of this organ. Its enormous size makes 
the right hypochondriac region bulge out, and its uneven surface is then 
easily detected by iuspection and palpation. 

In such prominent cases there is no difficulty in the diagnosis. But 
there are cases where the cancerous nodules lie out of reach of palpation, 
either deep in the substance of the liver or on its opposite surface. So is 
also the enlargement of the liver at the beginning of the disease very incon- 
siderable, and, in cases of few and small cancerous deposits, attended with 
general anaemia and marasmus, the liver may appear even smaller. 

2. Tenderness in the region of the liver is almost always manifest, at 
least on deep pressure, but it varies much in degree. A radiating pain 
towards the spine and the right shoulder-blade, as in other liver complaints, 
may be present. 

3. Icterus is present only when the situation of the tumors implicate the 
biliary ducts or when the cancer is associated with catarrh of the ducts. If 
once developed it never disappears. The skin generally presents a peculiar 
ash-colored, dirty-yellowish hue, and, being dry and brittle, peels off in mi- 
nute scales. 

4. Ascites results in those cases where the morbid mass is sufficiently 
large, and so situated that it impedes the portal circulation, by pressure 
upon its vessels, or it comes and grows with general dropsy, or it is due to 
chronic peritonitis, extending from the liver over the peritoneum. 



CARCINOMA HEPATIS. 607 

5. Disturbed nutrition and gastric symptojns are almost always present, 
but show nothing characteristic of this complaint. 

6. The spleen is very rarely enlarged. 

7. Fever is, as a rule, quite slight, amounting at the most to febrile mo- 
tions. Where we find high fever, it is occasioned by some other compli- 
cation. 

8. Hcemorrhages in the later stages we find in the interior of the tumor, 
and from this into the abdominal cavity, also from the stomach and intes- 
tines, from the mouth, nostrils and vagina, and in the form of petechias and 
ecchymoses upon the skin, similar to those of purpura and scurvy. 

The Diagnosis of cancer of the liver is by no means always easy. 
Where the characteristic enlargement and uneven surface of the liver has 
not yet been developed (in the incipient state of the disease), or where 
it does not develop sufficiently to be recognized, we will have to balance the 
following points : 

1. Can it be colloid liver? No; because it is not the result of syphilitic 
or mercurial cachexia, nor is it attended by enlargement of the spleen and 
albuminuria. 

2. Can it be fatty liver ? No; because it is not the result of tuberculosis 
or overfeeding. 

3. Can it be syphilitic inflammation of the liver? No; because there is 
no constitutional syphilis present. 

4. Can it be cirrhosis? No; because there is no enlargement of the 
spleen. 

5. Can it not be nutmeg liver? No; because there is no heart or lung 
disease for its foundation. After having thus narrowed the field of possi- 
bilities, we now observe, in addition, swollen jugular glands, which Virchow 
considers of great diagnostical importance, we ascertain whether there is any 
cancerous formation in any other organ, or a hereditary tendency to it. 

Further, it is among the rarest events that cancer of the liver co-exists 
with tuberculosis, organic heart diseases, typhus or acute exanthematic 
fevers ; while, on the contrary, it is frequently associated with other cancer- 
ous affections, especially within the abdominal cavity. Finally, we consider 
the age of the patient. Cancer seldom happens before the thirty-fifth year of 
age; usually between the years of fifty and sixty. 

THERAPEUTIC HINTS are rather a scarcity in this complaint. 
I do not know of a well-attested case that ever has been made known as 
cured. The principal remedies promising the best alleviating results are: 
Arsen., Bell ad., Carb. an., Conium, Hydrast., Lycop., Sepia, Silic, and others 
according to special indications. 



608 LIVEK. 

Hydatids of the Liver, Echinococcus-cysts. 

They consist of a thick, fibrous, white-glistening or yellowish sac of a 
roundish shape, and of various sizes, attaining even that of a child's head. 
The sac is lined on its inner surface by a half-transparent, gelatinous blad- 
der, which contains a watery, somewhat turbid fluid, in large quantities, and 
at the same time a number of smaller cysts, of the same structure, which 
again contain still smaller cysts, and so on to the fourth generation. Be- 
sides this, we observe, within these cysts and adhering to some part of their 
interior surface, groups of whitish granules, which are the scolices of taenia 
echinococcus. Under the microscope they appear with heads similar to that 
of the taenia solium or the common tape-worm ; having four sucking cups, in 
the middle of each of them a nozzle or snout, which is encircled by a double 
row of hooks. This echinococcus-cyst has been found in any and every part 
of the liver, sometimes singly, sometimes two, three or more in number. The 
parenchyma of the liver retains its integrity, and only where it is compressed 
by the foreign growth, its cells obliterate, and that part of the liver assumes, 
according to Rokitansky, sometimes a nutmeg-like appearance. The cysts 
themselves may undergo different changes. Their fluid contents may be 
converted into a cheesy substance, whereby the inmates perish, or the inner 
surface of the sac may become inflamed and lead to obliteration of the cyst, 
or the cyst may burst and pour its contents either into the abdominal cavity 
where it almost always causes a fatal peritonitis, or into other organs, with 
which, by previous inflammation, adhesions have been formed, exactly as in 
the case of an abscess of the liver. There are cases on record, where echino- 
coccus-cysts, by perforating the diaphragm, emptied their contents into the 
pleural cavity, from which they were discharged through the bronchial tubes, 
by means of abscess-formation in the lungs. There are cases also where they 
were discharged through the abdominal walls, or into the intestines, gall- 
bladder, or a large blood-vessel. Almost always such perforations are fol- 
lowed by a fatal termination, although, in favorable cases, where, for exam- 
ple, the discharge took place into the intestines, or through the abdominal 
walls, the cysts obliterated and a perfect cure followed. 

The echinococcus, when found in the liver, is also frequently found in 
other organs: the spleen, lungs, kidneys and the omentum. 

The essential Cause of the formation of hydatids is the swallowing of 
the ova or embryos of the taenia echinococcus, which pass from the stomach 
or intestine into the liver and there undergo development. This taenia 
echinococcus is a small tape-worm belonging to the dog, which explains the 
fact that hydatids are most frequently found in Iceland, where the dog is an 
indispensable domestic animal. 

Symptoms. — Of all liver diseases this complaint causes the least dis- 



CATARRHAL INFLAMMATION OF THE BILIARY PASSAGES. 609 

turbance in the system, and the occasional symptoms, caused by its pressure 
upon this or another organ, are of the least diagnostic value. Ouly when 
rupture and perforation take place, we observe, as in the case of liver ab- 
scesses, a series of violent symptoms, all of which are consequences of inflam- 
mation of those organs into which the perforation or rupture takes place. 

Our diagnosis is therefore confined to its physical signs alone. These 
are the following: 

1. A round, smooth, elastic swelling in the region of the liver. 

2. A sense of fluctuation on percussing the part in short, abrupt strokes, 
while the examining fingers of the other hand are held in close neighbor- 
hood. What Piorry has called the vibratory sense of hydatids is nothing 
more nor less than the above-mentioned sense of fluctuation; ascites or ova- 
rian cysts yield it just as clear, under certain conditions even clearer. 

Differential Diagnosis. — Liver abscess is attended by fever, pain 
and great constitutional disturbances. 

Distended gall-bladder is preceded by colicky pains, is usually accom- 
panied by jaundice, and the swelling corresponds to the normal position of 
the gall-bladder. 

Encysted pleuritic exudation does not alter the place of dull percussion 
sound on deep inspiration; while the outline of the dulness on percussion 
lowers considerably by deep inspiration in hydatids. 

Catarrhal Inflammation of the Biliary Passages. 

Anatomically it is characterized by similar changes as appear in 
catarrhal inflammation of other mucous membranes. Post-mortem exami- 
nation reveals the lining membrane to be pale or livid, softened, tumid, and 
covered with a tenacious, vitreous, or grayish-yellow, purulent secretion, 
which often produces firm plugs of mucus in the duodenal opening of the 
ductus choledochus, and a total stoppage to the flow of bile into the intestines. 
These changes are particularly found in the lower portion of the ductus cho- 
ledochus and in the gall-bladder, less frequently in the hepatic duct and its 
roots. 

In chronic cases the walls of the ducts become thickened and dilated, 
either uniformly over long tracts or in the shape of oval sacs. In these pools 
of stagnant secretion concrements are sometimes deposited, and in rare cases 
the walls of the ducts ulcerate. 

Catarrhal inflammation of the biliary passages is most frequently in- 
duced by inflammation of the stomach and intestines, sometimes by hyper- 
emia and chronic inflammation of the lower, and more rarely, by fatty and 
waxy degeneration. Its Symptoms correspond, therefore, with the symptoms 
of those ailments of which it is the result, always associated with the symp- 
39 



610 LIVER. 

toms of more or less intense jaundice and tenderness in the region of the liver. 
In a few cases the gall-bladder can be felt as a pear-shaped tumor at the 
margin of the liver. The jaundice lasts in most cases for some time after the 
gastric symptoms have disappeared. In cases dependent upon diseases of 
the hepatic parenchyma, the jaundice is of a fainter tint, and the digestion 
suffers less, but the symptoms are more apt to return. 

THERAPEUTIC HINTS —Compare catarrh of the stomach and in- 
testine, also jaundice and the other affections of the liver. 

In children the following are most frequently indicated: Chamom., or 
Merc. sol. Besides compare Bellad., Bryon., Nux vom., etc. 

Cholelithiasis, Gall-Stones. 

Gall-stones are made up of substances which are all contained in a state 
of solution in normal bile, with the exception of epithelium and mucus, both 
being furnished by the mucous membrane of the biliary passages. The prin- 
cipal constituent of gall-stones is cholesterine, although it is only sparingly 
contained in the bile ; but in virtue of its insolubility it contributes, as uric 
acid does to the formation of urinary calculi, the main portion to the forma- 
tion of gall-stones. Other constituents are the bile-pigments (cholepyrrhin 
of a brownish, cholechlorin of a green color) and their combinations with 
lime, the biliary acids and their calcareous salts, fatty acids and soaps, mucus 
and epithelium, uric acid and earths. 

In the biliary passages gall-stones occur in most cases, in numbers from 
five to ten or thirty, and occasionally even to more than a thousand. All of 
them which thus occur together, have almost invariably the same characters 
and composition, inasmuch as all of them owe their origin and growth to the 
same morbid process ; still exceptionally dissimilar calculi have been found 
in the same gall-bladder. Their size varies from that of a millet-seed to that 
of a hen's egg; their form is primarily globular, but changes during their 
subsequent growth in many ways ; very large stones usually assume an egg- 
shaped or cylindrical form, corresponding to the form of the gall-bladder; 
some stones present a warty or mulberry form, others but rarely found, are 
flattened, leaf-like concretions with black, metallic glistening surfaces, and 
still others are the branched varieties which form a cast of the bile-ducts in 
which they are developed. Their color is in most cases brownish or greenish- 
yellow, but all shades of color are met with, from snow-white to coal-black. 
Their specific gravity is heavier than water, but dried specimens will float on 
water because they contain air. Their structure varies exceedingly. In 
simple homogeneous calculi it is of a uniform texture, and presents an earthy, 
saponaceous, or crystalline fracture, according to their composition of earthy 



CHOLELITHIASIS. 611 

matter, or of bile-resin and its calcareous compounds, or of pure crystallized 
cholesterine. In compound calculi, we observe a central portion or nucleus, a 
shell of greater or less thickness surrounding the nucleus, and an outer crust 
covering the shell. The nucleus consists either of the compound of chole- 
pyrrhin and lime, or of foreign bodies (a small clot of blood, a worm, a 
needle, a plum-stone). The shell is usually striated, and consists of crystals 
of cholesterine, or in rarer cases it surrounds the nucleus in concentric laminae, 
like the layers of an onion, or it is devoid of all structure, of a soapy or earthy 
character. The external crust is of various thickness; it covers the shell 
either in a uniform manner, or is thicker on one portion than on the other ; 
it is not unfrequently covered with warty prominences, and its composition 
and color varies greatly according to the constituents of which it is composed. 

In addition to the gall-stones proper, pulverulent or gritty deposits, 
similar to those which are met with in the urinary passages, are found in the 
excretory apparatus of the liver. 

Not unfrequently gall-stones exhibit indications of commencing dis- 
integration ; their angles and edges disappear, and their substance is eaten 
away by erosions, resembling caries of the teeth, penetrating through several 
# layers, an effect undoubtedly produced by chemical action. Gall-stones may 
also be destroyed by cleaveage. 

Their mode of origin is still not fully explained. However, stagnation 
and decomposition of bile seem to constitute the primary cause of the forma- 
tion of gall-stones. The stagnation of bile is favored by repeated attacks of 
catarrh of the biliary passages, by cancer of the liver and other hepatic 
affections, and also by sedentary habits of life. The decomposition of bile is 
dependent upon physiological processes, the nature of which has thus far not 
been revealed. The tendency to gall-stones increases with the advance of 
life ; before thirty years of age they are rarely observed. Females are more 
liable to gall-stones than males. 

Gall-stones are found rarely in the hepatic duct and its branches, but 
most frequently and in largest numbers in the gall-bladder, which they ma} r 
leave by passing through the cystic duct into the ductus communis and from 
this into the duodenum ; or they may escape by fistulous openings into the 
stomach or intestine, or externally through the abdominal wall. Through 
the ductus choledochus all concretions pass which leave the liver, whether 
they have their origin in the hepatic duct or in the gall-bladder; they, as a 
rule, obstruct the duct and interrupt the excretion of bile. . 

Symptoms. — Gall-stones may lie for years in the gall-blader without 
giving rise to any symptoms whatever. But if they are washed from the 
gall-bladder, into the cystic duct, they cause, unless they are very small, the 
most violent symptoms, known under the name of " Gall-stone colic." 
Usually a few hours after a meal, when the contents of the gall-bladder are 



612 LIVER. 

poured into the duodenum, or in consequence of lifting a heavy load, or after 
mental emotions, an excruciating pain, of a boring and burning character, 
is felt in the right hypochondrium and epigastrium, radiating down to the 
navel, back to the spine, upwards into the chest, to the shoulder-blades and 
neck, and even down the arms to the very fingers' ends. The slightest touch 
increases the pain. It is attended with vomiting, great restlessness, singultus, 
even convulsions, delirium, syncope and speechlessness. In some cases the 
attack commences with rigors, often followed by heat and sweating, the 
temperature rising to between 99.5° and 104.9° F., and the pulse to between 
92 and 120. Oftener, however, the pulse is small and of normal frequency, 
or even slower than normal. Jaundice is absent at first, or only slight, and 
becomes marked only when the calculus fills up the ductus choledochus. 
The duration of hepatic colic varies greatly ; it may pass off in a few hours, 
or last for many days. In the latter case the pain recurs in paroxysms until 
the duct becomes so far dilated as to permit the calculus to pass. Sometimes 
the calculus, after entering the cystic duct, may return into the gall-bladder, 
when the pain likewise ceases, and in such cases no concretions are found in 
the stools. But when the calculus remains firmly impacted in the cystic 
duct, and completely closes up the neck of the gall-bladder, the colicky pains % 
gradually subside, and there only remains a sensation of tightness or pricking, 
while the gall-bladder, incapacitated of emptying itself, gradually becomes 
largely distended (Hydrops cystidis felleae), which may terminate at last 
in a destruction of this organ and consequent fatal peritonitis. 

Stones in the ductus choledochus usually excite less pain on account of 
the greater capacity of this duct, and when entering the ductus communis 
the pain ceases altogether; but reaching the abdominal opening, the pain 
returns with renewed severity until the excretions have passed into the in- 
testine. As long as a stone remains in the ductus choledochus, the bile is 
more or less completely shut off from the bowel, and jaundice makes its ap- 
pearance, growing the more intense the longer the obstruction lasts. 

The Diagnosis is easy, where we find the gall-stones passed off in the 
stools, or where we can feel them in the gall-bladder. The whole row of 
symptoms as described above is characteristic. Jaundice, although not a 
constant symptom, is nevertheless connected with the other symptoms of 
great diagnostical value. 

THERAPEUTIC HINTS.— Bellad., during the colic, is the most 
important remedy. 

B apt is., pain in the region of the gall-bladder, forcing the patient to 
stir about, although motion is painful. 

Berber., has been advised as curing quickly and permanently. (J. 
Angell.) 



THROMBOSIS AND OCCLUSION OF THE PORTAL VEIN. 613 

Chelid., with pain through under the right shoulder-blade. 

China, is indicated by "all the symptoms which arise from obstruction 
in the gall-bladder; the colic; the periodicity of its recurrence, though the 
periods of its return are often very unequal and irregular; the yellowness of 
the skin and conjunctiva; the constipated state of the bowels; the scybalated 
character of the dark, greenish stools, the scybala varying in size from that 
of the largest nutmeg to that of sheep-dung, and even smaller than the 
smallest peas." "I give usually China 6 , six pills twice a day, till ten doses 
are taken ; then six pills every other day till ten doses are taken, etc., till at 
length the dose is taken only once a month." "I have not failed in a single 
instance to cure, permanently and radically, every patient with gall-stone 
colic who has taken the remedy as above directed." (David Thayer.) 

Coloc, twisting, boring pain in the stomach, relieved by pressure; 
rending, tearing pain, extending up to the right mamma ; nausea with cold- 
ness of tire extremities. (R. Arnold.) 

Caesium. (Baruch.) 

Besides these the following remedies have been recommended: Alum., 
Apomorph., Arsen., Calc. carb., gall-stones triturated (German physi- 
cians), Card, mar., (Rademacher), Chionauthus, Evon., Chlorof., Hepar, 
Laches., Lycop., Mercur. (Porges), Nux mosch., Nux vom., Opium, 
Osmium, Podoph., Silic, Sulphur, Tereb. (Mossa), Thuja, Ver. alb. 

Olive oil is believed to dissolve some kinds of gall-stones, if taken in 
doses of three to four ounces each night for four nights. (C. I). Fairbank.) 

Thrombosis and Occlusion of the Portal Vein; Pylethrom- 
bosis; Pylephlebitis Adhaesiva Chronica. 

The portal vein derives its venous blood from the stomach, intestines, 
spleen and pancreas. It is divided into two chief branches for the right and 
left lobes of the liver in front of the transverse fissure. These two branches 
are further subdivided till they finally end in the terminals, or the so-called 
interlobular veins from which the capillary system of the hepatic lobules 
originates. From the capillaries of each acinus the blood is carried by the 
so-called vena centralis lobuli into the hepatic veins, and from the latter into 
the inferior vena cava. The radicles, trunk, and the hepatic ramifications 
of the portal vein are all destitute of valves. The blood flows in the portal 
vein under very slight pressure and with slight rapidity. Stasis of blood in 
its territory, therefore, occurs very readily, giving rise to ectasia, dilatation, 
and sinuosity of the vessels, and to coagulation of the blood contained in 
them. In addition to the slight vis a tergo, inspiration acts as a motive 
force, accelerating the blood-current in the portal vein, while expiration 
rather retards it. 



614 LIVER. 

From this it may be seen that coagula or thrombi may be developed in 
the portal vein as well as in other parts of the venous system. Their most 
frequent Causes are local disturbances of the circulation of blood, resulting 
from granular induration, cirrhosis and chronic atrophy of the liver, by 
which a destruction of numerous capillaries or a constriction of the branches 
of the portal vein is induced. 

Less often the same effect may be produced in consequence of weakened 
force of the circulation, from diminished action of the heart; or from maras- 
mus, and cases have also been observed where thrombosis of the portal vein 
was the result from compression of the vessel below the liver by contractile 
connective tissue, and by tumors of various kinds. 

The Symptoms of occlusion of the portal veins are, besides those which 
are characteristic to the diseases which lead to it: ascites, which in a few 
days attains an extraordinary amount, and which immediately returns after 
the performance of paracentesis ; the superficial veins of the abdominal pari- 
etes enlarge and extend in the form of thick cords from the abdomen over 
the lower part of the thorax towards the axillse ; the spleen increases in size ; 
diarrhoea supervenes, of a watery, or often bloody character, not unfrequently 
accompanied by vomiting; the urine is scanty and dense; the patients de- 
cline rapidly and present a pale, cachectic appearance. The termination of 
the disease is, perhaps, without exception, fatal. 

Pylephlebitis Suppurativa, Purulent Inflammation of the 

Portal Vein. 

In this affection the thrombus softens from the centre into a dirty 
grayish-red pulp and afterwards dissolves more or less completely into a 
purulent fluid. The wall of the vein is thickened, softened, and infiltrated 
with exudation; its inner coat is discolored, red, brownish, or greenish- 
yellow, wrinkled, and not unfrequently torn and covered with fibrinous 
layers, or fluid pus. These alterations may spread to the hepatic branches 
of the portal vein, and even to its roots. 

It may be Produced by a direct lesion of the vascular walls (traumatic 
pylephlebitis), to which the pylephlebitis of the newborn belongs starting 
from the umbilicus ; or by an inflammatory or ulcerative focus within those 
organs from which the radicles of the portal vein start ; or by suppuration 
in the vicinity of the csecum and its vermiform appendix (perityphlitis) ; or 
by a purulent or ichorous focus in the spleen ; or by purulent deposits be- 
tween the layers of the mesentery, due to disease of the lymphatic glands ; 
or by diseased conditions of the liver, the biliary passages, or in Glisson's 
capsule and the hepatico-duodenal ligament. 

Besides the Symptoms which belong to the disorders of which pylephle- 



ICTERUS, CHOLJEMIA, JAUNDICE. 615 

bitis is the result, its commencement is marked by pains in the epigastrium, 
the right or left hypochondrium, the csecal or umbilical region, according as 
the trunk or one of the radicles of the vein is first diseased. This is soon 
followed by rigors, heat and profuse sweating, often recurring without any 
certain type. Liver and spleen, as a rule, increase in size, and the skin and 
urine become jaundiced. The stools are copious, thin and bilious, only ex- 
ceptionally constipated. Later symptoms of diffuse peritonitis, painful dis- 
tention of the abdomen, vomiting, etc., usually supervene; the patients 
rapidly lose flesh and strength; the fever assumes a hectic character, and ul- 
timately delirium or somnolence is developed and termiuates in death. This 
series of symptoms may run its course in one or two to four or six w T eeks, 
oftentimes with several deceitful remissions. If its development could not 
be prevented its cure will scarcely be possible. 

Icterus, Cholaemia, Jaundice. 

Jaundice is not a disease, but only a symptom, and consists of a yellow 
discoloration of the skin by the deposition of the coloring constituents of 
bile, namely: biliary pigment, biliphsein, cholepyrrhin. 

The so-called liver-spots (chloasmata, maculae hepaticse) have no relation 
to the diseases of the liver, but are partial deposits of pigment from various 
causes ; and in some cases yellow discoloration is a disease of the skin of the 
chest, pityriasis versicolor, which consists of vegetable parasites. The yel- 
low discoloration of icterus varies greatly in degree, from a slight and light 
yellow through all shades to a blackish, and greenish-brown color. 

It is now conceded on all sides, but still not fully explained by experi- 
ments, that jaundice may originate in two different ways. First, by obstruc- 
tion to the escape of bile from the secreting gland (hepatogenous cholcemia), 
and secondly, by some alteration in the metamorphosis of substances con- 
tained in the blood {hoematogenous cholcemia, or blood icterus). 

1. Hepatogenous Cholaemia which owes its origin to a mechanical 
impediment to the excretion of bile, and its resorption into the blood, is the 
best understood form of the two. The passage of the bile into the circula- 
tion seems, according to recent demonstrations, to take place almost exclu- 
sively by way of the thoracic duct, which would afford additional support to 
the theory, that there is between the secretory cells and the blood-capillaries 
of the liver, quite an extensive system of channels for the flow of lymph, 
and obviate at the same time the difficulty of understanding the mode how 
the bile could be infiltrated into the blood-capillaries which are everywhere 
separated from the gall-capillaries by the cellular substance of the liver. 

The Causes, of which stagnation of bile is the result, are very manifold. 
The ductus choledochus and hepaticus may become obstructed ; by catarrh of 



616 LIVER. 

their lining mucous membrane, as in icterus catarrhalis ; by accumulation of 
fecal matter in the large intestines, or a pregnant uterus ; by enlargement of 
the lymphatic glands in the fissure of the liver from lardaceous, tubercular, 
or cancerous infiltrations; by concretions in their own channel, usually at- 
tended with colic; by adhesions of their walls in consequence of exudative 
processes; by carcinomatus growths from the lining mucous membrane of 
their walls, or of the pylorus, of the duodenum, of the head of the pancreas, 
or by tumors in the liver. 

The biliary passages within the liver may become compressed, or con- 
stricted by a large number of morbid alterations of the liver, such as cancer, 
echinococci, cirrhosis, etc. ; by stagnation of blood in the hepatic vein in con- 
sequence of organic cardiac diseases, and diseases of the lungs and pleura, in 
which affections the acceleration or retardation in the respiratory movement 
of the diaphragm exerts also a great influence, which may be sufficient to 
cause an obstruction to the flow of bile. 

The Symptoms of a stoppage of bile and its accumulation in the blood, 
manifest themselves in a jaundiced discoloration of the liver, of the serous 
exudations, and of the secretions, especially those of the kidneys and skin. 
The urine becomes saffron-yellow, reddish-brown, dark brown, greenish- 
brown, or brownish-black, accordiug to the quantity and quality of the bile- 
pigment which enters into it. The best reagent is nitric acid which is not 
altogether free from nitrous acid. By adding the concentrated acid, drop 
by drop into a small glass containing urine, the well-known play of colors 
from brown to green, blue, violet and red will be seen arranged in layers, 
one above another, like a rainbow. The sweat, especially of the axilla, colors 
the white linen yellow, and so also have the sputa in bilious pneumonia a 
brown, or usually, a leek-green color. With this tinging of the secretions 
with pigment goes hand in hand the discoloration of the tissues. The skin 
assumes a pale, sulphur yellow, later a saffron or citron yellow, or an olive 
or bronzed color, according to the intensity and duration of the disease. 
This discoloration is seen first on those places where the epidermis is thin, 
for instance on the nose-wings, the angles of the mouth, the forehead and 
neck. As the coloring proceeds from the deeper layers of the epidermis, the 
yellow color of the skin remains until desquamation of the epidermis has 
been accomplished, which does not take place sometimes till long after the 
removal of the causes of the jaundice and the disappearance of the coloring- 
matter from the urine. The mucous membranes become only slightly tinged, 
but the coloring matter penetrates into all tissues : the adipose cellular tissue, 
the serous and fibrous membranes, the areolar tissue, the walls of the blood- 
vessels and of the lymphatics, and the substances of the bones and of the 
teeth. The cartilage, brain and nerves are less affected. When the brain 
appears yellow, the discoloration proceeds from infiltration of the cerebral 



ICTERUS, CHOUEMIA, JAUNDICE. 617 

substance with yellow serum. In the eye the jaundice color extends over all 
membranes, humors, and especially the vitreous body. In pregnant women 
even the foetus participates in the yellow color. The nervous system exhibits 
occasionally the following abnormal conditions: Itchiness of the skin; de- 
rangement of the general sensations, such as sadness and peevishness of temper, 
headache, giddiness, great exhaustion and debility ; yellow sight or xanthopsy, 
bitter taste by clean tongue; slow pulse, in most cases 50 or 40 beats in a 
minute, in some cases still lower; the temperature in simple cases remains 
unchanged. 

The symptoms of the digestive organs, the most important in a practical 
sense, is the change in color of the feces. A total absence of bile makes the 
stools ash or clay-colored, with a tendency to constipation ; a partial want of 
bile merely makes them paler than usual. 

The Duration and Prognosis of jaundice depends principally upon 
its primary causes. 

2. Hematogenous cholaeinia, blood-icterus, seems to be caused by 
some alteration in the metamorphosis of substances contained in the blood 
not fully understood yet ; it runs its course independently of any influence ex- 
erted by the liver and without any detectable mechanical impediment to the 
excretion of bile. To this class belong jaundice from the effects of ether, 
chloroform and phosphorus, from snake-bites, from pyseinic infection of the 
blood, from swamp fever, typhus and relapsing fever, and from yellow fever. 

Jaundice from violent mental emotions, especially vexation, anger, 
fright, etc., seems likely to be produced by iuterruptions to the circulation 
of blood through the liver in consequence of the influence of the nerves ex- 
erted over the calibre of the branches of the portal vein, and by interrup- 
tions to the heart's action, the respiratory movements and the renal secretion. 

Icterus menstrualis is probably produced by sudden changes in the 
blood pressure in the portal vein. 

Icterus gravidarum, which makes its appearance in the latter months 
of pregnancy, is produced by the pressure of the distended uterus, or by ac- 
cumulation of fecal matter in the colon, upon the biliary ducts, or it is char- 
acterized by serious derangements of the nervous system, and, so far as cases 
of this kind have as yet been examined, depends upon acute atrophy of the 
liver and diseased kidneys. 

Icterus neonatorum appears soon after birth, and in ordinary cases 
seems to be produced by the diminished tension of the capillaries in the 
hepatic tissue, which takes place upon the stoppage of the influx of blood 
from the umbilical vein, and which gives rise to an increased transfusion of 
bile into the blood. A graver form is that in consequence of phlebitis um- 
bilicalis followed by purulent infection. In some cases it may be produced 



618 LIVER. 

by a catarrh of the duodenum or an accumulation of mucus within the gall- 
ducts. 

Jaundice of newborn children must not be confounded with the slight 
yellowish discoloration of the skin, which, in most children, is seen a few 
days after birth and is nothing but a change of color of the hsematin, which, 
in consequence of the great hyperemia of the skin after birth, becomes de- 
posited in the skin. In such cases the yellow color of the white of the eye is 
absent. 

Dr. Quine makes the following remarks upon the significance of jaun- 
dice in diagnosis: "1. Jaundice occurring suddenly in apparent health, and 
painlessly, is usually of emotional origin and transitory. 2. "When it depends 
on disease or injury of the brain, acute atrophy of the liver, snake-poisoning, 
or infectious fever, it is always associated with mental disturbances. 3. If it 
be attended with fever and well marked, it is secondary to inflammation of 
the biliary passages, pneumonia, toxaemia, or infective inflammation of the 
portal vein. 4. If it occur suddenly and is preceded by paroxysmal pain 
and vomiting, it is caused nine times out of ten by biliary calculi. 5. If it 
is preceded by typical symptoms of gastro-duodenitis, it is obviously of catar- 
rhal origin. 6. Impassable obstruction of the common duct is shown by 
great intensity of jaundice, clay-colored stools, and in recent cases by disten- 
tion of the gall-bladder. 7. Jaundice caused by sudden obstruction of the 
biliary passages is always associated with paroxysmal pain and nausea, but 
there is no means of ascertaining the nature of the obstructing body except 
its discovery in the stools. 8. In the rare cases of sudden obstruction by 
cancerous, hydatid and aneurismal tumors, there is almost always a history 
of impaired health, enlargement and deformity of the liver, ascites, etc., which, 
aided by the revelations of physical exploration, will lead to correct differen- 
tiation. 9. Sudden return to normal coloration of the feces confirms the 
diagnosis of obstruction. 10. Occlusion of the cystic duct may be attended 
with as much pain, nausea and distention of the gall-bladder as occlusion of 
the common duct, but there is no jaundice. In occlusion of the hepatic duct, 
the same symptoms are present, including jaundice and excluding distention 
of the gall-bladder. It is often impossible to distinguish between occlusion 
of the hepatic and of the common duct. The former is rare because the duct 
increases in size from above downwards. 11. If jaundice persists after the 
symptoms of biliary colic or catarrhal inflammation have a month since dis- 
appeared, or if jaundice has disappeared after a biliary colic to return slowly 
and painlessly, it may be assumed that stricture of the duct has resulted from 
inflammatory thickening, adhesion of the walls or cicatrization of an ulcer. 

12. A history of repeated attacks points to the probability of gall-stones. 

13. If jaundice comes on slowly without antecedent colic or catarrh, and 
without attendant evidence of impaired health or portal obstruction, it is 



619 

probably caused either by pressure upon the duct or by the growth of a 
tumor within its walls. The pressing body, when large enough, may be 
readily appreciated, as in the case of ovarian tumor, aneurism, distended 
colon, etc., but when it is small or constituted by enlargement of lymphatics 
in the fissure of the liver, it is apt to escape detection. 14. Slight but per- 
sistent jaundice may be due to incomplete occlusion of the common duct, or 
to complete occlusion of a branch of the hepatic, but usually it is found asso- 
ciated with either valvular disease of the heart, some disease of the lungs 
which obstructs the circulation, or cirrhosis of the liver. 15. If ascites be 
associated with it, the disease is either cirrhosis or cancer of the liver ; if the 
liver be abnormally small, the disease is cirrhosis ; if it be large, the disease 
is either hypertrophic cirrhosis or cancer. Differentiation between the two 
is seldom attended with difficulty. 16. Absence of jaundice does not imply 
absence of hepatic disease, since the liver may be destroyed by disease or 
extirpated by operation without jaundice ensuing. 17. It is not a prominent 
symptom of hepatitis, if catarrhal inflammation of biliary passages be rigidly 
excluded. It is not characteristic of hepatic abscess when at most mere mud- 
diness of the complexion is usually seen. It is not a symptom of waxy or 
fatty liver or of hydatids excepting as an extraordinary complication." 
{Medical Times and Gazette.*) 

THERAPEUTIC HINTS.— Aeon., pain changing about from the 
stomach to the liver, or to the navel ; fever, great thirst ; catarrh of small 
intestines ; constipation or diarrhoea, sometimes in alternation ; during preg- 
nancy ; in newborn children ; after fright. 

Arsen., in different liver affections; in consequence of intermittent 
fevers ; heat, restlessness, anxiety, irritable mood alternating with low-spir- 
itedness. 

Aurum, pain in the liver and upper part of the abdomen; bowels con- 
stipated; stool grayish, ashy; urine scanty, green, brownish; lower extremi- 
ties, from the knees down to the feet, painful and tired. 

Bellad., after the abuse of Peruvian bark or mercury; in complication 
with stones in the gall-bladder; hardness of the liver; congestion to the head. 

Berber., spells of icterus with pale, tough alvine discharges, or profuse, 
acrid, watery diarrhoea; urine dark, turbid, with copious sediment; morbid 
hunger alternating with loathing of food, or great thirst alternating with 
aversion to all kinds of drink ; constant, troublesome bloatedness of the ab- 
domen, with occasional forcible and noisy discharge of flatus. 

Bryon., stitching pain on pressure in the liver; pressure in the pit of 
the stomach; pain in the limbs, worse from motion; obstinate constipation; 
thick, white, coated tongue; nausea; gagging; vomiting after eating and 
drinking; general malaise; disinclination to move. 



620 LIVER. 

Calc. carb., stitches in the liver during or after stooping; cannot bear 
tight clothing around the waist ; enlargement of the liver ; habitual constipa- 
tion ; grayish, whitish feces ; indigestion ; pit of the stomach swollen out like 
a saucer turned bottom up. 

Card, mar., in complication with gall-stones; great sensitiveness of the 
head to cold ; loss of memory and smell ; colicky pains in the stomach, w T ith 
waterbrash ; vomiting. 

Carb. veg., psoric taint; scorbutic and intermittent fevers; cachexia; 
irritable, vehement disposition ; loathing of meat, butter, fat ; constipation, 
or pale, whitish stools; dark red, bloody-looking urine. 

Chamom., after chagrin, imprudent diet, or taking cold; in newborn 
children. 

Chelid., pain in the liver, and in the back under the lower corner of 
the right shoulder-blade ; very irregular pulsations of the heart. 

China, gastro-duodenal catarrh, particularly after great loss of animal 
fluids, or after heavy illness; dulness. and muddled condition of the head; 
oppressive, tearing headache, particularly at night; restless, unrefreshing 
sleep ; yellow coating of the tongue ; dry lips ; loss of appetite ; loathing of 
meat; loathing, and yet canine hunger; bitter or sour eructations and taste; 
gagging; oppression of the stomach and chest, especially after eating; fre- 
quent whitish stools; emission of fetid flatulence without relief; great languor, 
out of humor, and vehement. Gall-stones. 

Conium, hard swelling of the liver; glandular swellings elsewhere; 
the flow of urine stops suddenly, but continues again after a while; cough 
worse after lying down. 

Digit., constant nausea and gagging, with a clear tongue covered with 
white slime; soreness and bloatedness of the pit of the stomach ; soreness and 
hardness in the region of the liver ; stool delayed, chalky ; urine scanty, thick, 
turbid, blackish ; pulse full, slow ; chilliness and shuddering alternating with 
heat; tearful, low-spirited. 

Fel tauri, violent pain in the bowels with thin stools, which are followed 
after straining by crumbling masses. 

Gels em., prostration; clay-colored, creamy stools. 

Hepar, especially after mercurial poisoning. 

Hydrast., gastro-duodenal catarrh; sense of sinking and prostration 
at the epigastrium, with violent and continued palpitation of the heart. 

Ignat., silent melancholy ; twitching of one muscle at a time, (dishing.) 

Iodium, dirty, yellowish skin; great emaciation; downcast, irritable 
mood ; yellow, almost dark brown, color of the face ; thick coating of the 
tongue; much thirst; intense canine hunger all the time, with vomiting after 
eating ; white diarrhceic stools alternating with constipation ; dark, yellowish- 



ICTERUS, CHOL-EMIA, JAUNDICE. 621 

green, corroding urine; after mercurial poisoning; organic lesions of the 
liver ; dyscratic states of the system with hectic fever. 

Kali carb., swelling of the liver; stitch-pain in the right side of the 
chest through to the shoulder; pressive, sprained pain in the liver; can lie 
only on the right side; complete exhaustion; neither thirst nor appetite; 
purulent sediment in the urine ; abscess of the liver. 

Laches., in different liver complaints; during the climacteric age; 
after intermittent fevers ; pain as if something had lodged in the right side, 
with stinging and sensation as if forming into a lump moving towards the 
stomach; inability to bear anything tight around the waist, not even the 
pressure of the night-jacket; pain when coughing as if ulcerated. 

Leptand., full, aching pain in the region of the gall-bladder; hot 
aching pain in the liver extending to the spine ; with chilliness along the 
spine; clay- colored diarrhoea. 

Lycop., chronic liver complaints ; after fright; obstinate constipation ; 
incarcerated flatulence ; chronic intestinal catarrh. 

Magn. mur., chronic hard swelling of the liver, with pressive pain 
extending to back and stomach; face dirty, dark yellow; tongue dirty, 
yellowish; bowels distended and hard with pressure and heaviness; stool 
hard, gray; urine turbid; dyspnoea; palpitation of the heart; oedema of the 
feet up to the calves of the legs; weak, emaciated; fearful, easily frightened. 

Mercur., one of the most frequently indicated remedies, with and with- 
out fever; duodenal catarrh, with thickly coated, flabby tongue, showing the 
imprints of the teeth ; bad smell from the mouth ; nausea ; loathing ; vomit- 
ing; soreness in the region of the liver; diarrhoea; gall-stones; jaundice ot 
newborn children ; after abuse of Peruvian bark. 

Myrica cerif., dragging pain in the back; miserable feeling all over; 
dull pain in the hepatic region ; tongue thickly coated of a dirty white or 
yellowish color ; no appetite, loathing of food, strong desire for acids ; sleep- 
lessness, unrefreshing sleep. 

Nitr. ac, in consequence of chronic derangements of the liver ; costive- 
ness; great tearing pain in the rectum, continuing a long time after stool, 
even more intense after a loose stool. 

Nux vom., gastro-duodenal catarrh ; after allopathic dosing, overloading 
the stomach, the use of coffee, liquor, in sedentary habits, after anger. In 
complication with gall-stones. Headache, dizziness, loss of appetite, bitter 
taste; nausea, vomiting, gagging; pressure in the stomach, better from 
belching, soreness of pit, stomach and bowels; unsuccessful urging to stool, 
constipation. Itching of the skin in the evening; restless sleep; wakes about 
three or four o'clock in the morning and falls again into a heavy, unrefreshing 
morning sleep; peevish, irritable. 

Phosphor., in complication with pneumonia or deep-seated brain 



622 LIVER. 

diseases. Atrophy of the liver; during pregnancy, with dry cough and in- 
voluntary discharge of urine; constant chilliness, even in a warm room; 
dejected spirits; aphonia and hoarseness. 

Plumbum, nausea in evening or at night; vomiting of food; restless, 
broken sleep. 

Podoph., in complication with gall-stone; then the pain extends from 
the region of the stomach towards the region of the gall-bladder, and, when 
at its height, is mostly attended with excessive nausea ; or in complication 
with inflammatory or hypersemic states of the liver; then there is a fulness, 
with pain and soreness, in the right hypochondrium ; chronic costiveness or 
alternate constipation and diarrhoea. 

Pulsat., in consequence of chronic susceptibility to hepatitis and de- 
rangement of the secretion of bile, with looseness of the bowels; duodenal 
catarrh ; disordered digestion ; feverishness and thirstlessness ; after quinine. 

Rheum, in consequence of eating unripe fruit, and accompanied w T ith 
white diarrhoea. 

Sepia, with pain confined to the liver; yellow saddle across the bridge 
of the nose ; brown, yellowish color of the eyelids. 

Silic, hardness and swelling of the region of the liver; throbbing, ul- 
cerative pain in the right hypochondrium, increased by contact and walking. 

Sulphur, in psoric persons, with or without hardness and swelling of 
the liver ; vomiting of ingesta or blood ; pain in the pit of the stomach and 
right hypochondrium ; abdomen bloated ; stool constipated ; sleeplessness ; 
nightly itching of the skin ; hectic fever ; red lips. 

According to Hartman compare, if icterus be caused by chagrin or 
anger: Aeon., Bryon., Chamom., China, Ignat., Nux vom., Natr. mur., 
Sulphur. 

By taking cold in consequence of sudden changes of temperature : Chamom., 
Dulcam., Merc, sol., Nux vom. 

By improper food and overloading the stomach: Ant. crud., Bryon., 
Carb. veg., Chamom., Natr. carb., Nux vom., Pulsat. 

By the abuse of chamomile tea: China., Ignat., Nux vom., Pulsat. 

By the abuse of mercury: Arsen., Asaf., China, Hepar, Iodium, Nitr. ac, 
Sulphur. 

By the abuse of Peruvian bark: Arsen., Ipec, Mercur., Pulsat. 

If being attended with much flatulence, according to Boenninghausen : 
Carb. veg., Chamom., China, Ignat., Lycop., Nux vom., Plumbum. 



DIGEST TO JAUNDICE. 



623 



Digest to Jaundice, 



Tearful: Digit 

Silent, melancholy: Ignat. 

Anxiety : Arsen. 

Fearful and easily frightened: Magn. 

mur. 
Low-spirited: Arsen., Digit, Iodium, 

Phosphor. 
Irritable : Arsen , Carb. veg., Iodium, Nux 

vom. 

and peevish : Nux vom. 

Out of humor and vehement : China. 
Miserable feeling all over : Myriea. 
Dizziness : Nux vom. 
Dull and muddled in head: China. 
Congestion to head : Bellad. 
Headache worse in night : China. 
Head sensitive to cold : Card. mar. 



Eyelids brown, yellowish : Sepia. 

Face yellow, almost dark brown : Iodium. 

, dirty : Iodium, Magn. mur. 

Yellow saddle across bridge of nose: 

Sepia. 
Loss of smell and taste: Card. mar. 
Lips dry : China. 

red: Sulphur. 

Tongue clear, covered with white slime: 
Digit. 

coated thick : Bryon., Iodium, Mercur. 

white : Myriea. 

yellowish : China, Magn. mur., 

Myriea. 

flabby, showing imprints of teeth : 

Mercur. 
Taste bitter: China, Nux vom. 
Bad smell from mouth : Mercur 
Appetite, loss of: Kali carb., Myriea, Nux 

vom. 
Loathing of food: Mercur., Myriea. 

meat, butter, fat: Carb. veg. 

food and yet morbid hunger : Berber., 

China. 
Canine hunger with vomiting after eat- 
ing: Iodium. 
Desire for acids : Myriea. 
Thirst : Aeon., Iodium. 



Thirst alternating with aversion to all 
kinds of drink : Berber. 

Thirstless : Kali carb., Pulsat. 

Eructation, bitter: China. 

N*ausea : Bryon., Plumbum, Podoph. 

and vomiting: Card, mar., Nux vom., 

Plumbum. 

Vomiting after eating with canine hun- 
ger: Iodium. 

or drinking : Bryon., Sulphur. 

Gagging : Bryon., China, Digit 

Pit of stomach sinking with palpitation : 
Hydrast 

sore : Digit., Nux vom. 

, presure in : Bryon. 

, better from belching : Nux vom. 

swollen out like a saucer turned bot- 
tom up: Calc. carb. 

Oppression of stomach and chest, after 
eating: China. 



Abdomen bloated: Berber., Sulphur. 

, hard, with pressure and heavi- 
ness: Magn. mur. 

Duodenal catarrh: Aeon, Chamom., 
China, Hydrast, Mercur., Nux vom., Pul- 
sat 

Colicky pains with waterbrash: Card. 



Liver, hardness of: Bellad., Conium, Magn. 

mur., Silic, Sulphur. 
, swelling of: Calc. carb., Conium, Kali 

carb., Magn. mur., Silis., Sulphur. 

, pain in : Sapia. 

, dull pain: Myriea. 

, soreness in : Mercur., Podoph. 

, sprained, pressive pain : Kali carb. 

, stitching on pressure or motion: 

Bryon. 
, , during and after stooping : Calc. 

carb. 
, ulceration, worse from contact and 

walking: Silic. 
, pain in, and pit of stomach : Sulphur. 



624 



LIVER. 



Liver, like a lump moving towards stom- 
ach: Laches. 

, pain in, and upper part of abdomen: 

Aurum. 

■ , pain changing to stomach or to 

navel : Aeon. 

, pain in, and stomach and gall-blad- 
der: Podoph. 

, aching in, and gall-bladder : Leptand. 

, pain in, extending to spine : Leptand. 

, , extending to back and stomach : 

Magn. mur. 

stitch-pain through to shoulder: Kali 

carb. 

, pain in, and lower corner of right 

shoulder-blade : Chelid. 

Cannot bear anything tight around 
waist: Cole, carb., Laches. 



Constipation : Aurum, Bryon., Calc. carb. 
Carb. veg., Lycop., Nitr. ac, Nux vom., 
Podoph., Sulphur. 

and diarrhoea in alternation: Aeon., 

Iodium, Podoph. 

Diarrhoea: Berber., Leptand., Mercur., 
Pulsat., Bheum. 

with straining, with passing crumb- 
ling masses: Feltauri. 

, with long-continuing pain in rectum 

afterwards: Nitr. ac. 
Stool, ashy, grayish, clay-colored, creamy, 

pale, whitish: Aeon., Calc. carb., Carb. 

veg., China, Digit, Gelsem., Leptand., Buta. 
Flatulence: Berber., Carb. veg., China, 

Ignat., Lycop., Nux vom., Plumbum. 
Urine, its flow is suddenly interrupted for 

a short time : Conium. 

, squirting when coughing: Phosphor. 

— — , turbid : Berber., Digit., Magn. mur. 

, scanty: Aurum, Digit. 

, thick, blackish: Digit. 

, brownish, green : Aurum. 

, dark, yellowish-green, corroding: 

Iodium. 

, dark red, bloody looking : Carb. veg. 

Sediment, copious: Berber. 
, purulent : Kali carb. 



Aphonia and hoarseness : Phosphor. 



Dyspnoea: Magn. mur. 

Cough worse after lying down : Conium. 

with pain as if ulcerated : Laches. 

dry with squirting of urine: Phosphor. 

Palpitation of heart: Hydroph., Magn. 

mur. 
Irregular pulsations of heart: Chelid. 
Pulse full and slow : Digit. 



Back, dragging pain in : Myr. cerif. 
Limbs, pain in, worse from motion : Bryon. 
From knees to feet, pain and tired: 

Aurum. 
CEdema from feet to calves: Magn. mur. 
Twitching of one muscle at a time: Ignat. 
Itching of skin in evening: Nux vom., 

Sulphur. 
Emaciation : Iodium, Magn. mur. 
Exhaustion : Gelsem., Kali carb. 
Disinclination to move : Bryon. 



Fever : Aeon., Arsen., Pulsat. 

or no fever : Mercur. 

, hectic: Iodium, Sulphur. 

Chilliness: Pulsat. 

even in a warm room : Phosphor. 

and shuddering alternating with heat : 

Digit. 



Sleeplessness : Sulphur. 

Sleep restless, unrefreshing : China, Myr- 

ica, Nux vom. 

, broken: Plumbum. 

, wakes about 3 or 4 o'clock a.m., and 

then heavy, unrefreshing morning sleep : 

Nux vom. 
Restlessness: Arsen. 

CAUSES. 
Abuse of chamomile tea: China f Ignat, 

Nux vom., Pulsat. 
mercury : Arsen., Asaf., Bellad., China, 

Hepar, Iodium, Nitr. ac, Sulphur. 
Peruvian bark : Arsen., Bellad., Ipec., 

Mercur., Pulsat. 

quinine: Pulsat. 

Allopathic dosing: Nux vom. 
Chagrin or anger: Aeon., Bryon., China, 

Chamom., Ignat, Natr. mur., Nux vom., 

Sulphur. 



DISEASES OF THE SPLEEN. 



625 



Improper food or overloading stomach: 

Aid. crud., Bryon., Carb. veg., Chamom., 

Natr. carb., Nux vom., Pulsat. 
Unripe fruit : Rheum. 
Coffee, liquor : Nux vom. 
Intermittent fevers: Arsen., Carb. veg., 

Laches. 
Sudden changes of temperature : Chamom., 

Dulcam., Mere, sol., Nux vom. 

COMPLICATIONS. 

Brain diseases : Phosphor. 

Catarrh of small intestines: Aeon., Cha- 
mom., China, Hydroph., Lycop., Mercur., 
Nvx vom. 



Gall-stones : Bellad., Card, mar., China, 

Mercur., Nux vom., Podoph. 
Liver-complaints of different nature: 

Arsen.. Bellad., Conium, Iodium, Kali 

carb., Laches., Lycop., Magn. mur., Nitr. 

ac, Phosphor., Podoph., Pulsat, Sulphur. 
Pregnancy: Aeon., Phosphor. 
Pneumonia: Phosphor. 
Climaxis: Laches. 
Newborn children: Aeon., Chamom., 

Mercur. 
Dyscratic states of system : Iodium. 
Psoric taints: Carb. veg., Sulphur. 



DISEASES OF THE SPLEEN. 

Physical Examination. — When of normal size— which in an adult is 
as follows : length, four to five inches ; breadth, three to four inches ; thick- 
ness, one to one and a half inches — the spleen yields on percussion a dull 
sound, bounded as follows: posteriorly by the body of the eleventh dorsal 
vertebra; in front by a vertical line drawn from the anterior border of the 
axilla to the free end of the eleventh rib ; superiorly by the ninth rib ; and 
inferiorly by the free end of the eleventh rib. In order to obtain a clear 
result by percussion the patient ought to be placed upon his right side. It 
must likewise be considered whether' the stomach be not filled at the time of 
percussion. In cases of accumulation of fluids in the left thoracic cavity, 
either pleuritic or pericardial, in accumulation of gas, abdominal or thoracic, 
in tumors of neighboring organs (liver, omentum, kidney), it may sometimes 
be next to impossible to define the size and position of the spleen. 

A considerably enlarged spleen, however, under ordinary circumstances 
is easily detected by percussion. And it is sometimes enormously enlarged 
and displaced, reaching inferiorly to the os pubis and anteriorly to the 
median line of the abdomen; in some cases even filling almost the whole 
abdominal cavity. 

In such cases it is also accessible to palpation. Even a moderate en- 
largement may be felt, if it extend below the eleventh rib. Its surface, 
except when invaded by cancer, is always smooth; and its form oval and 
sometimes wedge-shaped. Its rounded apex, and the notch which corre- 
sponds to the middle line of the spleen, and which becomes the more marked 
the larger the spleen grows, are characteristic signs by which to distinguish 
it from any other abdominal tumor. 

Notwithstanding great and laborious experiments, we know as yet but 
40 



626 SPLEEN. 

little concerning the functions of this organ. Only so much seems to be 
certain, that it bears an important relation to the formation of white blood- 
corpuscles, although we do not know how and in what manner. And this 
seems to be corroborated by the fact, that diseases of the blood always affect 
the spleen, altering it in size and consistence and, vice versa, that lasting 
diseases of the spleen lead to a diseased state of the blood, causing anaemia, 
leucaemia, hydrops, scurvy. 

Cases in which such a connection does not seem to exist, prove, perhaps, 
only that the function of the spleen may, under certain circumstances, be 
performed by some other organ or organs instead. 

Anatomical Peculiarities of the Spleen. 

It consists of a much softer and looser texture than any other glandular 
organ of the body; its areolar framework is made up of the elastic tunic 
which forms sheaths for the vessels in their ramifications through the organ, 
which again are loosely connected by small fibrous bands, issuing in all 
directions from said sheaths. In this way a multitude of interstices is formed, 
which contain a soft, granular substance. This peculiarly loose construction 
makes the organ pre-eminently fit for the reception of large quantities of 
blood ; and the more so as its capsule is also of a yielding nature, offering 
little resistance to extension; so that, on the other hand, if once overdistended, 
it regains its previous normal state very slowly; and this on account of the 
inelasticity of its tissue. The veins of the spleen constitute, by their numer- 
ous dilatations, the principal part of its bulk ; they pour their blood, after 
uniting with the veins in the stomach, and other less important vessels, into 
the portal vein. 

The whole organ is held loosely in its position by a duplicature of the 
peritoneum. 

The knowledge of these anatomical peculiarities of the spleen at once 
explains its participation in various abdominal and pectoral affections. All 
hepatic troubles, and all diseases of the heart and lungs which obstruct the 
portal circulation, must necessarily retard or prevent the normal egress of 
blood from the spleen, and cause it to swell; a stagnation of blood in the 
splenic vein must cause a like stagnation in the veins from the stomach, and 
thus bring on vomiting of blood, and its loose connection explains at once 
the possibility of its sinking quite low down into the abdominal cavity under 
certain circumstances. 



INFLAMMATION OF THE SPLEEN. 627 

Hemorrhagic Infarction, Splenitis, Lienitis or Inflammation 

of the Spleen. 

Hemorrhagic infarction is of much more frequent occurrence in this 
organ than in any other. It consists of a blocking-up of the smaller splenic 
arteries by fibrinous coagula, which have formed in the left ventricle of the 
heart in consequence of endocarditis, and which have been washed away by 
the stream of blood, and carried through the splenic artery into its smaller 
branches, where they stick fast. This is of such frequent occurrence that it 
is very rare not to find hemorrhagic infarction in the spleen, in all cases 
where post-mortem examination reveals valvular destruction to any con- 
siderable degree; much more rarely, such emboli come from gangrenous 
places of the lungs. In such cases they have to pass through the pulmonary 
veins, the left ventricle, aorta and splenic artery. Hemorrhagic infarction 
forms also in consequence of malarial infections, typhus, septicemia, and 
acute exanthematic fevers; in these cases, it seems, by a stagnation of circu- 
lation within the splenic veins. These hemorrhagic coagula or thrombi are 
usually situated at the periphery of the spleen, and are roundish or wedge- 
shaped, their broad base being nearest to the periphery, while their apices 
point toward the interior. 

They appear at first of darker color and harder than the surrounding 
tissue, which appears perfectly sound. By-and-by, however, they become 
discolored and changed into a yellow, firm, homogeneous mass, which during 
the further progress of the disease may undergo several changes. It may 
shrink and leave a cicatrix, or suppurate and form abscesses of the spleen, 
which, if they are many, may transform the whole spleen into a mass of cor- 
ruption. 

These abscesses again may go on to different terminations. They may, 
by fibrinous exudation, become encysted, or they may cause pyemia, or they 
may burst and discharge their contents, like abscesses of the liver, into the 
peritoneal sac ; or when adhesions have been formed with neighboring or- 
gaus, they may, by perforation, discharge their contents into the stomach, 
colon, or the pleural cavity. 

A primary inflammation of the spleen is of very rare occurrence ; even 
external injuries, a blow, a fall, a wound, are apt to cause a rupture, rather 
than an inflammation. 

Its Symptoms are frequently quite obscure and of an uncertain character, 
so that it is often not recognized until post-mortem examination brings it to 
light. We have a better chance of discovering its presence when it is pro- 
duced by cardiac diseases, and there is also an enlargement of the spleen, 
which, however, never reaches more than double its normal size, and in many 
cases is so insignificant that it cannot be discovered by percussion. 



628 SPLEEN. 

Pain in the region of the spleen originates not in the substance of the 
spleen itself, but in its enveloping membrane or in the neighboring organs, 
and is, therefore, sometimes entirely wanting. When it does exist, it is of a 
dull character, and is increased by deep inspirations, different movements of 
the body, and percussion. A sharp pain denotes an inflammation of its 
peritoneal covering. A radiating pain into the left shoulder is likewise 
sometimes observed. 

Fever is usually entirely or partly dependent on the original disease; 
but when suppuration has taken place, the characteristic rigors make, as a 
rule, their appearance. 

Peritonitis follows in case of rupture or perforation. On the whole a 
certain diagnosis can only be made when, after traumatic causes or in conse- 
quence of pysemia, endocarditis, etc., local and general symptoms arise which 
can be referred to the spleen. And the diagnosis increases in probability if 
metastatic inflammation of other organs are developed at the same time, for 
instance in the kidneys with albuminuria and hematuria. 

THERAPEUTIC HINTS— Compare such remedies as are pointed 
out under the heads of those diseases which are either the causes or compli- 
cations of splenitis, as endocarditis, valvular derangements of the heart, etc. 

Acute Tumor, or Hyperaemia of the Spleen. 

This consists of a more or less copious accumulation of blood within the 
gland, by which its volume may become enlarged to three or four times its 
normal size. The color of its tissues varies from red to brown or violet, and 
in case of a longer duration it changes to a dirty gray or slate color. 

This acute swelling of the spleen is an almost constant attendant upon 
typhus, intermittent, remittent, yellow and puerperal fevers ; likewise upon 
cholera in its stages of reaction, and of a number of other complaints, such 
as pylephlebitis and cirrhosis, by which a stagnation in the portal circulation 
causes stagnation of blood in the spleen. We find it likewise attending 
anomalies of menstruation. It is therefore always of a secondary nature, 
and its symptoms must vary accordingly. Symptoms, which belong exclu- 
sively to it, are — 

1. The conspicuous enlargement, which can easily be discovered by per- 
cussion and palpation. 

2. A dull pain in the region of the spleen, which is generally increased 
by motion, pressure, deep breathing, and lying on the left side. 

3. A conspicuous anaemic appearance of the patient which, especially 
in intermittent fevers, sets in very quickly and keeps pace with the enlarge- 
ment of the spleen. 



CHRONIC TUMOR. 629 

All other symptoms belong to the primary disease which causes it ; for 
therapeutic hints compare these diseases. 

Hyperemia of the spleen leaves with the primary disease; in some cases, 
however, it assumes a permanent form ; and thus originates — 

Chronic Tumor, or Hypertrophy of the Spleen. 

The spleen sometimes attains a weight of 10, 15 to 20 lbs., filling almost 
the entire abdominal cavity. Its resistance is often like that of a board, and 
its substance appears dark brown-red. This is simple hypertrophy, consisting 
of an increase of granular substances in the interstices, formed by the numer- 
ous fibrous bands of the splenic structure. In other forms it has, as a rule, 
the appearance of waxy or colloid degeneration, and consists indeed of the 
same homogeneous colloid mass, which the colloid liver presents, and then is 
called amyloid degeneration of the spleen. 

A peculiar variety of this affection is the so-called SagO-Spleen, where 
the whole organ appears to be infiltrated with half-solid, transpaAnt, round 
globules, which can be taken out, and very much resemble boiled sago. It 
seems that the development of this peculiar appearance depends upon the in- 
filtration of the same colloid mass into the vesicles of Malpighi. 

The chronic tumor resulting from intermittent fevers is of a slate 
color. 

The Causes of this chronic enlargement of the spleen, when it is simple 
hypertrophy, are, all such disorders as cause a stagnation of blood within the 
venous circulation, to wit: heart and lung diseases, inflammation and oblitera- 
tion of the portal veins, and cirrhosis of the liver ; but w T hen it consists of an 
amyloid degeneration, a number of diseases, which depend upon a morbid state 
of the blood — so-called dyscrasias — malaria, constitutional syphilis, mercurial 
cachexia, rachitis, scrofulosis, Bright's disease, in a lesser degree, chlorosis, 
scurvy and leukcemia. 

Symptoms. — Enlargement of the spleen, usually very great, and charac- 
terized by its roundish apex and the notch on its inner edge. All other 
symptoms belong more or less to the primary affection, and are therefore of 
no diagnostic value for the tumor itself. 

THERAPEUTIC HINTS must be looked for under the respective 
heads of causes ; however, the following remedies have a special relation to 
the spleen : Arnica, Asaf., Arsen., Borax, Bromium, Carb. veg., Ceanothus 
in spleen-pain, China, Dulcam., Ferrum, Ignat., Laches., Lauroc, Mercur., 
Mur. ac, Xatr. carb., Natr. mur., Nux mosch., Platina, Plumbum, Ran. bulb., 
Rhus tox., Ruta, Stannum, Sulphur, Zincum. 



630 PANCREAS. 

Spleen affections and obstinate diarrhcea: Anac, Asaf., Bryon., China, 
Dulcam., Ignat., Pulsat., Rhus tox., Sulph. ac. 

Cancer of the Spleen 

Is a very rare disease ; is generally of the medullary or encephaloid form, 
and sometimes attains a pretty large size; it is always connected with cancer 
in other organs, especially those of the abdomen. 

Its Diagnosis is easy, when the existence of cancer in other organs has 
been proved, and when the enlarged spleen shows on palpation that charac- 
teristic cancer-unevenness. 

Echinococcus-cysts 

Are of very rare occurrence; they may exist in the spleen alone, and also 
in other organs at the same time. 

Its Diagnosis is difficult, being possible only under those favorable cir- 
cumstances in which the echinococcus-cyst is accessible to percussion and 
palpation, when it may be discovered as a roundish fluctuating tumor. 

Rupture of the Spleen 

May be caused by external injuries, violent concussions of the body, or by 
pathological changes of the gland itself, as in its rapid enlargement, especially 
in typhus, or during the chilly stage in intermittens. 

Symptoms. — A sudden very intense pain in the region of the spleen, 
spreading over the whole abdomen. And in consequence of the internal 
hemorrhage: paleness, collapse, cold extremities, small pulse, vanishing of 
sight and hearing, syncope, distention of the abdomen, death. 

Its Diagnosis must be founded upon the sudden pain in the region of 
the spleen, and a knowledge of the previous ailments. A perforation of the 
stomach or of the intestine always causes tympanitis by its air rushing into 
the peritoneal cavity, and peritonitis. The latter is also caused by ruptures 
of the liver, gall-ducts, and of the bladder; and besides, the pain which is 
hereby produced is not in the region of the spleen. A fatal termination 
usually follows, generally within twenty-four hours. 

DISEASES OF THE PANCREAS. 

The pancreas, the abdominal salivary gland, is situated behind the left 
lobe of the liver and the stomach, and discharges its secretion by a main 
duct into the duodenum in the vicinity of the opening of the ductus chole- 
dochus into the duodenum. Sometimes the pancreatic and biliary ducts be- 
come united just before they enter the duodenum. 



PANCREATITIS. 631 

Its secretion assists in the transformation of starch into dextrine and sugar, 
and in the digestion of albumen and of fat. It shares its saccharifying power 
with the saliva, perhaps also with the secretion from Brunner's glands, its 
peptonizing properties with the gastric juice and succus entericus, and its 
power of emulsifying neutral fats with the bile ; while its power of breaking 
up fat into fatty acids and glycerine is the only one which, as far as our 
knowledge of to-day goes, can be said to be peculiar to the pancreas. 

From this statement it may easily be seen why a diagnosis of diseased 
conditions of this gland is in most cases very difficult and in some altogether 
impossible. The following symptoms, however, may hint to affections of the 
pancreas without being pathognomonic: Emaciation of the whole body, be- 
ginning early and proceeding to an unusual degree ; a flow of saliva-like 
fluid from the mouth, either as eructations or by frequent spitting; the pres- 
ence of fat in the stools, sometimes in the urine floating upon it on cooling, 
like masses of butter; the presence of large quantities of undigested striped 
muscular fibres in the fecal discharges; the presence of diabetes mellitus and 
also chronic jaundice. The pain in the epigastrium is shared by a great 
number of other ^disturbances, and even the results of palpation are in 
many cases negative on account of the deep position of the pancreas, and its 
being covered by the stomach and liver. Occasionally, however, palpation 
may lead to positive results, when performed with both hands by lateral 
pressure on the hypochondriac regions, or in the knee-elbow position, when 
the altered pancreas may be discovered lying crosswise in the epigastric re- 
gion as a slighty movable swelling, or as a round, firm, or fluctuating tumor, 
either smooth or nodular on its surface. Among these symptoms the most 
important are: fatty stools, mellituria, darting pains in the epigastrium 
(cceliac neuralgia), together with a palpable tumor. 

Just as little certainty exists as to the Causes of pancreatic diseases. 
In most cases, as far as we know, these affections are of a secondary nature, 
arising from diseases of neighboring organs. Fortunately pancreatic diseases 
are of great rarity. 

From among the special forms of morbid conditions of the pancreas as 
discovered principally on post-mortem examinations, the following may be 
mentioned : 

Pancreatitis, Inflammation of the Pancreas. 

Pathologically, it is characterized by swelling, redness and softening of 
the areolar tissue, which surrounds the lobules of the gland; in a higher de- 
gree it alters the whole gland into a firm mass. It results either in resolution 
or suppuration, or leads to induration of the areolar tissue and obliteration 
of the glandular structure. It may be of an acute or chronic nature. 



632 KIDNEYS. 

Fatty Disease of the Pancreas 

Consists of a fatty degeDeration of the gland-cells, analogous to fatty degen- 
eration of other glandular organs, which destroys the secreting cells and 
causes atrophy of the entire organ, of which often nothing remains but a flac- 
cid band of connective tissue. 

Cancer of the Pancreas 

May be primary, originating in the gland, or secondary, spreading from 
neighboring organs to the gland. It causes no characteristic symptoms be- 
sides the general cancer-cachexia, and is, therefore, not distinguishable from 
other co-existing cancerous affections. 

DISEASES OF THE KIDNEYS. 

The kidneys being the organs for secreting urine, any morbid state 
within them will, no doubt, cause changes in the product of their physiologi- 
cal function, although disease of the kidneys does not atte*nd every abnormal 
state of the urine. Before we enter upon a consideration of the different 
renal disturbances, it will be expedient first to collect those symptoms which 
we may gain by — 

Examination of Urine. 

1. Its Reaction. Urine is naturally acid, which is easily tested by 
dipping it into blue litmus paper. This acidity varies much even in normal 
urine ; it is increased before meals, decreased after meals ; during digestion 
it is augmented by sulphuric, nitric, phosphoric, tartaric and oxalic acids 
when taken into the system. 

An alkaline reaction may take place sometimes* daring digestion without 
being a sign of disease ; or it results from taking an excess of fixed alkalies, 
such as the salts of soda and potassa. In this case the red test-paper is col- 
ored blue and retains this blue color when exposed to heat. When it exists 
as a permanent condition it generally indicates nervous depression, resulting 
from exhaustion by mental anxiety, spermatorrhoea, etc. It is said to be pro- 
duced temporarily by the juice of lemons and oranges. An alkaline urine 
may be caused also by a volatile alkali, such as carbonate of ammonia, in 
consequence of decomposition. This is generally recognizable by its odor, 
and the test-paper at once loses the blue color and receives back its original 
red tint when exposed to a gentle heat. This alkalinity of the urine denotes 
pathological disturbances, such as the presence of mucus or pus in the urine, 
in consequence of a disease of the mucous coat of the bladder, o.r in conse- 
quence of paraplegia, whereby the urine is too long retained in the bladder. 



EXAMINATION OF URINE. 633 

2. Its General Appearance. A light, pale color is usually found in 
chlorotic and anaemic states of the system; in neuralgia; in hysteria Qurina 
spastica); in diabetes mellitus, with much increased quantity and gravity; 
in chronic morbus Brightii; in leukaemia; in consequence of wear and tear 
of the nervous system, with a dash of white in it, containing phosphates. 

A deep, dark color may be caused — 

1. By an increase of urea in the urine, which appears perfectly clear 
and transparent when freshly voided, and its foam when agitated is perfectly 
colorless. 

2. By an admixture of blood. In this case the urine is opaque. It is 
found : a, in haemorrhages from the kidneys ; b, in haemorrhages from the 
bladder; and c, during menstruation or haemorrhages from the womb, when 
it is of a mere accidental occurrence. 

3. By an admixture of bile. In this case the freshly voided urine is 
usually clear and transparent ; its foam, when agitated, is intensely yellow ; 
white paper and linen, when dipped into it, become yellow, even olive-green, 
and a drop of nitric acid, when permitted to fall on a thin layer of such 
urine, causes at once an interesting play of colors — commencing with green 
and blue, passing to violet, red, and finally to yellow or brown. It is found : 
a, in icterus ; b, in the highest state of pyaemia; c, in the acute yellow atrophy 
of the liver; d, in some cases of pneumonia, especially on the right side. 

4. By different drugs, such as santonin, rhubarb, senna, turpentine, dyer's 
weed, beets, tar, kreosote, etc. 

A turbid appearance of the urine, when freshly voided, may result — 

1. From an admixture of epithelium, thrust off by catarrhal processes of 
the mucous linings within the urinary organs. It is of a flocculent appear- 
ance and does not alter the specific gravity of the urine. 

2. From gonorrheal or leucorrhceal discharges, appearing in the otherwise 
transparent urine as whitish flakes. 

3. From cylindrical casts from out of the uriniferous tubuli, during the 
acute or subacute stages of Bright's disease. They soon settle to the bottom 
of the vessel, and form a light, downy sediment. 

4. From blood, as stated above, or chyle. 

5. From pus, which settles as an opaque, creamy or clayey mass; re- 
action, generally alkaline; it is dissolved into a dense gelatinous mass, when 
agitated with an equal quantity of liquor of potassa, and smells foul and 
ammoniacal in consequence of decomposition. It is a sign of suppuration 
somewhere in the genito-urinary system, or a proof that an abscess has opened 
into and is being discharged through this channel. In chronic catarrh of 
the bladder pus forms a layer of grayish-white sediment. 

6. From earthy salts, generally, however, only after cooling, a, Uric 
acid settles in little red granules of a crystalline character, visible to the 



634 KIDNEYS. 

naked eye, while urates constitute more of a pinkish or yellowish sediment; 
the urine appears dark, shows an acid reaction, and becomes transparent by 
the application of heat. When a few drops of nitric acid are added, and the 
mixture is slowly evaporated nearly to dryness over a lamp, the addition of 
a drop of ammonia instantly produces a rich purple (Dr. Prout's Purpurate 
of Ammonia). 6, Phosphates — a combination of phosphoric acid with soda, 
lime or magnesia. Such urine always yields an alkaline reaction, is usually 
of a whitish milky color with whitish sediment of an offensive odor, and clears 
up at once by the addition of a few drops of acetic acid. 

3 a . The urine contains one or the other of its normal con- 
stituents in excess or in decreased quantity — (Compare CI. Mitch- 
ell's "Clinical Significance of the Urine and its Normal Constituents.") 

Urea, C H 4 N 2 O, may be suspected in excess if the urine is of a deep 
yellow color, of a strong urinous smell, and of high specific gravity, and may 
be chemically demonstrated as follows: "Pour an equal bulk of nitric acid 
upon the given specimen, which has not been boiled, and which ought to be 
part of the entire quantity of urine passed in twenty-four hours." This will 
produce the formation of crystals of nitrate of urea. 

Urea is increased in all fevers (except yellow fever), in acute febrile 
states with emaciation, in inflammations generally, also those of thoracic vis- 
cera often, in nervous diseases, such as epilepsy, chorea, progressive muscular 
atrophy, in pyaemia, diabetes, atrophy from dyspepsia (in children), and dif- 
fuse bronchial catarrh (without fever). 

The amount of urea is diminished in paralysis, cholera, yellow fever, 
albuminuria, acute yellow atrophy*of the liver, long-continued organic dis- 
eases, chlorosis, ovarian tumors and uterine cancer. 

Chlorides of Sodium (Na CI) and Potassium (K CI) are soluble, 
hence do not appear as a deposit in the urine. Sodium chloride is largely in 
excess of the two. If a sample of urine is evaporated and the residue placed 
under the microscope, there appear octahedral crystals, which can be dis- 
tinguished from oxalate of calcium by their solubility in water. If urea be 
present instead of octahedral crystals the sodium chloride may assume the 
form of stars or daggers. Or after filtering a sample of urine, then boiling 
and acidulating it with two to three drops of nitric acid, in order to remove 
the albumen, and adding to this solution, free from albumen, a solution of 
silver nitrate (strength one to ten), a white precipitate, silver chloride, which 
is insoluble in nitric acid but soluble in ammonia, indicates the presence of the 
chlorides. 

The chlorides are increased in intermittents only during the chill and 
fever, and in progressive muscular atrophy; they are decreased in acute 
diseases, including especially inflammations with exudations, fevers, cholera, 
diabetes insipidus (not invariably) and dyspepsia (also not invariably). 



EXAMINATION OF URINE. 635 

The Phosphates, as sodium bi-phosphates or sodium phosphate, and po- 
tassium, calcium and magnesium phosphate. The alkaline phosphates (sodium 
and potassium) are soluble, and therefore not found as a deposit. The 
earthy phosphates are insoluble in alkaline liquids, and hence appear as a de- 
posit wlien the urine is alkaline ; the deposit is whitish in color, the urine is 
of alkaline reaction and of a fetid odor. If some of this whitish deposit is 
diluted with distilled water, then acidulated with a few drops of nitric acid, 
and to it is added ammonium molybdate and heat applied, a yellow precipi- 
tate indicates the presence of earthy phosphates. The alkaline phosphates 
may be detected by the addition of a little ammonium hydrate (ammonia) to 
the urine and heat applied, which precipitates the earthy phosphates. After 
these are filtered off, and we add to the filtrate ammonium carbonate and 
magnesium sulphate, we obtain a white flocculent precipitate which consists 
of alkaline phosphates. 

The total amount of phosphates may be increased in phrenitis, meningitis, 
mania (acute paroxysms), paralysis following injury to the head, paralysis 
in general, especially if spinal cord be affected, chorea, apoplexy and epilepsy 
(after the attack), acute febrile diseases, Bright's diseases and cholera. 

The calcium phosphate may be especially increased in rachitis, molli- 
ties osssium, extensive burns, nervous exhaustion from severe study and loss 
of sleep, diabetes (when thirst is satisfied by drinking water), tertiary syphi- 
lis, cerebral and spinal tumors, osseous tumors, cancer, caries, meningitis. 

The magnesium phosphate may be especially increased in meningitis and 
in progressive muscular paralysis, while the ammonio-magnesium phosphate, 
the so-called "triple phosphate," is found largely present in the urine in cal- 
culus, paralysis of bladder, retention of urine, diseases of the spinal cord. 
Urine containing this "triple phosphate" is apt, when passed, to be alkaline, 
putrid, whitish in color. 

The total amount of phosphates may be decreased in functional disturbances 
of kidneys, as in Bright's disease, in disease of the digestive organs (food not 
thoroughly absorbed), in intermittent fever during the interval, in chronic dis- 
eases of the brain, mania (exhaustion stage), in acute dementia (least amount 
when mind most feeble), in pneumonia (when grave), in gout, arthritis de- 
formans, delirium tremens. 

We find magnesium phosphate lessened in amount in the urine of typhus 
fever and of grave fevers generally. 

The Sulphates of potassium and sodium are soluble in water, hence do 
not appear as a deposit. They are detected by acidulating a small quantity 
of urine by a few drops of hydrochloric acid, and then adding barium chlo- 
ride, which causes a precipitate of sulphate of barium, insoluble in nitric 
acid. Vogel finds but little satisfaction in investigating the clinical import 
of the sulphates in disease. 



636 KIDNEYS. 

The Urates of sodium, potassium and ammonium are soluble ; acid urine, 
however, on cooling may contain them as a deposit in which the urate of 
sodium is generally the most abundant of any. If such deposit disappears 
again on heating, it consists of urates. If a heavy, yellow or pink deposit oc- 
curs in acid urine on cooling, place a few grains or crystals of it on a porce- 
lain disk, add a drop of nitric acid, heat gently, add a drop of ammonium 
hydrate; magnificent red color indicates presence of urates or uric acid. 
(Uric acid is crystalline under the microscope, but urates are not.) 

The amount of urates may be increased in ordinary fevers, pulmonary 
emphysema, capillary bronchitis, diphtheria, dysentery, influenza, intermit- 
tent (febrile stage), nephrites, scarlet fever (at eruption), and chiefly free uric 
acid deposit, as in tetanus, acute polyarthritic rheumatism, chronic affections 
of heart, liver and spleen, atrophy from dyspepsia in children, incipience of 
gravel or of calculus. 

The amount of urates may be diminished in yellow fever, remittent fevers, 
diabetes, albuminuria, cholera, chlorosis, anaemia, hysteria, gout (before the 
paroxysms), progressive muscular atrophy. 

3 b . The urine contains other than normal constituents, of 
which the most important are : 

1. Grape sugar. — This substance increases the specific gravity of the 
urine up to 1040 and higher; in one case it was changed as high as 1074. 
To detect it, Trommer's test with caustic potash and sulphate of copper is 
still considered the best. "If a solution of sugar is treated with a little 
caustic potash and a few drops of a solution of sulphate of copper, either no 
precipitate occurs, or that which takes place dissolves again to a beautiful 
blue fluid. If this mixture be heated the fluid is first colored orange-yellow, 
soon becomes cloudy, and finally a beautiful red precipitate of cuprous oxide 
separates." (Neubauer.) "This, then, is what happens when sugar is 
actually present ; when sugar is absent, the addition of caustic potash solution 
causes, perhaps, a cloudiness to appear ; then, when the sulphate of copper 
is added, the beautiful blue color may or may not be present, according to 
the quantity of copper sulphate added, but when heat is applied, there 
results either (1), a liquid, generally of a color slightly darker than normal 
urine, containing dirty, white flocks of phosphates, or else (2), a bluish 
liquid containing these same flocks of phosphates; when there appears no 
orange-yellow, which soon becomes cloudy, ending in a beautiful red precipi- 
tate, there is no sugar." (Clifford Mitchell.) 

Or, "if a solution of grape-sugar be warmed with caustic potash, it be- 
comes a beautiful brown-red color ; if nitric acid is then added, a piercing, 
sweetish odor is evolved, which reminds one of caramel or of formic acid." 
(Neubauer.) " In the case of urine containing sugar then, caustic potash 



EXAMINATION OF URINE. 637 

solution added, heat applied, and further nitric acid added, converts the 
liquid into a substance strongly resembling molasses." (Clifford Mitchell.) 

2. Alblinien. — In general its presence may be looked for if the specific 
gravity of the urine is persistently below 1015, and it may be detected by 
heating the urine up to a boiling point which coagulates sero-albumen, if 
only the urine itself be acid and has been rendered clear by previous filtra- 
tion. Neutral or alkaline urine must be rendered acid before the operation 
by addition of nitric acid. Or to avoid all possible chance of confounding 
albumen with phosphates or urates, fill a test-tube one-third full of a solution 
of picric acid, and pour one or two drops of the urine, to be examined, into 
it. If it contain albumen, a cloudiness will at once be seen in the previously 
clear fluid, which, on the application of heat, balls into a compact mass and 
rises to the surface. 

3. Chyle. — " In tropical regions, especially in the Brazils and in 
the Southern States of North America, the urine presents, on exceptional 
occasions, at rare and long intervals of time, an aspect that might easily be 
mistaken for milk. This appearance depends upon a quantity of fatty mat- 
ters, stirred up into a fine emulsion, and mixed with the secretion from the 
kidneys ; in fact, the fat is sometimes so abundant as to form a thick cream 
upon the surface of the fluid. Looked at under the microscope it does not 
present the form of fat-cells or fat-drops, such as we see in ordinary milk, 
but appears as a finely granular opacity that pervades the fluid, and is capa- 
ble of being entirely separated from the urine by treating this with ether. 
We find invariably associated with it a considerable quantity of albumen, 
also red and white blood-cells, all characteristic, formed elements of chyle. 
For this reason the affection thus manifesting itself has been termed chyluria. 
The exact nature of it is still unknown." (Bartels.) 

4. Blood. — Its presence can usually be recognized by it characteristic 
colors which may, however, vary from that of pale, raw meat up to brown- 
black, in accordance with the quantity present. Bloody urine is oftener 
sooty or dark colored than bright red, and the liquid is more usually cloudy 
than clear. Small quantities may be recognized by allowing the urine to 
stand in a funnel-shaped glass when the blood-corpuscles will sink to the 
bottom. By means of the microscope the blood-cells can be distinguished in 
the sediment. Bloody urine is invariably albuminous. 

5. Urinary Casts of Cylinders, when found in the urine, always de- 
note an abnormal condition of the kidneys ; they are, as a general rule, asso- 
ciated with the excretion of albumen in the kidneys. There are different 
kinds of cylindrical formations. 

a. Epithelial casts consist of simple pipes formed of the epithelia of renal 
tubes which are shed in their natural continuity in the course of acute in- 
flammation. They are not often seen. 



638 KIDNEYS. 

b. Blood casts consist of coagulated fibrine with a large amount of en- 
tangled red blood-corpuscles, and are derived from the renal tubules in 
hematuria. 

c. Hyaline casts consist of a perfectly homogeneous, transparent and 
colorless mass; their outlines are only with difficulty rendered apparent in 
the fluid surrounding them, but may be made visible by adding a solution of 
iodine or iodide of potassium, which colors them yellow, or a weak solution of 
carmine, which stains them red. 

d. Dark granular casts consist of granular masses and are less trans- 
parent than the hyaline casts. 

e. Waxy casts consist of a homogeneous mass which exhibits under the 
microscope a peculiar glistening aspect and they often have a distinct yellow 
staining. 

/. Cylindriform casts consist of a homogeneous, colorless and very pale 
mass ; they present under the microscope more the appearance of strips of 
ribbon, than of real cylinders, and their edges run parallel to each other, 
their ends are either frayed out or tattered, or pointed at one edge, or folded 
or twisted up in a spiral. The presence of such casts proves the presence of 
albuminuria, but does not point out the nature of the cause in producing 
albuminuria. However the following remarks may assist in the diagnosis 
of kidney diseases. 

A great number of pale or dark granular casts comes from an inflamed 
kidney. In the acute form the pale casts with an abundance of red or white 
blood-corpuscles, — in the chronic form the dark granular casts prevail. 

The waxy casts always point to chronic and deep-seated renal affection 
and are never present in recent cases of nephritis, nor in transitory albu- 
minuria. With them are generally found at the same time the other forms 
in the sediment. 

The dark granular casts always indicate a notable impairment of the 
nutrition of the organ, such as chronic nephritis and amyloid disease of the 
kidneys. 

Narrow hyaline colorless casts can appear in any albuminous urine, and 
they are always found in company with the dark granular and waxy 
cylinders. 

The Sediments of the urine may be distinguished in the following 
manner : 

1. A light, flocculent, cloudy deposit is commonly mucus, entangling 
epithelial cells or spermatozoes. 

2. A yellow, orange, or pinkish deposit, dissolving by the application of 
heat (urine acid) is almost always due to urates. In very rare cases a dark 
citron-yellow color is caused by the great abundance of renal casts. 



DIABETES, MELLITURIA, GLYCOSURIA. 639 

3. A dense, abundant, 'white deposit, dissolving by the addition of acetic 
acid (urine alkaline) consists of phosphates. 

4. A granular, or crystalline deposit of reddish color and small in quantity 
is uric acid. 

5. A dark, sooty and dingy-red deposit is blood. 

The Quantity of urine varies, even in health, considerably. It is 
increased, however, in diabetes, chronic diuresis, hysteria, and by drinking 
large quantities of water or other fluids. Decrease: Fevers of all kinds, 
deep functional disturbances, profuse excretions other ways, such as sweat or 
diarrhoea; in consequence of heart diseases, liver diseases, dropsy. Its secre- 
tion ceases altogether in cholera, and in typhus at times. 

Its Specific gravity is also greatly variable. According to Clifford 
Mitchell's observations upon fifty analyses of urine, an increase in specific 
gravity simply means an increase of solids. In most febrile conditions, urea, 
phosphates, sulphates and urates are increased in amount, and with them the 
specific gravity of the urine. The presence of earthy phosphates may raise 
it to 1037. When the specific gravity is 1040 or upwards, we are very sure 
of finding sugar in the urine. When the specific gravity ranges from 1015 
to 1030, we need not expect, as a rule, to find either sugar or albumen, 
although we may find blood or pus. When the specific gravity is persistently 
below 1015, we are warranted in looking for albumen. The lowest specific 
gravity has been observed in diabetes insipidus and renal cirrhosis, varying 
between 1004 and 1010, and sinking at times to 1002, or even to 1001. 

Diabetes, Mellituria, Glycosuria. 

This disease is characterized by the presence of sugar in the urine, and 
although not strictly a kidney disease, it may as well be treated of here as 
under any other heading, especially as the modes of its development are still 
under discussion. The most probable modes, as applying to the majority of 
cases of diabetes, Senator states in the following language: (1) "An ab- 
normally heightened saccharinity of the chyle, or of the blood in the portal 
vein, or of the two together, in consequence of an impeded conversion of the 
sugar present in the intestine into lactic acid, or in consequence of accelerated 
absorption of the sugar; (2) an unnatural acceleration of the portal circula- 
tion, whereby, on the one hand, more sugar reaches the liver — a part of 
which, without being changed into glycogen, passes on into the circulation; 
and, on the other hand, the glycogen formed from sugar or other materials 
passes into sugar more rapidly and in greater quantity and is washed away." 

Under the first proposition is taken into account that the saccharinity 
of the blood may originate in the intestine by an abnormally large ingestion 
of starch or sugar with the food, or by an abnormally heightened transit of 



640 KIDNEYS. 

sugar from the intestine into the lacteals even without increased ingestion, 
all of which would explain those symptoms so common in diabetics which 
point to an implication of the gastro-intestinal canal, and which exists often 
even before the outbreak of the disease and during its development. Under 
the second proposition is taken into consideration the theory of Claude Ber- 
nard and others that the saccharinity of the urine may originate a, in some 
disturbance of the nervous system (Bernard's puncturing the fourth ventricle 
on the floor of the fossa rhomboidea, immediately above the point of origin 
of the vagi nerves, or Schiff's section of the optic thalami and the great crura 
cerebri, or the destruction of the pons Varolii and the middle and posterior 
crura cerebelli, or the complete division of the spinal cord at the level of the 
second dorsal vertebra, or in its lumbar portion, or Pavi's section of the me- 
dulla oblongata, etc.), causing either a dilatation of the blood-vessels by par- 
alyzing the vasomotor nerves, or a specific irritation of the nerves which 
govern the formation of sugar (both views being hypothetical), or b, from the 
action of the liver by which sugar, glycerine, gelatine, and probably albumi- 
nates, are converted in its cells into glycogen, and that the latter is trans- 
formed into grape-sugar by reaction with the blood which bathes the cells, 
that it then passes into the general circulation, and if its quantity exceeds a 
certain limit, is finally excreted by the kidneys. These modes of development, 
which we may designate as gastro-enterogenic, the neurogenic and the hepa- 
togenic, do not exclude each other, but may for the most part, or altogether, 
occur simultaneously, or the one may proceed and the others may join in. 

Post-mortems have shown various morbid changes in the corresponding 
and other organs, although these changes are by no means constant. In the 
brain tumors, extravasations of blood, softenings, and on microscopic exami- 
nation, a wasting of the gray substance, degeneration and striking pigmenta- 
tion of the ganglion cells and fatty degeneration of the vessels have been 
found. The sympathetic nerves in the abdomen were found thickened and 
also the vagus. The lungs frequently showed signs of chronic inflammations, 
tuberculosis and pleuritic exudations. The stomach and the intestinal canal 
frequently bore signs of chronic catarrh, hyperemia, thickening, tumefaction 
of their mucous membrane, slaty pigmentation and hemorrhagic erosions. 
The liver has frequently been found hypersemic, uniformly enlarged and 
hypertrophied. The pancreas has frequently been found atrophied, or, in 
addition, degenerated ; and the kidneys appeared, as a rule, abnormally en- 
larged, heavy, firm and containing an abundance of blood, but without more 
profound textural changes. The pelvis of the kidneys and the ureters were 
frequently found in a state of catarrhal inflammation; and in some cases of 
young persons the testes were found atrophied. Diabetes is not of frequent 
occurrence, seems to be to a certain extent hereditary, is often connected with 
diseases of the nervous system, particularly epilepsy and mental affections, 



DIABETES, MELLITURIA, GLYCOSURIA. 641 

occurs at every period of life, but far more rarely in childhood than in middle 
age; after the age of sixty or sixty-five it scarcely ever develops; men are 
much oftener attacked than women; also obesity seems to predispose to the 
disease. As Exciting Causes the following have been mentioned : mechani- 
cal injuries, especially concussions of the whole body or of the brain and 
spinal cord in particular; diseases of the nerve-centres, such as inflammations, 
degenerations, softenings and tumors of the brain ; violent mental emotions, 
such as fright, anxiety, anger, grief, solicitude, care, immoderate mental 
strain; errors in diet; exposure to cold and moisture; severe bodily exertions; 
sexual excesses; and not unfrequently diabetes has been observed to make its 
first appearance during the convalescence from febrile diseases of greater or 
less gravity, especially after intermittent fever. Besides these exciting causes 
the following substances, which, whether introduced into the general blood- 
current or into the portal circulation, have been found to cause mellituria 
with more or less certainty: Curare, cantharis, carbonic oxide, chloride of 
carbon, nitrite of amyl, nitro-benzole, phosphoric acid, turpentine, corrosive 
sublimate, nitrate of oxide of uranium, morphia and strychnia; injections 
into the veins of solutions of common salt, of carbonate, acetate, phosphate, 
hyposulphite, valarianate and succinate of soda ; of ether, alcohol or ammonia 
into the portal vein, and of large quantities of lactic acid into the stomach. 

The Symptoms of diabetes set in at times suddenly, but in general very 
gradually, with an increase of the urinary excretion and of thirst. Its initial 
stage, if there be any, is characterized usually by loss of appetite, nausea, 
vomiting, pyrosis, eructations, irregular actions of the bowels, headache, sleep- 
lessness, and even mental aberrations. But perhaps much oftener the disease 
invades the system unnoticed, until the frequent desire to pass water, the 
constant dryness of the mouth, the increased debility, or an impairment of 
sight, force the attention of the patient upon it. 

In the proportion as the urine increases in quantity, its color becomes 
lighter, verging on greenish or looking almost entirely colorless and as clear 
as water; it is free from sediments. Its odor is often peculiarly aromatic, 
likened by the older physicians to that of hay, being derived, according to 
recent observations, from acetone and alcohol. Its reaction is not only acid 
while fresh but remains so much longer than healthy urine generally does. 
Its specific gravity very commonly rises to 1035 or 1040 and even to 1060 or 
1074. Its quantity is greatly increased, and generally in proportion to the 
severity of the disease, amounting to six and eight litres daily. 

Next to the altered state of the urine there is increased thirst and hunger. 
The thirst particularly is in direct ratio to the excretion of sugar. Farina- 
ceous and saccharine food not only increases the sugar but also the thirst. 
The appetite is usually largely increased, so that even unusually hearty food, 
especially the saccharine and starchy, seems able to appease the hunger only 
41 



642 KIDNEYS. 

for a short time. Still at times temporary disturbances with signs of gastric 
and intestinal catarrh set in, impairing the effect of an exclusively animal 
diet. 

The patient's breath commonly emits a peculiar, apple-like odor, and 
chronic pneumonia leading to phthisis is of frequent occurence, although in 
patients under favorable surroundings and good dietetic conditions it is de- 
veloped exceedingly slow. 

The nervous system shows many disturbances, of which are to be men- 
tioned : pronounced mental affections and aberrations, delusions of rapidly 
approaching financial ruin, becoming parsimonious, avaricious, varying 
moods, irritability, sadness, melancholy, disinclination to bodily or mental 
exertion, headaches, sensations in the limbs as being asleep, formication, 
neuralgic pains, partial anaesthesia, muscular twitchings, and a decrease of 
the sexual instinct. The most common form of disturbance of vision is oc- 
casioned by the formation of cataract, less often by partial paralysis of ac- 
commodation, by amblyopia, gradually passing into progressive atrophy of 
the optic nerve, by hemorrhagic and inflammatory affections of the retina. 
The hearing is rarely impaired ; oftener there is a nervous roaring in the 
ears. Blunting of the senses of smell and taste have also been observed. 

The skin is usually dry, and hectic sweats set in only as concomitants of 
pulmonary phthisis. As a general thing, there is a great tendency to the 
formation of furuncles and carbuncles, also at times to gangrene of the skin, 
or of the toes or even a whole limb. (Edema, especially of the lower limbs, 
is the result of advanced cachexia, exceptionally only of a complicating 
severe affection of the kidneys. 

Fever, in the absence of inflammatory complications, does not occur; on 
the contrary, the temperature is very commonly somewhat below the normal, 
between 95.9° and 97.7° F., and even temperatures as low as 93.2° F. have 
been observed. 

The duration of the disease is, in rare cases, extraordinarily brief, lasting 
only some weeks or months. Such cases occur, without exception, only in 
children and young persons. Usually the disease lasts for years. Ko doubt a 
number of cases have been cured by different modes of treatment, or have at 
least been greatly relieved. 

THERAPEUTIC HINTS.— The diet, as recommended on physio- 
logical grounds, should be selected from the following articles : the flesh of 
mammalia and birds, fishes, oysters, clams, crabs, lobsters, etc., cheese, eggs; 
salads, cucumbers, water-cresses, spinach, asparagus, cabbage, oyster-plant, 
radishes, beets, truffles ; butter, lard (oil to a certain extent) ; fruits, especially 
peaches, cherries, strawberries and currants; nuts. Bread, although con- 
taining a great deal of starch, can never be entirely omitted. Milk is allow- 



DIABETES, MELLITURIA, GLYCOSURIA. 643 

able, but exclusive use of skinuecl milk can only be exceptionally borne ; 
some have seen nothing but detriment from it. Among the spirituous drinks 
the red wines are allowable ; sugared brandies, sweet wines, champagne and 
cider should be entirely avoided. 

Dr. During, in Hamburg, treats his patients in the following manner : 
At six o'clock, a.m., the patient is wrapped in wet sheets and being well 
covered with blankets, he remains lying by open windows for one to two 
hours. After having been rubbed until dry, he gets his breakfast consisting 
of milk, with the addition of one tablespoonful of lime-water to one cupful 
of milk, and stale bread. This is followed by one to two hours walk in the 
open air. At about 10? to 11 a.m., the patient receives another piece of stale 
bread with some meat, or a soft-boiled egg and half a glass of good red wine 
mixed with water. Should this not agree he receives instead a plateful of 
rice or farina soup, with or without milk, the milk being always mixed with 
lime-Avater. This lunch is again followed by a walk in the open air of one- 
half to one hour's duration. Before dinner the patient takes a nap or rest 
for one hour. For dinner at two o'clock p.m., he receives rice and roasted 
meat, or ham or smoked meat, or venison — but without spices or vinegar. 
In some cases dry peas or white beans, well boiled, are allowed. Dried 
apples, prunes or cherries, also asparagus, green beans, cauliflower and car- 
rots boiled in water, not in broth, and without butter or fat, constitute other 
articles for dinner. A moderate allowance of green apples or cherries is 
given only in exceptional cases. The dinner is followed again by a walk of 
one to two hours' duration. Supper takes place at seven o'clock p.m., con- 
sisting of rice, grits, pearl-barley or water soup, with salt but without butter, 
and is followed by another half-hour's walk. At nine or latest at ten o'clock 
the patient retires to bed. 

This mode of treatment of Dr. During has produced undoubtedly the 
most gratifying results in diabetic patients, and it clearly demonstrates that 
the exclusive " meat diet," recommended on " physiological grounds," is very 
much like the treatment of chlorotics with "iron preparations" on physio- 
logical grounds, both of which lack merely in this important point, that they 
do not cure, because the human body is not a chemical laboratory, but a 
living organism. . 

Prout's experience, probably the largest of any observer, and drawn 
principally from the well-to-do class, is to this effect: "Within the last thirty 
years I have seen more or less of nearly seven hundred instances of diabetes, 
and of this great number, as far as minor and concomitant symptoms have 
been concerned, no two cases have been exactly alike, or have been benefited 
by exactly the same treatment, so greatly diversified in this apparently 
simple form of disease." 

Therefore a specific remedy for diabetes does not exist, and a homoeop- 



644 KIDNEYS. 

atliist will only feel gratified to find the special hints extended over a large 
number of remedies. 

Arg. met., Hahnemann says, some forms of diabetes may be cured by 
silver if the other symptoms correspond to the symptoms of this remedy. 
Riickert mentions a case which he cured by Argent., but which died of 
phthisis afterwards. He mentions: urine turbid, of a sweetish taste and 
profuse, especially at night; scrotum and feet oedematously swollen; anxiety 
and pressure in the pit of the stomach and want of breath. 

Ars. alb., in a drunkard, horrible thirst, emaciation and exhaustion, 
with odd hallucinations. Eruptions on the skin and tendency to boils ; vulva 
and vagina become red and swollen, with pruritus; teeth loose; skin dry and 
mealy ; cachexia ; kidneys affected ; oedema of legs. 

Asclep. vin., five cases reported as essentially improved by it: arthri- 
tis ; bleeding of gums ; impotence. 

Berber., sticky saliva, like cotton; pale yellow urine with a gelatinous 
sediment; pulse slow and weak; paralyzed, bruised sensation in the back; 
intense coldness of knees. 

Canthar., one case improved as reported by Goullon, with frequent 
and profuse urination, rapid loss of strength and great dejection of spirits. 
(30th potency in water every two hours.) And one case was cured by Canthar., 
given on account of existing satyriasis. (Fellger.) 

Carb. ac, one case with short, dry, hacking cough. (Haesseler — 
T J^ and later y 1 ^ dilution.) Goullon thinks it one of the most important 
remedies. 

Chelid., enlargement of liver and icteric color of face, bloated face; 
great weakness, emaciation. (In ten-drop doses of tincture.) 

Coloc, urine when voided is white and turbid, when getting cold it 
coagulates and becomes a milk-white, jelly-like mass, which, when poured 
out, glides in a compact cake out of the vessel. (Chyluria?) 

Cuprum, recommended, but no cures. 

Curare, recommended for acute cases. 

Digit., recommended, but no cures. 

Helon. dioic, several cases reported as cured. Dull, gloomy and 
irritable; melancholy; complete impotence; pain and lame feeling in back; 
numbness in the feet, going off by motion. 

Hepar, after previous abuse of mineral drugs. " The slightest thing 
made him break out into great violence; he could have killed some one 
without hesitation." (Thos. Skinner, Berridge.) 

Iodium, appears to have all the peculiar symptoms of diabetes; unap- 
peasable hunger with steadily increasing emaciation; violent thirst; hepatic 
and gastric troubles; increased secretion of urine; pulmonary inflammatory 



DIABETES, MELLITURIA, GLYCOSURIA. 645 

symptoms ; tendency to eruptions and furuncles. I cannot find that it has 
ever been given. 

Kali brom., tongue red and tender; gums spongy and bleeding; liver 
tumid and tender; bowels constipated, urine loaded with sugar. 

Kali hydr., in complication with pneumonic troubles, recommended by 
Kafka. 

Kreos., three cures and one improvement. Heaviness all over with 
drowsiness; dimsightedness ; impotence; bruised sensation of chest and all 
along the back; physical exhaustion. 

Laches., recommended. 

Lact. ac, recommended by Cantani and used with considerable success 
by others. Tongue dry, parched, sticky; feeling of emptiness and sinking 
at stomach; bowels costive, feces hard and black; debility; aversion to 
move; chilliness, especially extremities. (First dil. in five-drop doses morn- 
ing and evening. J. E. Wittemore.) 

Lycop., excessive micturition in gushes; fluor albus drops out in clots; 
drawing pains in right groin on rising from seat, better after motion. 
(Lippe.) Sexual desire and power gone; pulmonary phthisis, with hectic 
fever ; gouty lithsemia. 

Lye. virg., from central and sympathetic nervous system; bronchial 
irritation, with sighing respiration ; cardiac depression. 

Magn. usta, relieved in one case. 

Magn. sulph., cured one case. 

Mineral waters, Karlsbad, Gastein, Wildungen, in Germany; Vichy, 
in France ; Bethesda and Gettysburg, in United States. 

Moschus, one case with impotence cured. 

Natr. mur., despondency; excessive dryness of mouth; no sweat; skin 
cool ; sallow complexion ; constipation, with sensation of contraction of the 
anus. 

Natr. sulph., one case cured by Aegidi, with 3d dil., five drops four 
times a day. Hydrogenoid constitution. 

Nux vom., spinal lesions exciting cause; irritable temper; odd sensa- 
tions in the limbs, fidgets; numbness and paretic condition of the lower 
extremities ; stomach and liver complaints. Good livers, sedentary habits, 
previous abuse of liquors and drugs. 

Opium and its derivatives. Dulness, sadness, weak memory; after 
mental shocks, or injuries. 

Phosphor., gouty diathesis; disease of the brain; cerebral symptoms; 
cheesy degeneration of the lungs. 

Phosph. ac., urine like milk, mixed with jelly-like, bloody mucus, or 
clear like water; pain in the back and region of the kidneys; sleeplessness; 
excessive emaciation; great prostration. After loss of animal fluids; after 



646 KIDNEYS. 

grief, anguish, sorrow and care. "When the starting point lies in the 
nervous system." (Prout.) 

Plumbum, lowness of spirits, anguish and melancholy; diminution of 
sight ; dryness of mouth ; dry, cracked tongue ; suppuration of lungs ; hectic 
fever; impotence; dryness and brittleness of skin; gangrene. Dr. Hering 
considered it one of the most important remedies in this form of disease. 

Rat an., case much improved. 

Sec. corn., is similar to Plumbum; furuncles, petechia?, gangrene. 

Silic, successful in several cases. 

Sulphur, cured one case. 

Sulph. ac, a case much improved. 

Tarant., profound grief and anxiety; loss of memory and dimness of 
sight ; violent pain in lumbar region and paralysis of the lower extremities 5 
miliary eruptions and furuncles. 

Tereb., caused sugar in the urine. 

Uran. mur. and nitr., many cases have been cured or much improved 
by either of these preparations, usually administered in the 1st or 2d tritura- 
tion or dilution, several times a day for weeks. It is indicated, according to 
Prout, when the disease originates in assimilating derangements. Tongue 
reddish at edges ; dyspepsia. 

Dr. Francis Black recommends : 

For debility: Phosphor., Phosph. ac, Arsen., China, Moschus, Camphora, 
Pier. ac. 

For liver symptoms: Digit., Kali bichr., Merc, sol., Iod. m., Hepar, 
Sulphur, when there is diminished bile in the feces. 

Euvonymin, Iridin, Leptand., Podoph., Merc, corr., Iod. m., Nitr. ac, 
when there is increased flow of bile. 

Nux vom., Lycop., Nitr. ac, Merc, corr., Iod. m., Chelid., when there is 
no marked disturbance in the secretion of bile, but headache, frontal or 
occipital, vertigo, languor, weariness in limbs, uneasiness about the liver or 
scapular regions, furred tongue, often indented at sides, loss of appetite, 
flatulence, great depression and irritability of temper, constipation, with dark 
or pale motions, or normal color, sometimes alternating with diarrhoea, in- 
termitting pulse and palpitation of the heart. 

Amm. mur., when there is lithsernia and catarrh of the fauces extending 
to stomach. 

Colchic, Nux vom., Kali iod., when there is gouty disposition. 

Kali iod., in syphilitic taint. 

For urinary and sexual symptoms: Arsen., Aeon., Camphora, Tereb., 
Canthar., Kali bichr., when there is rapid decrease in the secretion of urine 
with strangury, or excessive itching and sense of fulness in the vagina. 

For pulmonary affections: Phosphor., Arsen., Iodium, Hepar. 



DIABETES INSIPIDUS. 647 

For nervous symptoms: Aeon., Atropia, Phosphor., Argent., Aurum, 
Kali hydr., if cerebral. 

Xux vom., Veratr., Silic., Phosphor., if spinal, and Aeon., Atropia, 
Opium, Xitrite of Amyl, if tendency to apoplexy. 

For furuncles and carbuncles: Arnica, Phosphor., Arsen., Silic, Hepar. 

This list may be enlarged from the above given special hints. 

Diabetes Insipidus, 

Also going under the name of polyuria, hyperwresis, urhice profluxio, poly- 
dipsia, "is applied to every chronic, morbidly increased excretion of urine, 
free from sugar, which is caused by no profound structural changes of the 
kidney, and which constitutes either the sole or at least the most prominent 
and primary morbid phenomenon." (Senator.) 

The term diabetes insipidus excludes any temporary increase of urine 
which is caused by excessive ingestion of fluids, by the use of diuretics, by 
interference with the loss of water through the lungs and skin, by the ab- 
sorption of watery exudations, during convalescence from febrile diseases, or 
duriug hysteria or other diseases in the nervous system. 

The amount of urine evacuated in twenty-four hours varies greatly in 
different cases and in the same case at different times; it may vary from a 
point only slightly above the physiological maximum to ten or twenty times 
that amount. Its color is pale and clear, resembling water with a slight 
greenish tint ; a peculiar odor of the urine is scarcely to be perceived, and 
its reaction is very faintly acid ; it becomes neutral and alkaline more rapidly 
than usual, and turbid from earthy phosphates and bacteria. 

Its specific gravity varies, as a rule, between 1004 and 1010, though it 
may approach the lower physiological limit, or sink lower than in any other 
disease, viz., to 1002, and even to 1001. This low grade of specific gravity 
is not the result of an absence of solid urinary constituents, but of the rela- 
tively too great amount of water with which they are diluted. Compara- 
tively there is as great an amount of solid urinary constituents excreted as 
in healthy persons, at times even a greater. A diminished amount occurs 
only exceptionally and temporarily, and for any great length of time, or 
during the whole disease only in consequence of the association of some other 
malady. 

With the amount of urine excreted stands in direct proportion the thirst 
of diabetic patients ; it is almost inappeasable. As a very peculiar phenom- 
enon may be mentioned a great flow of saliva at the same time in a case ob- 
served by Kuelz. The skin is generally dry and the temperature insignifi- 
cantly lowered, but on the other organs and on the general health, diabetes 
insipidus has, so far as its direct influence is concerned, no effect worth men- 



648 KIDNEYS. 

tioniiig, if the patients are allowed to drink freely. A sudden deprivation of 
drink may seriously endanger the life by the drying of all the tissues, and 
would cause besides a scarcely endurable distress to the patient. 

Diabetes insipidus is much more frequently observed in youth and 
middle age than in later life. As Exciting Causes have been mentioned : 
injuries of the skull, violent and sudden emotions, chronic diseases of the 
brain and spinal cord, and a single excessive ingestion of cold beverages or 
other fluids. The patients very rarely die of this disease if uncomplicated ; 
it may last for years if not an intercurrent disease, or the malady in the 
course of which the diabetes has arisen, and which is to be regarded as its 
cause (affections of the brain or spinal cord), terminates in death. On the 
other hand recovery has been sometimes brought about by an intercurrent 
disease, by pregnancy, etc. 

THERAPEUTIC HINTS —The single case will have to be studied, 
and it is quite likely that a remedy might be found to suit the case without 
having the two prominent signs of the disease: "profuse urination and in- 
satiable thirst," in a very high degree. The following remedies have been 
recommended : Apis, Bellad., Cepa, Ferr. phosph. (Schiissler and Huber), 
Nitrum, Phosph. ac, Squilla. Compare also Diabetes Mellitus. 

Hematuria, Passing Blood with the Urine. 

The blood mixed with the urine may be derived : 

1. From the substance of the kidney. — In this case the coagula present 
will he few, if the hematuria be produced by venous stasis; there will be a 
large number of renal casts, entangling blood-cells, present, if the bleeding 
be caused by inflammation of the kidneys; and there will be profuse bleed- 
ing as leads to the formation of large clots in the pelvis of the kidney or in 
the bladder, only in the rare instances of traumatic lesion of one kidney (for 
example, crushing or rupture of a kidney by a kick or the like), or in cases 
where a high vascular cancer has grown into the pelvis of the kidney. 

2. From the pelvis of the kidney. — In this case the haemorrhage may be 
more profuse and form blood-clots corresponding to the shape and size of the 
calices, being most generally caused by renal calculi, preceded by renal colic 
and attended with calcareous deposits in the urine. If the entire pelvis of a 
kidney be filled with blood or with masses of cancer, it may happen that the 
corresponding ureter becomes blocked up and distended with a thrombus, 
which assumes the shape of the ureter, measuring often more than a finger's 
length, and being of about the size and shape of a lumbricoid worm when 
finally passed. 

3. From the bladder. — In this case the blood-clots may form of so large 



HEMATURIA. 649 

a size that they cannot pass through the urethra without being first com- 
pressed by the contraction of the bladder or broken up by instruments. 
Haemorrhages of this kind may be caused by traumatic lesions (urinary cal- 
culi, external violence upon the bladder), by catarrh and ulceration of the 
bladder or by suppressed hemorrhoidal or menstrual flow. 

4. From the prostate gland or urethra. — In this case the blood often dis- 
charges from the urethra without micturition and on examination will reveal 
the sore and swollen parts from which it derives. Its causes are most fre- 
quently external injuries or inflammations, especially gonorrhoeal. 

The presence of blood in the urine can best be demonstrated by the mi- 
croscope, which shows the cells in the sediment. However, there are cases 
where only the coloring matter of the blood is present, but no cell, where, 
therefore, a dissolution or destruction of the blood-corpuscles has taken place, 
as in the case of graver forms of typhoid fever, in hemorrhagic small-pox, in 
scorbutus, in morbus maculosus Werlhofii, in septicemia and in poisoning by 
phosphorus, arsenic and its compounds and sulphuric acid. The source of 
the bleeding in these cases has been traced to one or the other kidney pelvis, 
or, more rarely, to both, or to the bladder, or the dissolution of the red cells 
has taken place even before they leave the renal vessels. The Causes of re- 
nal hemorrhage, apart from the effects of injuries and cancerous growths, are: 
different kinds of inflammations of the kidney substance; active congestion, like 
that produced by turpentine or cantharides, or in some persons by asparagus, 
or in rare cases by the action of cold upon the integuments of the body ; by 
venous or passive congestion, like that although but rarely induced by car- 
diac insufficiency, or by hemorrhagic infarction of the kidney, the result of 
embolism in consequence of heart disease. 

THERAPEUTIC HINTS.— Arnica, when caused by external vio- 
lence. 

Arsen., hemorrhoids of the bladder; very painful micturition; scanty 
secretion ; burning pain in the urinary organs ; paralytic symptoms of the 
bladder; great anguish and restlessness; dissolution of blood-corpuscles. 

Calc. carb., in chronic cases; hemorrhoidal affections; polypi; leuco- 
phlegmatic persons. 

Camphora, after irritating drugs, especially cantharides, and after 
exanthematic fevers. 

Canthar., violent cutting, pressing and crampy pains in the bladder, 
extending into the urethra and into the kidneys ; strangury, burning pain 
before, during, and after micturition; cylindrical exudations in the urine; 
pain increased from drinking water, even from the sight of water. 

Colchic, after being drenched when sweating. 



650 KIDNEYS. 

Chim. mac, in consequence of severe and long-continued gonorrhoea! 
inflammation. 

Crotal., haemorrhage from all the orifices of the body. 

Eriger., empirically used, without any characteristic indications; gon- 
orrhoea. 

Hamam., haemorrhoids of the bladder; passive congestions. 

Ipec, profuse bleeding, with fainting, deadly paleness, sickness of the 
stomach ; oppression of the chest. 

Laches., the urine looks black like coffee-grounds; scarlet fever. 

Lycop., especially in connection with gravel or chronic catarrh. 

Mercur., painless discharge of blood; also very violent urging to uri- 
nate, and painful micturition, whereby sweat easily breaks out. 

Mezer., crampy pain in the bladder; and, after that, bloody urine is 
voided. 

Millefol., pain in the region of the kidneys, with chilliness, necessity to 
lie down; the blood forms a sediment in the vessel like a bloody cake; pres- 
sive pain in the urethra during the flow of blood. 

Nitr. ac, according to Goullon, specific in active haemorrhage, also 
after mercury; urging after micturition, with shuddering along the spine 
during micturition ; gonorrhoeal affections ; dissolution of blood-corpuscles. 

Nux vom., after the abuse of alcoholic stimulants, or allopathic drugs; 
suppression of haemorrhoidal or menstrual discharges ; full, tensive feeling, 
pressure and distention in the abomen, loins and region of the kidneys; signs 
of stagnation in the portal circulation. 

Phosphor., dissolution of blood-corpuscles ; after sexual excesses ; after 
poisoning with turpentine ; haemophiles. 

Pulsat., drawing, cutting pain around the navel into the small of the 
back ; penis and scrotum drawn up ; crampy pain in the right leg from the 
knee to the groin. 

Secale, passive haemorrhage ; blood thin; blood-corpuscles wanting in 
consequence of dissolution; or painless discharge of thick, black blood in 
consequence of kidney disease ; coldness of the body ; cold perspiration on 
forehead ; great weakness. 

Sulphur, after suppressed cutaneous eruptions and haemorrhoidal dis- 
charges ; stinging and burning in the urethra. 

Tereb., the blood is thoroughly mixed with the urine, forming a dirty, 
reddish-brown or blackish fluid, or a coffee-ground-like sediment ; burning, 
drawing pains in the kidneys ; pressure in the bladder, extending up into the 
kidneys when sitting, disappearing when walking about; before urination, 
pressing and straining in the bladder when sitting, going off when walking; 
burning in the bladder, worst during micturition ; in complication with scor- 
butic affections, and if caused by living in damp, moist dwellings. 



ALBUMINURIA. 651 

Uva ursi, constant urging to make water and straining, with discharge 
of blood and slime ; or constant straining without any discharge at all, or 
only a few. drops of urine, after this burning and cutting in the urethra, which 
is succeeded by a discharge of blood ; hard stools. 

Zincum, vicarious bleeding through the urethra in consequence of sup- 
pressed menstruation, with pain in the bowels, diarrhoea, and night-cough 
with expectoration of mucus. 

Compare also the corresponding diseases, of which Hematuria may be 
the consequence. 

Albuminuria. 

Albumen in the urine is not only derived from the kidneys; it may 
come from the renal pelves, from the ureters, from the bladder, or even from 
the urethra, when the mucous membrane of these passages has become in- 
flamed, or when some abscess has burst and poured its matter into these chan- 
nels; but then the percentage quantity of albumen present is only trivial. 
A highly albuminous urine has been observed after the application of large 
Spanish fly-blister, in consequence of the inflammation of the urinary passages 
caused thereby. 

A transitory presence of albumen in the urine, secreted by the kidneys, is 
usually due to an abnormal increase of the blood-pressure with perfectly healthy 
kidneys, as we find, for instance, in heart disease, especially mitral stenosis, 
or extensive muscular degeneration, in pleuritic effusions, in obliteration of 
several branches of the pulmonary artery, as follows upon cirrhotic degenera- 
tion of the lung substance, in emphysema. Still, as a rule, the above affec- 
tions of the respiratory organs do not often lead to congestive albuminuria. 
Much more frequently we meet albuminuria, as an entirely temporary symp- 
tom, during attacks of severe fever, as occur in the course of severe angina, in 
pmeumonia, in typhoid fever and the congestive stage of the acute exanthemata, 
in pycemia, and occasionally in cerebrospinal meningitis. This febrile albu- 
minuria is not attended with any specific disease of the kidneys, and must, 
therefore, not be confounded with albuminuria in consequence of acute diffuse 
nephritis, which so often occurs in diphtheria, relapsing and scarlet fever. 
This inflammatory albuminuria is the prominent symptom of inflammation of 
the kidneys, and especially that form which runs a chronic course. It fur- 
nishes the largest percentage amount of albumen to the urine, which we find 
also usually containing, at the same time, fibrine and white and red blood- 
cells. It seems that by the inflammatory process the walls of the capillaries 
within the glomeruli are so changed as to constitute a special perviousness to 
albuminous substances from the blood. Other diseases of the kidneys, such 
as fatty degeneration of the renal epithelium, cirrhosis, granular atrophy, 



652 KIDNEYS. 

amyloid disease of the kidneys, are not particularly characterized by the 
presence of albumen in the urine, although it may not entirely be wanting 
in these affections. It is the diffuse inflammation of the kidneys (the acute 
and especially the chronic form) which furnishes the largest amount of albu- 
men to the urine, and to which the term albuminuria is particularly applic- 
able. 

THERAPEUTIC HINTS— According to Buchner, when in conse- 
quence of gonorrhoea or syphilis: Thuja, Sabina, Nitr. ac, Aurum, Cuprum, 
Tart. emet. (Natr. sulph., Benz. ac, Kali bichr.). 

Nitr. ac, worse at night; nausea; sour taste; bilious diarrhoea or 
constipation; dry shin; fever; headache; dull systolic sound of the heart 
(similar to Arsen.); pressure in the kidneys; turbid, fetid urine; oedema 
of the feet. 

Albuminuria being merely a symptom, but pre-eminently a symptom 
of acute and chronic nephritis, further special hints will be given in these 
chapters. 

Uraemia. 

Notwithstanding the most strenuous efforts by a host of inquirers to dis- 
cover the essential nature of ursemia, only conflicting views have thus far 
been the result of the labors of the different experimenters. The most 
probable of all theories seems to be this, that "uraemia arises in consequence 
of imperfect depuration of the blood in renal disease, the results of the re- 
tention in the blood of the dross of the capillary interchanges, namely, 
nitrogenous substances and specific urine contents." (Bartels.) 

Acute uraemia, in acute as well as chronic kidney diseases, manifests 
itself in the form of epileptic convulsions, which are succeeded by coma or, in 
some instances, by a condition of maniacal excitement. Not unfrequently a 
series of such epileptic attacks terminate at last in death. At times these 
uremic fits are preceded by dropsy, dyspepsia, obstinate vomiting, and even 
amaurosis, which latter, however, may subside as suddenly as it comes. 

In the Chronic form of uraemia the epileptiform fits are usually 
absent or amount only to twitchings of certain groups of muscles, or they 
close the scene after long-continued, complete coma. The principal symptoms 
are increasing somnolence, apathy, or stupefaction, advancing at last to com- 
plete coma, frequently preceded by stubborn and incessant vomiting of masses 
which contain carbonate of ammonia. Often there is in this form a most 
tormenting itching of the skin, which compels the patient to scratch himself 
incessantly, even when lying in a state of unconsciousness. This symptom 
has been observed in patients who had crystals of urea upon the surface of 



ACUTE PARENCHYMATOUS NEPHRITIS. 653 

their skins, or exhaled a urinous odor from their persons. Lastly there have 
been observed in chronic renal affections, a long while before the fatal ter- 
mination, paroxysms of asthma, most frequent at night, with intervals of com- 
plete freedom. 

THERAPEUTIC HINTS according to Buchner: 

Main remedies : Arsen., Cuprum, Phosphor., Aurum, Tereb. 

Cuprum, eclamptic form; alternation of convulsions and nervous 
asthma with talkative delirium, which is interrupted by amaurosis or deaf- 
ness ; the most violent paroxysms are followed by apathy and greatest in- 
difference. During the paroxysm : face distorted, often red ; eyes projecting, 
staring; spasms most promiuent in the extensors; tongue and breath cold; 
long, shrill screams ; finally exhaustion, sweat, torpor, and cessation of con- 
vulsions. 

Arsen.., in the narcotic form, with cedema of the brain. 

Phosphor., where there is acute atrophy of the brain and medulla 
oblongata. 

Hydr. ac, action of heart diminished; pulse accelerated, soft; stag- 
nation of circulation in heart and lungs; palpitation, with indescribable 
anguish and dyspnoea; depression of sensibility; first convulsions and after- 
wards paralysis; extreme apathy; slow moaning breathing; rattling in 
trachea ; paralysis of larynx or sudden paralysis of heart. 

Nicot., paralysis of diaphragm; indifference; want of reaction; cold 
forehead; thirstlessness ; serous transfusion in the intestines, without diar- 
rhoea ; want of secretion in liver and kidneys. 

Acute Parenchymatous Nephritis. 

This is the First stage Of Brigllt'S disease of 'many writers, or albu- 
minous nephritis of others, or the acute desquamative nephritis of Johnson, or 
Traube's hcemorrhagic nephritis, or the catarrhal of some, and the woupous 
nephritis of other recent pathological hand-books. 

Its Pathological Changes consist in the following: dropsical effusion 
into the subcutaneous cellular tissue, at times also into the pleura, the peri- 
cardium, or the peritoneal cavity; still less frequently extensive pulmonary 
cedema ; and rarest of all cedema of the mucous membranes of the folds at 
the upper part of the larynx. The kidneys are enlarged and swollen, espe- 
cially the cortical substance, so that the cajmile is tightly stretched; the 
color of the cortical substance on section is paler than normal; it has a dull, 
grayish-red aspect, and gives a doughty feel ; the glomeruli distended with 
blood, contrast with the paler ground as dark red points and streaks; the 
pyramids are always greatly congested, sometimes bluish-red in color. In 



654 KIDNEYS. 

other cases no very essential deviation is exhibited from the normal appear- 
ance of the kidneys, with the exception of the swelling of the cortical sub- 
stance, and even this is in some cases, when the patient died from other 
causes than the attending nephritis, very slight in degree. Between these 
extremes many differences in degree appear which correspond to the differ- 
ences in the intensity of the functional disturbances observed at the bedside 
previous to death. 

The epithelial cells are cloudy and swollen, owing to a deposit of gran- 
ular masses in them; the interstices between the renal tubules, which are 
distended and dilated by the swelling of their epithelial lining, appear wider, 
and contain lymphoid elements in varying numbers ; there appear drops of 
fat in the cellular stroma, and in more protracted cases yellow patches seem 
to indicate fatty degeneration. In all cases there is an infiltration of the 
epithelial cells and an albuminous transudation from the blood-vessels. Acute 
cases are usually attended with haemorrhages into the tubuli uriniferi, where 
they form blood-casts, which are also found in the urine; also homogeneous, 
small and pale cylindrical plugs have been observed filling here and there 
the lumina of the tubuli. 

The Etiology of acute inflammation of the kidneys embraces specific 
and mechanical causes. 

As Specific Causes must be mentioned: poisoning with cantharides 
and similar irritating drugs; but scarlet fever is the most common cause. 
Yet not all scarlatina epidemics furnish a like percentage of this disease. 
For although malignant epidemics, generally speaking, show the largest per- 
centage, yet there are epidemics in which even bad cases produce no nephritis, 
and others where quite light cases are followed by it ; and this is not referable 
to any imprudent exposure of the patient, as the disease may attack a child 
which never has left the bed. The onset of the disease, if an average be 
taken, occurs about the twentieth day from the first appearance of the rash ; 
the earliest date of its occurrence was the tenth, the latest the thirty-first day. 
With this renal inflammation we must not confound febrile albuminuria 
(compare Albuminuria), which generally appears at the height of the ex- 
anthem and disappears again with the subsidence of the fever. 

Next to scarlet fever follows diphtheria as a specific cause of nephritis ; 
and like scarlet fever it does not excite a renal affection in every instance ; 
nor does the renal affection stand in direct proportion to the intensity of 
diphtheria. 

Measles, rubeola (Rotheln), small-pox excite nephritis far less frequently 
than either scarlet fever or diphtheria, but relapsing fever is, according to 
Ponfink, almost without exception attended by nephritis. Besides these 
principal specific causes are yet to be mentioned : erysipelas, carbuncles, phleg- 
mons, profuse suppurations in cavities where decomposition of the pus begins 



ACUTE PARENCHYMATOUS NEPHRITIS. 655 

in consequence of the admission of atmospheric air, and very rare cases of 
dysentery. 

The Mechanical Causes which act upon the vessels and thus effect the 
circulation of the blood through them, are: Cholera, which leads to complete 
stoppage of the circulation in the kidneys and a cousequent anuria; catching 
cold, which contracts the cutaneous vessels and drives the blood into the in- 
ternal parts of the body where it produces an elevation of the blood-pressure ; 
extensive burns of the surface of the body, which cause a general depression of 
the temperature of the body in consequence of the great loss of heat; ab- 
dominal typhus and other diseases attended by an unbroken continuous high 
temperature, which causes dilatation of the vessels and other alterations in 
the walls of the vessels (of rare occurrence) ; and acute rheumatism, when 
complicated with endocarditis. Pregnancy also is a cause of acute parenchy- 
matous nephritis. Usually its appearance takes place in the last months of 
pregnancy, and it attacks primiparas more frequently than women who have 
already borne children. Its first symptom in the majority of cases is drop- 
sical swelling not confined to the lower extremities, but attacking face and 
hands as well. The percentage of albumen is greater than in nephritis of 
any of the other causes, and its fearful terminal symptoms : epileptiform con- 
vulsions, amaurosis and maniacal excitement are well known under the name 
of eclampsia gravidarum, parturientium et puerperarum. However, it must not 
be surmised that every case of eclampsia must be ascribed to disease of the 
kidneys and uraemia, not even if there should be found albumen and a few 
casts in the urine after the attacks, inasmuch as cases of this kind have been 
observed which showed after death not a sign of diseased kidneys. 

The Symptoms of acute parenchymatous nephritis are in the majority 
of cases accompanied by the symptoms of the primary disease — the febrile 
movement especially must often be ascribed to the latter. In cases from 
catching cold, however, the temperature has been observed to rise above 104° 
F., lasting commonly but a short time ; the outbreak of uremic convulsions 
or of secondary inflammatory processes, too, heighten the temperature. Ach- 
ing pains in the lumbar region is not at all a constant symptom and frequently 
is absent altogether. But a tenderness in the region of the kidneys upon 
deep pressure is often present. Frequent and excessively urgent desire to mic- 
turate, with the voidance of only a few drops, often of bloody urine, is also 
not a constant symptom and is apt to disappear very quickly. The quantity 
of urine is always diminished at the commencement; the urine may even be 
entirely suppressed; later, when the case takes a favorable turn, the quantity 
increases above the normal quantity or may for some time alternately in- 
crease and diminish. The urine is at first always cloudy from the presence 
of urates and other elements. Its color is from the admixture of blood 
tinged reddish, or is quite dark blackish-red, when a thick sediment of 



656 KIDNEYS. 

chocolate-brown color is formed, consisting of urates and blood-corpuscles. 
Its reaction is always acid and its specific gravity varies with the quantity 
passed. At first it may rise as high as 1031, and later, when the quantity 
increases, sink as low as 1011, 1009 and even 1006. The urine always con- 
tains albumen, although in no case as much as in chronic parenchymatous 
nephritis, and also casts of a hyaline nature with epithelial cells from the 
tubuli uriniferi attached to them, or covered with small drops of fat, also 
white and red blood-globules and their debris, epithelial cells from the uniferi 
tubules, and granular masses f the latter being probably the detritus of broken- 
down epithelial cells. 

The danger of acute nephritis consists in the retention in the blood of 
the special constituents of the urine, causing acute uraemia, and in the insuf- 
ficient excretion of water, which leads to dropsy, a symptom which is scarcely 
ever absent, except in very mild cases. The cedema commences usually at 
first iu the lumbar region of the back or in the face ; later often an accumu- 
lation of water fills the serous cavities of the trunk ; in rare cases there is 
oedema of the glottis. 

Vomiting is occasionally at the commencement severe and obstinate; at 
a later period it may be uroemic in its character. 

The Prognosis of acute nephritis depends much upon the cause from 
which it is derived. That following scarlet fever is the most dangerous. 

Its transition to a chronic renal affection is only exceptional ; that fol- 
lowing catching cold or articular rheumatism is perhaps the most prone to 
chronic renal troubles. Total suppression of urine, except in cholera, is 
a very grave symptom, often fatal; ursemic attacks do not always prove 
fatal. 

THERAPEUTIC HINTS —In complication with scarlet fever com- 
pare: Apis, Arsen., Ascl. syr., Bellad., Bryon., Colchic, Helleb., Kali carb., 
Laches., Lycop., Mercur., Rhus tox., Secale, Senega, under the head of Scar- 
let Fever. 

After the abuse of cantharides, or balsam of copaiva, the best antidote 
is Camphora ; after turpentine, Phosphor. 

Aeon., high fever; restlessness; dark, scanty urine; consequence of 
exposure to cold. 

Apis, after scarlatina or diphtheria. 

Arsen., after burns. 

Bellad., skin sweaty; renal region very tender to pressure; ursemic 
spasms. 

Canthar., high fever; pulse frequent and hard; drawing, tearing pain 
in loins and testes, worse from motion ; sometimes in spells, stopping breath- 
ing; micturition exceedingly painful, drop by drop; scanty, dark urine, 



ACUTE PARENCHYMATOUS NEPHRITIS. 6-57 

with burning in the bladder and urethra ; the urine contains cylindrical 
casts of fibrinous exudation, epithelial cells and blood, and is therefore easily 
coagulable ; constipation; ursemic, cerebral symptoms, like stupor, numbness : 
after exposure to cold, or mechanical injuries; complication with prostatic 
derangements, inflammation of the bladder, and stricture of the urethra : 
after burns. 

Chelid., with pneumonia on right side. 

Balsam of Copaiva and Cubebs have been observed to cause in- 
flammation of the kidneys, though their sphere of action is not sufficiently 
known. 

Colonic, after getting thoroughly wet; articular rheumatism. 

Helon., in connection with pregnancy, and symptoms of approaching 
convulsions. 

Hepar is recommended by Kafka on the ground of its having a de- 
cided relationship to croupous exudations elsewhere. 

Kali carb., tensive pain in the region of the left side; swelling 
of the inguiual glands; oedema of the left foot, extending gradually to the 
right foot and upwards over the whole body; oedema of upper eyelid; 
blackish urine, which, on shaking, foams, and on standing leaves a thick, 
reddish, slimy sediment; frequent, soft, palish evacuations from the bowels: 
after a blow upon the left side and staying for hours in wet clothes. 

Kali hydr., scanty, dark urine; painful micturition; sediment dirty, 
yellowish ; great thirst ; heat in the head. Likewise recommended by Kafka 
on the same ground as Hepar. 

Laches., after scarlet fever or diphtheria; dark, almost black urine: 
difficulty of breathing. 

Merc, corr., great dyspnoea; colic and tenesmus; offensive secretions: 
pufnness of face and feet. 

Phosphor., the skin is pale and anaemic; frequent watery diarrhoea : 
in complication with pneumonia, bronchial catarrh, ulceration of the bones, 
amaurosis. Antidote to turpentine. 

Rheum, '"bloating around the eyes, pallor of face, covered with cool 
sweat; forehead and hair sopping wet, lips, eyelids, fingers twitching; urine 
scanty, hot, with slimy shreds and strings of blood on diaper; renal region 
tender to pressure. After diphtheria." (M. B. Tuller.) 

Rhus tox., tearing pain in the region of the kidneys; cedematous 
swelling all over; after exposure to wet. 

Tereb., scanty secretion of dark (occasionally), bloody urine, which 
coagulates on addition of nitric acid under the application of heat; oedema 
all over; intestinal catarrh and diarrhoea; bronchial catarrh with expectora- 
tion of much mucus. 

42 



G58 KIDNEYS. 

Amaurotic symptoms may especially require: Apis, Arsen., Colonic, 
Gelsem., Hepar, Kalmia, Merc, corr., Phosph. ac, Plumbum. 

Chronic Parenchymatous Nephritis. 

This is the Second Stage of Bright'S disease of most writers, or the 
non-desquamative nephritis of Johnson. Being, as stated in the last chapter, 
occasionally developed from acute nephritis, its anatomical changes may cer- 
tainly be expected to correspond to a certain extent to those described there. 
We find the kidneys still more enlarged than in the acute form, and being 
exceedingly ansemic, they look strikingly pale, almost white, with a strong 
tinge of yellow, wherefore Wilks called them the "Large white kidney." 
"With this yellowish-white color of the surface as w T ell as of the cortical sub- 
stance contrast sharply the bluish-red, stellate venous radicles and the en- 
larged, but often dark red pyramidal substance. The microscopical examina- 
tion reveals the same changes as described under acute nephritis. The 
long-continued inflammatory hyperplasia of the interstitial tissue finally 
results (in consequence of the pressure which the callous tissue exerts upon 
the blood-vessels) in a gradual obliteration of the glomeruli and a secondary 
atrophy of the secreting parenchyma of the kidneys, although such kidneys 
are rarely found much smaller than normal kidneys. In cases like these the 
left ventricle of the heart becomes hypertrophied. The bodies are always 
more or less dropsical. 

The Etiology of chronic nephritis shows a small percentage of cases 
to have grown out of some acute forms, but the great majority of cases 
develops insidiously during the course of affections that are accompanied hy 
persistent suppuration, such as diseases of the bones and joints, the more severe 
forms of inveterate syphilis, phthisical, ulcerative destruction of the lungs; in 
consequence of long-continued exposure to cold and moisture (a sudden catching 
cold is more apt to produce acute nephritis, and therefore almost all writers 
on the causes of chronic Bright's disease, mention living in cold and wet 
habitations, occupations in which the body is frequently wetted and chilled 
through, etc., as one of the causes) ; and in consequence of marsh miasm. 
Young persons are decidedly more frequently attacked with this disease than 
those who are advanced in years. 

Symptoms of chronic parenchymatous nephritis are on account of its 
insidious inroad at first entirely wanting ; not even a pain is felt by those 
persons who enjoyed previous good health. When no examination of urine 
has been instituted, the first sign that betrays the malady is dropsy, and at 
the same time the patient appears pale and anozmic, and complains of losing 
bodily strength. The dropsy, beginning either in the feet or in the face, ex- 
tends gradually over the whole body; the external genitals in particular, and 



CHRONIC PARENCHYMATOUS NEPHRITIS. 659 

also the abdominal walls are greatly swollen, before any perceptible quantity 
of fluid is collected in the peritoneal, pleural or pericardial cavity. The 
general anasarca develops to a higher degree than in any other disease of the 
kidneys, often to such an extent that the epidermal layer bursts, and the 
dropsical fluid trickles out of the cracks in enormous quantities. In such 
places where the corium has been deprived of its epidermis, frequently fol- 
lows a gangrenous destruction of the parts. Even the lining mucous mem- 
brane of the intestinal tract becomes involved in the dropsical swelling, which 
manifests itself by vomiting of watery masses and profuse watery diarrhoea. 
The advance of the dropsy will not be checked until the excretion of urine 
again becomes abundant, and even then it may take a long time before it 
entirely and permanently disappears. When this is accomplished the patients 
appear skeleton-like, for not only the subcutaneous adipose tissue, but also 
the muscles have been reduced to the merest remnants; there is extreme 
anaemia. Should complete recovery take place, which is rarely the case, the 
convalescence is very slow. Dropsy is absent only in the very mildest cases. 

The urine invariably contains albumen, and when the disease is at its 
height, in greater quantity than under any other circumstances; it also con- 
tains casts of various description, epithelium, debris, white blood-cells, urates 
and uric acid. Bed blood-corpuscles appear only transitorily in cases which 
commenced acutely, for instance, after catching cold. In consequence of and 
according to the presence and quantity of these contents, the color of the 
urine is ordinarily dirty brown, and darker in proportion to the smallness of 
the quantity. The scantier the excretion, the more clouded it is — even before 
cooling. The urates are held in suspension after cooling, when there is a 
large amount of albumen present, and make the urine thick and muddy. 
The uric acid crystals fall to the bottom and adhere to the vessel. 

The specific gravity of the urine is highest at the height of the disease — 
in some cases above 1040, and it falls below the normal weight as soon as a 
more abundant excretion of urine sets in, even before the diurnal quantity 
of urine has reached its normal point. With this fall in specific gravity is 
not found a like fall in the amount of albumen, while it may be taken as a 
rule that the relative quantity of urea to a certain extent rises and falls with 
the rise and fall of the specific gravity of the urine. 

The palse at the beginning is usually remarkably slow, full and tense, 
and the heart-sounds loud and sharp, in persons who, previous to the attack, 
were robust and vigorous, but later becomes weaker and more frequent, while 
in enfeebled persons the pulse and action of the heart are weak from the first. 

Respiratory difficulties set in only in consequence of dropsy in the serous 
cavities, or of pulmonary oedema. 

Digestion may and may not be disturbed; but vomiting and diarrhoea 



G60 KIDNEYS. 

arc frequent symptoms when the dropsy is at its height ; the latter may ter- 
minate in secondary dysentery and ulceration of the bowels. 

Epileptiform attacks, coma, amaurosis, are much less frequently observed 
than in acute nephritis. 

When secondary atrophy has taken place, a hypertrophy of the left ven- 
tricle develops, with its train of symptoms, in consequence of the obliteration 
of so many peripheral arterial branches. 

The Prognosis of this disease is a bad one, when the affection has lasted 
already for a long time, or is complicated by some incurable constitutional 
or organic disease, or when the urine is very scanty, high in specific gravity, 
with a large amount of albumen; or when the urine, after the subsidence of 
dropsy, is pale, of low specific gravity, never even temporarily attaining a 
normal density, and still containing albumen and casts in extraordinary 
number, with commencing secondary hypertrophy of the left ventricle; or 
when oedema of the glottis or lungs, pneumonic infiltrations of the pulmonary 
tissue, phlegmonous inflammations of the subcutaneous cellular tissue are 
added to the already poor condition of the patient. 

THERAPEUTIC HINTS. -Com pare Acute Nephritis. 

Arg. nitr., is said to have caused albuminuria. 

Arsen., great anxiety at night, driving out of bed; vomiting of brown- 
ish masses, with violent pain in the bowels; pressure and burning pain in the 
stomach; swelling of the genitals; palpitation of the heart, left side of heart 
predominantly affected. 

Aurum, when complicated with gout, renal calculi, protracted suppu- 
rations, syphilis, liver degenerations, mercurial affections. (Buchner.) 
Melancholy; desires death. 

Benz. ac, gouty diathesis, with strong-smelling urine. 

Brachiglottis repens (puke-puke), highly recommended by Dr. C. 
F. Fisher. 

Bryon., intercurrent inflammation and exudation of serous membranes. 

China stands next to Arsen. (D. Thayer.) 

Colonic, damp rooms; relapses from taking cold in damp weather; 
suppressed perspiration; affection of salivary glands; cannot bear the smell 
from cooking. 

Digit., peculiar, seemingly rheumatic pains, and catarrhal affections of 
the lungs, with serous secretions. 

Helleb., indifferent, sad, silent; anasarca and effusion in the pericar- 
dium or pleura; black urine. 

Hepar, after abuse of mercury; renal region sensitive to slightest 
touch ; incessant, painful urging to urinate, with voiding of a few drops of 
thick urine; fever; thirst; colliquative diarrhoea; night sweats. 



INTERSTITIAL INFLAMMATION OF KIDNEYS. 661 

Lycop., hydropericardium ; ascites; anasarca, especially lower limbs; 
oozing of water from sore places of the ©edematous legs; urine dark red, 
scanty, albuminous, with strangury. Very irritable after sleep; scarlet, 
fever. 

Nitr. ac, pulse intermits every third or fourth beat; urine scanty, 
dark brown, smelling strong, like horses' urine ; turbid urine ; syphilis; abuse 
of mercury. 

Phosphor., tuberculosis; diseases of right heart and of the pulmonary 
artery. (Buchner.) 

Phytol., after diphtheria in rheumatic and syphilitic patients. 

When in consequence of exposure to cold and wet : Calc. carb., Colchic., 
Duleam., Kali carb., Mercur., Nux vom., Rhus tox., Sepia. 

When in consequence of suppuration, cachectic states of the system : 
Asaf, Aurum, Calc. phosph., China, Ferrum, Hepar, Mezer., Phosphor., 
Silic, Sulphur. 

Buchner recommends for: 

Anasarca: Arsen., Duleam., Helleb. 

Hydrothorax : Arsen., Bryon., Colchic. 

Hydropericardium: Arsen., Digit., Lycop. 

Ascites: Arsen., Aurum. 

Affections of the liver: Aurum, Cuprum, Lycop. 

After taking cold: Arsen., Calc. carb., Duleam. 

Interstitial Inflammation or Induration of the Connective 
Tissue of the Kidneys. 

This is the so-called Third stage of Bright's disease of many authors, 
or genuine contracting kidney, or the granular atrophy of the kidney, or renal 
cirrhosis, or renal sclerosis of other writers. 

It is, according to Bartels, "the result of a primary growth or pro- 
liferation of the intertubular connective tissue, and commences and pursues 
its course quite independently of the other forms of renal inflammation pre- 
viously described. It is, in fact, an altogether independent form of the disease. 
This process leads from its commencement steadily to the dwindling of the 
substance of the gland, a wasting preceded by no anterior inflammatory 
swelling of the organ. And this wasting does not affect the whole mass of 
the cortical substance simultaneously, but commences in scattered spots upon 
the surface of the kidney and extends very gradually from the spots first im- 
plicated both upon the surface and into the depth of the organ. 

Post-mortem examinations show, in most cases, both kidneys atrophied 
principally in their cortical substance, though the medullary substance also 
takes part in it. The pelvis is occasionally distended to a pouch, but oftener 



GG2 KIDNEYS. 

drawn together into narrower dimensions than normal. The capsule is tough 
and thick, and portions of the renal substance are always found adhering to 
it. The surface of the gland, after being freed from the capsule, appears 
finely granulated, and its entire substance is very tough; occasionally small 
cysts are found in the scanty cortical substance. The color of the kidneys is 
sometimes dark colored throughout, at other times pale, nearly grayish-white, 
but in no case is that marked yellow color exhibited which we find in the 
secondary contraction after nephritis. The microscope shows an extensive 
wasting away of the glandular structure proper, of the renal tubes with their 
epithelium and of the vessels attached to them. There are extensive layers 
of very firm and chiefly fibrinous organized connective tissue, and between 
them here and there some well preserved renal tubules. The great number 
of wasted glomeruli appear like dark round bodies, in which the outline of 
the capillary coils is still plainly perceptible. The cysts in the cortical sub- 
stance above mentioned, appear to be developed from partially dilated and 
strangulated renal tubules, the contents of the tubes having subsequently 
suffered colloid metamorphosis, and the granules upon the surface of the kid- 
ney seem to be the remains of the renal tubuli still beset with epithelium. 
However, such general degeneration is not found in every case. In some 
only a partial contraction has taken place, while other portions retain their 
normal appearance; neither are both kidneys always affected alike. In al- 
most every instance, however, there is found, hypertrophy of the left ventricle 
of the heart. Other features often met with are: retinitis albuminurica, 
thickening of the skull cap, apoplectic effusions, and occasionally drojisical effu- 
sions usually of small amount. 

The Etiology of renal cirrhosis is not very clearly understood. It is 
of rare occurrence in youth, more frequently in middle life, and at any age 
most frequent in the male sex. As exciting causes are mentioned : spirituous 
liquors, especially gin, lead-poisoning, gout and inveterate gonorrhoea. 

Symptoms. — Its commencement eludes diagnosis. As the first symptom 
which draws attention to itself is the frequent desire to pass water, especially 
at night, and without pain or ache. In some cases the patient experiences 
occasional attacks of palpitation, accompanied sometimes with vertigo, or a 
sense of great uneasiness, or suffocation, or want of breath, also principally at 
night. In such cases the heart will be found hypertrophied. There also 
occur occasional paroxysms of headache under the form of hemicrania, re- 
curring often and lasting for several days. A terrible itching of the skin 
with more or less extended so-called rheumatic pains sets in frequently toward 
the end of life, but visual disorders under the form of retinitis albuminurica, 
also occasionally a most rejmlsive smell of the breath are symptoms of an earlier 
stage. At first, appetite and strength are not affected, later, however, the 
apj)etite fails, especially for meat-diet, with occasional vomiting after eat- 



INTERSTITIAL INFLAMMATION. 663 

ing, and an increased thirst for large quantities of water, with increased 
excretion of urine. This is followed by emaciation, ancemia, and loss 
of strength; the skin acquires a peculiar dryness and assumes a dirty, 
faded color, and the sexual power is either greatly diminished or lost al- 
together. The larger number of patients die either of ancemia or apoplexy, 
or of inflammatory exudations into the serous cavities, or of inflammatory in- 
filtration of the lung tissue, or else of erysipelatous and phlegmonous inflamma- 
tions of the general surface of some part of the body. Dropsy may be entirely 
wanting, except when the disease advances to its most extreme grade, in 
which the kidneys become incapable of performing their function, or when 
intercurrent diseases of the lungs or heart, especially mitral insufficiency, 
bring it about independently of the kidney affection. Diarrhoea is often 
found toward the end of the disease, and then very profuse, watery and fetid. 
Haemorrhages from different parts of the body (nose, mouth, bronchi, stomach, 
intestines, and the skin principally of the extremities in the form of petechia? 
or ecchymoses) occur likewise in the later stages of the disease. But the 
most important indications can only be gained by frequent and careful 
examinations of the urine. "As a general rule, the genuine process of con- 
traction of the kidney is associated ivith polyuria. But neither does this 
symptom at once become prominent at the very beginning of the malady, nor 
does it persist absolutely to the very end of the case. In fact, in the progress 
of the disease it may entirely subside for a longer or shorter interval of time, 
whenever, from any debilitating influence, the vigor of the heart's propulsive 
power is diminished for a longer or shorter period, or the urinary secretion 
may be completely arrested for several days before death, if the patient loses 
much water by any other channel, or severe collapse precedes death for some 
time." (Bartels.) 

The color of the urine is pale yellow, or yellowish-green. It is clear with- 
out sediment, only occasionally crystals of uric acid, and still more rarely 
urates are found upon cooling. Its specific gravity is, as a rule, below normal, 
fluctuating between 1004 and 1012, and its reaction sligh'ly acid, but may 
become alkaline by decomposition, dietetic or medicinal treatment, or vesical 
affections. It contains albumen in the vast majority of cases, though this 
abnormal constituent may be wanting at the beginning, or for a greater 
length of time during the course of the disease, or be absent altogether in 
exceptional cases. On the whole, however, the percentage of albumen in 
this disease is much less than that 'furnished by the inflammatory processes 
in the kidneys before described; its amount changes greatly according to the 
mode of life, the food and the general state of nutrition, and there is no con- 
stant ratio between the percentage of albumen and the total quantity of urine. 

The percentage of solid constituents, especially of urea, is abnormally 
small; epithelial cells from the renal tubes are seldom found; red blood-cor- 



6G4: KIDNEYS. 

puscles, few in number, may be found scattered in the sediment, but never to 
an extent as to make the urine red or sooty; and white blood-corpuscles or 
pus-cells seem to derive somewhere from the mucous membrane of the urinary 
passages. 

The most Diagnostic Signs then of renal cirrhosis are : the large quan- 
tity of urine, daily secreted, its pale color, its low specific gravity, and the 
comparatively small amount of albumen it contains, combined with hyper- 
trophy of the left heart. From this the secondary atrophy of the kidneys in 
consequence of diffuse nephritis, differs in the smaller amount of daily secre- 
tion of urine ; in the urinary sediment consisting of numerous casts of different 
character and of large quantities of granular detritus; and in the presence 
of considerable dropsy for a long time. 

THERAPEUTIC HINTS.— I find only one case as having been cured, 
which can be classed under this head, although neither albuminous urine nor 
hypertrophy of the left heart are mentioned in it, yet both may have been 
present according to the symptoms. The case is this: L. K. M., set. 52, of 
robust frame; family history good. The past and present absence of any 
oedema, the general profuseness of urine, with all else, led to the diagnosis of 
Bright's disease, — variety, granular degeneration. Perspires all over the 
body, so soon as he gets into bed ; perspiration comes and goes all through 
the night. Cough on first waking. Cough comes as he gets out of bed; con- 
tinues until he has had his breakfast. It is occasioned by a sensation as if 
he had a "wheat hull" low in his throat, just behind the manubrium sterni. 
Lying on his back makes him cough ; on right side also. When lying on 
his back, feels as if fluid rolled from one side of his chest to the other. 
(Purely subjective, no fluid there.) In the morning, mouth and lips are dry, 
and lips swallow. Tongue also dry. Lips crack open when coughing. Drinks 
at night on account of dry mouth. Oppressed for breath; breathes with 
difficulty, especially after waking. Going upstairs causes it. Is markedly 
weak now. Hash as it may appear, considering that the sweat did not break 
out each time he awoke, I gave him one drachm of Sambuc, first dec. dil., in 
half a glass of water, a dessertspoonful every hour. Result : No sweat that 
night. May 18th, Bryon. 30 , for pleuritic pains in the right lateral thoracic 
Avail. This was an old trouble of his — sinapisms and cantharides-blisters 
having hitherto been applied for them. The action of Bryon. won his heart. 
He had thought the effect of Sambuc. on his night-sweats a "coincidence;" 
but the Bryon. dispelled the pain inside of fifteen minutes. May 23d, his 
prescription was Plumb, met., 30th trit., a powder (two grains) every four 
hours. He has exchanged his pasty yellow look for the ruddy hue of health, 
for he is a ruddy man now again. (S. A. Jones, Am. Obs., Nov., 1875, 
p. 561.) 

Compare also the previous chapters. 



DEGENERATION OF KIDNEYS. 665 

Amyloid Degeneration of the Kidneys, Lardaceous or 
Waxy Kidney. 

Amyloid degeneration is scarcely ever confined to the kidneys alone, but 
exists at the same time in the spleen, the liver, the abdominal lymphatic 
glands, the blood-vessels of the mucous membrane of the intestines, as well 
as those of the various other organs, and is invariably the local manifestation 
of a general constitutional disease, of a cachexia which arises from prolonged 
suppuration, in consequence of scrofula, chronic tuberculosis or inveterate and 
hereditary syjihilis. Intestinal ulcerations favor the development of the dis- 
ease more than ulcers of any other mucous membrane. 

Post-mortem examination shows in lighter cases no abnormal appearances 
of the kidneys to the naked eye. In extreme cases the kidneys are greatly 
enlarged, heavy, tough and firm; the color of their surface is pale, at times 
almost white, and so is their broadened cortical substance; upon the cut sur- 
face in the cortex appears a peculiar polish ; but there is no sign of yellow 
coloration, as is always observed in the equally enlarged and anaemic kidney 
of chronic parenchymatous inflammation. If a watery solution of iodine or 
iodide of potassium is applied to the cut surface there soon appear bright 
reddish-brown points and branching lines, denoting the Malpighian tufts and 
the arteries with their branches, which have undergone annloid degeneration, 
and on adding a drop of concentrated sulphuric acid the reddish-brown 
structures at once turn blue. 

Amyloid degeneration often occurs together with chronic parenchyma- 
tous nephritis in both kidneys, and as it is furthermore the result of other 
constitutional troubles, it is scarcely possible to separate its Symptoms from 
those produced by the coincidental diseases. In fact it develops itself quite 
insidiously, or, so to speak, without sympttoms. The urine, as a rule, is aug- 
mented, and then always clear and pale like water; but when scanty it is 
darker and occasionally clouded with urates. Its specific gravity may sink 
to 1003, when passed freely, and may rise to 1030 and over, when passed but 
scantily. It contains albumen, and more at the beginning than later, when 
polyuria has set in. Casts are seldom found in any considerable number- 
Dropsy may or may not be present; but if it does appear, it usually remains 
persistent, especially the ascites, even in spite of abundant urinary secretion. 
Diarrhoea is very common and nearly always fatal, being induced by ulcera- 
tion, as in phthisis and syphilis. Vomiting is less frequent and consists of 
watery masses of a faintly acid reaction. Other vrcemic symptoms, if the 
vomiting may be considered as such, are still rarer, and the cardiac hyper- 
trophy is altogether absent, but in some cases the heart has been found small 
and atrophied. As a rule the fatal issue is brought about by gradual ex- 
haustion. 



666 KIDNEYS. 

The Prognosis is entirely dependent on the fundamental disease and 
its Diagnosis is always quite difficult, and in most cases impossible. 

THERAPEUTIC HINTS must be derived from a study of the con- 
stitutional malady of which amyloid degeneration is the result. 

Suppurative Nephritis, Renal Abscess. 

This may be produced : 

1. By renal concretions, which irritate the renal tissue and cause sup- 
puration. 

2. By injuries, for instance gunshot wounds, bruises, etc. 

3. By chronic retention and decomposition of the urine, which affects the 
renal pelvis and parenchyma almost always simultaneously. 

4. By metastasis through embolism of smaller renal vessels with infecting 
substances, in consequence of endocarditis sinistra. 

5. By the so-called pycemic affections. 

6. By the extension of suppurative processes from neighboring organs, 
especially from the perinephritic tissues, the psoas muscle, the liver, etc. 

7. By the misuse of diuretics, especially of cantharides. 

8. By unknown causes, perhaps 'exposure to cold, etc. 

The Diagnosis of traumatic nephritis rests upon the history of the 
case ; of all other forms it is exceedingly difficult, often impossible. 

THERAPEUTIC HINTS must entirely be derived from the special 
symptoms of the individual case. 

Nephrolithiasis, Renal Gravel or Calculi; Nephralgia, 
Colica Renalis. 

Renal gravel and larger renal concretions consist of and are developed 
from both normal and abnormal ingredients of the urine. Renal sand con- 
sists of fine powdery deposits ; renal gravel at most attains the size of a pin- 
head ; renal stones are of larger size, but seldom exceed that of a bean. The 
chemical composition of these concretions is various. Of the most frequent 
occurrence are those consisting of uric acid; those consisting of urates, es- 
pecially of urate of ammonia, are found much more frequently in nurslings 
than in adults; they are soft. Oxalate of lime calculi are very hard, thorny 
and warty, and very irritating to the tissues ; they are rare, and occur more 
frequently in alternate layers with urates. Calculi of basic phosphate of lime 
(bone earth) or of ammonio-magnesian phosphate, or of the two mixed, are 
white or yellowish-white and of not unfrequent occurrence, while concretions 



NEPHROLITHIASIS. 667 

of carbonate of lime are very rarely found. Cystine stones are of a dull yellow 
color, with scarcely any variation in the shade; they are rare; and still 
rarer are those composed of xanthine, which have a light brown or dark 
brown color, and a smooth surface. Concretions of fibrine are the result of 
renal hemorrhages with subsequent secretion of fibrine; they are often found 
mixed with other kinds of concretions ; they have a dirty white or yellowish- 
brown color, and their consistency is that of wax, tough and elastic. We 
know little of the Etiology of nephrolithiasis. Heredity and family idiosyn- 
crasy, also habits of life and conditions of nutrition, are among the predis- 
posing causes mentioned. 

Symptoms. — Renal sand usually causes no inconvenience to the patient; 
it is washed away with the urine. Gravel and calculi are often attended 
with more or less pain in the region of the kidneys, and when entering the 
ureters may cause the most severe paroxysms of pain, known under the name 
of renal colic or nephralgia. Most usually the pain is only on one side, fol- 
lowing the course of the ureter down into the bladder, and in males, into 
the corresponding testicle which is generally drawn up, often radiating to 
the glans penis, and causing a feeling of numbness in the corresponding 
lower extremity. These paroxysms of pain often alternate with remissions, 
but when at their height cause vomiting, cold perspiration, cold extremities, 
small pulse, great agony, collapsed features, even fainting fits and general 
convulsions. Pregnant women often abort under these circumstances. The 
urine is voided only drop by drop, with burning in the urethra, is scanty, 
red, brown or blackish, exceedingly loaded with blood, often mixed with 
mucus or pus, or is suppressed altogether, with subsequent uremic symptoms, 
when the ureters of both kidneys are obstructed at the same time. The 
urine is often colorless, as clear as water, when only one kidney is affected 
and its ureter obstructed, and it is of very rare occurrence that complete 
anuria should take place, if only one kidney be diseased. During the inter- 
vals of renal colic the urine shows at times single crystals or particles of the 
urinary components constituting the renal calculi. The paroxysms of ex- 
treme pain cease, as soon as the calculus has completed its way through the 
ureter into the bladder; this occurs suddenly in most cases. In other cases 
the colic abates only slowly and gradually, when for instance the stones are 
of but slight consistency and crumble by degrees into smaller particles within 
the ureter. In some persons attacks of renal colic appear periodically and at 
regular intervals of time. The latter attacks are milder than those previous, 
if the size of the calculi be not larger than the ones previously discharged, 
because the accumulation of fluids accompanying each attack results in en- 
largement of the calibre of the ureter. 

Nephrolithiasis is a chronic affection. A fatal termination may occur 
when, as the result of the arrest of renal stone during its passage through the 



668 KIDNEYS. 

ureter, a rupture of the latter takes place, which is followed by fatal perito- 
nitis ; or when, as the result of the complete arrest of the urinary secretion 
by obstruction of the ureters, uraemia is developed. Hydronephrosis, that is 
a dilation of the pelves and ureters by the retained urine, or suppuration 
of the renal parenchyma in consequence of the presence of renal calculi, as- 
sume a very chronic course, as one sound kidney usually is capable for a 
long time of performing the normal functions of both. 

THERAPEUTIC HINTS.— A prevention of the formation of renal 
sand and calculi will be possible only by a deep study of the single case, and 
a long course of treatment based thereon. The physician is called in most 
cases only to prescribe for the present emergency, the renal colic, and here 
Homoeopathy has won many victories. The following remedies have been 
applied in many cases most successfully. A prescribing of opium or mor- 
phine in large doses or hypodermic injections is not at all the highest aim to 
which a student of Homoeopathy should aspire. 

Arnica, piercing pains as if a knife were plunged into the region of the 
kidneys; violent tenesmus of the bladder; chilly and inclined to vomit. 
Sulphate of morphia had been given in large doses without relief. Arnica, 
1st. dec. dil., in water, relieved in half an hour. (A. E. Small.) 

Arsen., passage from time to time of gravel with dull pain in renal 
region, extending down to ureter; gastralgia; tickling and itching in 
urethra; difficult micturition; sediment of uric acid. (Bourgeois.) Urine 
alkaline, dark yellow, with sediment of mucus and crystals of urate of lime. 
(Schadler.) 

Bellad., spasmodic, crampy straining along the ureter, through which 
the calculus makes its way. After Opium or morphine. 

Berber., when there is red sediment in urine, pain in back, etc. (S. 
E. Newton.) 

Canthar., high; intense pain above crest of ilium. (S. Swan.) 

Diosc. has relieved the writhing, twitching and crampy pains. (E. 
M. Hale.) 

Lycop., after Nux vom.; colicky pain in the right side of the abdo- 
men, extending into the bladder, with frequent urging to urinate. Urine 
incrusting the vessel with red sand. 

Nux vom., always the best remedy after the palliative use of so- 
called anodynes; pain, especially in the right kidney, extending into the 
genitals and right leg; nausea; vomiting; constant urging to urinate; insuf- 
ficient urging to stool ; inability to lie on the right side ; better while lying 
on the back; rising and walking increase the pain. 

Opium, or Morphine is given by the old school in large doses, to lull 
the pain; it is indicated where there are pressive, squeezing pains, as though 



PYELITIS. 6G9 

something had to force its way through a narrow space; shooting pains from 
different places into the bladder and testicles; vomiting of slime and bile ; 
obstinate constipation; dysuria ; greatest anxiety and restlessness; constant 
changing position ; face hot; pulse slow. 

Piper meth., pain agonizing; irresistibly impelled to try all sorts of 
motions and positions for relief, without finding it. (Hiller.) 

Tabac, constant deadly sickness of the stomach and retching, with 
cold perspiration ; violent colicky pains in the region of the ureter, right or 
left side. 

The following may also be mentioned : Calc. urinaria, Cannab., Eriger., 
Eupat. perf, Galium., Sarsap., Silic, Zincum. 

Pyelitis, Inflammation of the Renal Pelvis. 

In the catarrhal form the blood-vessels of the mucosa are distended, and 
the surface of the mucous membrane is covered with mucus or a muco-puru- 
lent secretion. In the diphtheritic form we find upon the mucous membrane 
yellow spots, which consist of mortified tissue. 

In the calculous form stony concrements are always present. 

Pyelitis may be excited by the abuse of balsam of copaiva, cuhebs, tur- 
pentine, cantharides ; by catching cold ; by the presence of urinary concre- 
ments. animal parasites; by the ammoniacal decomposition of the urine; in 
women after obstetrical operations, in the puerperal stage, and during preg- 
nancy; by inflammation of neighboring parts; and it is often a complication 
of typhus, typhoid, and exanthematic fevers, of diphtheria, cholera, carbuncle 
and scurvy. 

It usually runs a latent course, when it is the accompaniment of some 
severe constitutional affection. In the catarrhal form the urine is alwavs 
acid, often contains some blood, mucus and pus, and at times epithelial cells 
of the renal pelves. A sense of weight or pain in the region of the kidneys 
extending downward to the bladder, slight febrile movements and digestive 
disturbances are often, but not always present. 

When it is caused by ammoniacal decomposition of the urine, it is al- 
ways a complication of some other chronic disease, strictures, hypertrophy of 
the prostata, catarrh of the bladder, spinal diseases, etc., which cause a reten- 
tion of urine. Its symptoms are finally those of uraemia. 

The inflammation of the renal pelvis sometimes extends to the paren- 
chyma of the kidneys, when it is called Pyelonephritis. 

The most characteristic symptom of pyelitis is the presence of epithelial 
cells of the renal pelvis in the purulent urine. But these are not always 
found, and the maladies which accompany pyelitis are often of so grave a 



670 KIDNEYS. 

nature that the morbid manifestation in the kidneys is altogether over- 
looked. 

THERAPEUTIC HINTS.— Purulent sediment: Canthar., Merc, corr., 
Nux vom., Petrol., Phosphor., Pulsat., Sepia, Sulphur. 

Gravel in the urine: Lycop., Sarsap. Compare the preceding chapter. 

Perinephritis, Paranephritis, Inflammation of the Renal 

Capsule. 

The capsule appears injected and infiltrated with exudation, or covered 
with purulent secretion, in consequence of which adhesions are formed with 
neighboring organs. It may lead to a thickening of the capsule, or to the 
formation of abscesses. 

Primarily, it is caused by external injuries, and exposure to cold. 

Secondarily, it may be a continuation of an inflammatory process in its 
vicinity, or of pysemia. 

Its Symptoms very much resemble those of other inflammatory affec- 
tions of the kidneys. There are rigors, followed by fever, and a temperature 
usually reaching 103 T l j° F. ; there is a dull and often acute pain in the re- 
gion of the kidney or kidneys; there is constant desire to urinate, with but 
little discharge; the urine is highly colored and hot, but contains no blood, 
thus differing from nephritis, nor purulent sediments, thus differing from 
pyelitis. There is vomiting, and when an abscess is formed, the pus dis- 
charges either into the peritoneal cavity, or, in consequence of adhesion, 
gradually burrows downward in different directions between the different 
fascias, or works towards the surface and breaks through the lumbar region. 
In the latter case we observe a gradual increasing swelling in the renal re- 
gion, which fluctuates, points and bursts. 

THERAPEUTIC HINTS— Aeon., Arnica, Bellad., after exposure to 
cold or external injury; Hepar, Mercur., Silic, for abscess. 

Morbus Addisonii. 

Quite a number of well observed cases have been recorded, in which 
the symptoms of this disease have been found in connection with disease of 
the supra-renal capsules, so that the probability of a relation of cause and ef- 
fect between the two becomes almost a certainty. The morbid changes found 
in the supra-renal capsules consist of a proliferation of small cells in conse- 
quence of chronic inflammation and final breaking clown of the structure 
into caseous masses of various sizes. In this way gradually every trace of 



MORBUS ADDISONII. 671 

proper tissue disappears and we have nothing left but a firm caseous mass, 
which has grown from the middle of the medullary portion towards the sur- 
face. There also have been observed in many cases of undoubted Adclisou's 
disease hemorrhages into the tissue of these bodies, which may be so severe 
as to swell one of them up into a tumor the size of a child's closed fist; less 
frequently new formations are found, comprising carcinoma, sarcoma and 
echinococcus. 

The changes met with in the sympathetic nervous system, such as: deposi- 
tion of pigment in ganglion cells, fatty degeneration, proliferation of the con- 
nective tissue, excessive hypersemia and dilatation of the vessels, are changes 
which also have been observed in connection with pathological processes. 

Symptoms. — Among the first signs of the disease which the patient can 
recall after ailing for months and longer, are great weariness throughout the 
body, and tearing, dragging pains in both hypochondria (frequently more 
intense in the right), along the back, in the sacrum and especially in the 
joints, which latter resemble most closely the arthritic neuroses of hysterical 
individuals and which might be mistaken for acute rheumatism, if it were 
not for the absence of any swelling or alteration in the shape of the joints. 
With these are associated dyspeptic symptoms, such as cardialgia, eructations, 
loss of appetite, nausea, vomiting and distention of the stomach and abdomen. 
The fat of the body is at first well preserved, but the loss of muscular power 
is apparent very early, manifesting itself by a slight tremor of the hands, an 
inability to squeeze tightly and a tiredness after very little exertion. These 
symptoms may be considered as the prodromal stage. 

Further on we observe an exceedingly soft, small, weak and generally 
rapid pulse, weak cardiac impulse and a want of sharpness, or of faint 
casual murmurs here and there, in the case of all the valves as also of the 
larger vessels. Resulting from this there is a remarkable paleness of the 
skin, sometimes amounting to cyanosis, a somewhat cmickened resignation 
and a temperature generally somewhat below the normal. The dyspeptic 
symptoms increase and an alternate constipation and diarrhoea is often present. 
The urine remains normal. Along with these symptoms, a more or less dis- 
tinctly marked discoloration of the skin gradually develops, commencing as a 
light dusky gray and passing on to dark brown, first on the hands and face, 
either as a mottling, or diffusely, or occasionally in streaks. The areola of 
the breast, the genitals and the folds of the axilla color most intensely. On 
the mucous membrane of the lips and cheeks, irregular bluish or blackish 
spots occur; the sclerotic, the nails, the palms of the hands and the soles of 
the feet, however, remain perfectly clear. With this associates quickly or 
more slowly an intense anemia and debility, painful deglutition, profuse diar- 
rhoza and vomiting, headache, dulness of the sensorium, difficulty in collecting 
his thoughts, weakness of memory and actual faintingfits, and epileptic seizures. 



672 BLADDER. 

Meanwhile the discoloration of the skin attains to an intensely dark bronze 
color, through all the shades from an ashy-gray, darkly icteric, mulatto and 
even copper color, while the sclerotics still remain strikingly white. 

There are cases in which the symptoms run a more acute and tumultuous 
course, when the patient, after ailing for some time, is suddenly confined to 
bed with great prostration, trembling of limbs on being raised, confusion of 
mind, dry tongue and lips, covered with sordes, a frequent and small pulse, 
and a temperature of 104° F., similating precisely a case of enteric fever, if 
it were not for the absence of rose-spots and enlargement of the spleen. 

Pulmonary consumption is the most frequent complication, which mixes 
itself up with the peculiar characteristics of Addison's disease, that we are 
often induced to look upon the double set of symptoms as almost inseparable. 

The Prognosis is thus far considered fatal. We have not, to my 
knowledge, an authenticated case of this disease cured in our literature. 

THERAPEUTIC HINTS— J. Payr recommends: Bellad., Natr. 
mur., Iodium, Ol. jec. asel., Cinchona, Ferrum, Phosphor., Cuprum 
Lycop., Carb. veg., Arg. nitr., Ars. hydr. 

Hughes mentions : Arsen., Cafe, ars., Kreos. 

Lilienthal refers to: Psorin., Therid., according to Baruch, and 
Natr. sulph., to which I may add Kali carb., on account of the paretic 
effects upon the heart-muscle of potassa salts; Sepia and Sulphur, es- 
pecially for the earlier stage. 

A. Rockwell has seen beneficial effects from the application of the Fara- 
day current. 

DISEASES OF THE BLADDER. 

Cystitis, Inflammation of the Bladder. 

As the walls of the bladder consist of a mucous lining interiorly, a mus- 
cular coat exteriorly, which is partly covered by the peritoneum, and con- 
nective tissue between them, it is clear that an inflammatory process may 
have its seat more or less exclusively in any of these tissues, or involve the 
whole structure. Books speak therefore of: 

Cystitis catarrhalis, when the mucous membrane; of 
Cystitis submucosa, when the submucous connective tissue; of 
Cystitis subserosa, when the subserous connective tissue; of 
Pericystitis or Paracystitis, w r hen the peritoneal covering; and of 
Cystitis 2)arenchymatosa, when the whole structure is the principal seat 
of the inflammatory process. But these forms are always more or less mixed 
up with one another. 



CYSTITIS. 673 

The catarrhal form, when recent, is characterized by congestion of, and 
mucous secretion from, the mucous membrane, when chronic, by a livid ap- 
pearance of the membrane, and slate colored spots on it ; the membrane itself 
gradually disorganizes, is found softened, thickened, infiltrated, and covered 
with a thick, grayish, purulent secretion, which by decomposition makes the 
urine ammoniacal. The inflammation rarely stays confined to the mucosa, 
but spreads to the • submucous connective tissue, causing the formation of 
abscesses, or involves the muscularis, inducing hypertrophy of the same. In 
this way the walls of the bladder may attain great thickness ; the bladder 
may enlarge in size generally, reaching often as high up as the navel (eccen- 
tric hypertrophy) ; or its size may shrink down to that of a walnut (con- 
centric hypertrophy). Sometimes, when the bladder is capacious, the muscu- 
lar bundles are pushed asunder and the mucous membrane prolapses between 
them, and becoming in time more and more distended by urine, forms diver- 
ticles of the bladder, which by degrees may attain the size of a fist and over. 
As the urine contained therein is scarcely ever completely evacuated, these 
diverticles of the bladder form exceedingly fit places for the retention of con- 
crements and the consequent formation of stones. 

The abscesses which form in the connective tissues may burst internally, 
and before bursting, if they be situated in the posterior or lateral walls of the 
bladder, may by their bulging into the bladder greatly obstruct the flow of 
urine from the ureters, and cause regurgitation of the urine to the kidneys, 
or if situated in the neighborhood of the neck of the bladder, may lead to 
complete retention of urine. An abscess may also burst externally, either 
into the peritoneum with rapidly following peritonitis, or into the cellular 
tissue surrounding the bladder, giving rise to infiltration of uriue, inflamma- 
tion, intense congestion, oedematous swelling of the ano-perineal region, per- 
foration of this region, or the rectum or vagina, and escape of urine through 
the fistulous openings subsequently remaining. In other cases fistula? may 
form at the side of the pubic symphisis. 

Cystitis may be caused by exposure to cold and wet, by external injuries, 
by irritating drugs (cantharides, copaiva balsam, etc.), either administered 
internally or injected, by calculi, by retention of urine, by extension of in- 
flammatory processes in neighboring organs (diseases of the prostata, strict- 
ures and inflammation of the urethra, etc.), by infectious diseases. 

Symptoms. — The acute form is characterized by severe pain in the 
region of the bladder, which is worse from external pressure and motion, and 
frequently extends along the ureters upwards into the kidneys, or downwards 
through the urethra, by frequent painful micturition and strangury. The 
urine is voided drop by drop, under great straining, and a feeling of scald- 
ing; it is highly colored, hot, and occasionally mixed with blood, mucus and 
43 



G74 BLADDER. 

pus. By fever, associated with a temperature of 100.4° to 102.2° F., vomiting, 
prostration, cold perspiration, singultus, etc., in severe cases. 

The chronic form is not so acutely painful, but always attended with 
frequent urging to micturate, and the passing of turbid urine which, after 
standing, yields a heavy, thick, glairy, viscid sediment of muco-purulent 
matter, which, on being poured from one vessel into another, falls out as a 
ropy mass. The specific gravity of the urine is not remarkably increased ; 
its reaction is at times slightly acid, at other times neutral, or alkaline; its 
smell is often offensive, ammoniacal. The chronic form is subjected to fre- 
quent acute exacerbations from any irritating cause, and is generally found 
in advanced age. Its Prognosis, if once advanced to a high degree of dis- 
organization of the bladder, is very doubtful. 

THERAPEUTIC HINTS.— The most infamous practice is the ad- 
ministration of morphine, which not only gives no real relief, but destroys 
all chances of recovery by paralyzing the whole nervous system. 

High fever; restlessness; constant urging, yet fearful of voiding the 
urine on account of the painfulness of the act, Aeon., Bellad, 

Violent burning in the bladder, Aeon., Arsen. 

Burning and pressure in bladder, Nux vom. 

Violent tenesmus and burning, Canthar. 

Bladder largely distended, Arsen. 

Congestion of the head; tongue red and dry, Aeon. 

If attended with vomiting, cold perspiration and anxiety, Arsen. 

Vomiting and nausea, Ganthar.; great thirst, Arsen., Canthar. 

Frequent small pulse, Canthar. 

After a fall, blow, etc., Arnica. 

After taking cold, Mercur., Pulsat. 

After irritating drugs, Camphora. 

In chronic cases, Calc. carb., Carb. veg., Coloc, Dulcam., Lycop., Phos- 
phor., Petrol., Sarsap., Sulphur, Uva ursi. 

Aeon., in all acute catarrhs, characterized by high fever, restlessness, 
and brought on by exposure to cold, dry winds. The urine is scalding hot, 
dark red or turbid ; micturition painful, difficult, sometimes only drop by 
drop ; children reach with their hands to the genitals and cry out. 

Apis, urine scanty, smoky, bloody; if caused by cantharides. 

Arsen., burning pain, especially at the commencement of urinating; 
fever; great restlessness; cold perspiration; face and extremities cold; or in 
chronic cases with inability to void the water; bladder greatly distended and 
paralyzed ; urine turbid, mixed with pus and blood. 

Bellad., if not better some twelve hours after Aeon.; rapid sinking of 
strength ; the region of the bladder is very sensitive to the touch ; the urine 



CYSTITIS. 675 

hot and fiery-red, clear at first, but soou becoming turbid on standing, and 
depositing a copious, slimy, bright red, bran-like sediment. 

Berber., stitching, recurring, crampy pain; constrictive pain in blad- 
der; thick mucous and bright red, mealy sediment. 

Camphora, if caused by cantharides, balsam of copaiva, turpentine, 
etc. ; after measles. 

Cannab., if not better after Canthar, within about twelve hours; 
gonorrheal inflammation; urine loaded with mucus. 

Canthar., spasmodic pain in the perineum along the urethra down into 
the testes, which are drawn up ; intolerable burning pain in the bladder ; 
cramping pain in the thighs; cutting through the abdomen ; burning pain in 
the glans penis, the orifice of which is reddened ; micturition difficult, only 
drop by drop, with a feeling as though melted lead were passing through the 
urethra, with violent straining, which increases the pain ; urine at first clear, 
but afterwards turbid, bloody, scanty, or only blood ; painful erections of the 
penis; great restlessness and fever; thirst, but drinking or even the sight of 
water increases the pain. 

Carb. veg., in old people and chronic cases where the acute inflamma- 
tion has subsided and only blennorrhoea exists. 

Caustic, when in consequence of long retention of the urine the mus- 
cular coat becomes paralyzed; compare Arsen., Gelsem., Helleb., Hyosc. 

Chimaph., urging to urinate after micturition; the urine is high 
colored, depositing a copious, mucous sediment; constipation. 

Coloc, after alleviation of the most violent symptoms, when the pain 
during micturition extends all over the abdomen, and the urine looks turbid 
when first voided, depositing, on standing, a tough, mucous sediment, which 
can be drawn into strings. 

Copaiva balsam, swelling and dilatation of orifice of urethra. 

Dulcam., in chronic cases, with constant desire to urinate, deep in the 
abdomen; urine is limpid when voided, but assumes an oily consistence on 
cooling, and contains a tough, jelly-like, whitish or reddish mucus, inter- 
mixed with little lumps of blood; it smells foul. All symptoms grow worse 
when the weather changes from warm to cold. 

Elater., constant heat at neck of bladder, with extremely painful mic- 
turition, inducing even convulsions. 

Gelsem., detrusor and sphincter muscles paralyzed; bladder distended ; 
urine constantly drippling off involuntarily; not a drop by straining; no 
pain. 

Helleb., the inflammatory process increases slowly to the greatest vio- 
lence, with constant desire to urinate, causing spasms; little urine is voided; 
constant nausea; distended abdomen. 

Hydrast., thick, ropy mucus and bloody sediment. 



676 BLADDER. 

Hyosc, retention of urine, so that the bladder becomes largely dis- 
tended; urine turbid, depositing a mucous or purulent sediment; great 
thirst ; dry tongue ; delirium ; subsultus tendinum. 

Kali bichr., urine alkaline and ropy. 

Laches., discharge of bad-looking mucus during micturition; dull 
pain in the bladder; sensation as if a ball were rolling in the bladder. 

Lycop., dull, pressing pain in the region of the bladder and abdomen; 
the urine is turbid, milky, depositing a thick, purulent sediment of a most 
nauseating smell ; chronic cases ; disposition to urinary concretions. 

Mercur., fever with chilliness; great soreness in the region of the 
bladder when touching it; violent urging; the urine flows in a thin stream, 
or only drop by drop ; contains mucus, blood, even pus ; during micturition 
sweat breaks forth ; gonorrheal inflammation. 

Natr. mur., pain is greatest after micturition. 

Nux vom., painful, ineffectual desire to urinate, or discharge of urine 
drop by drop, with burning and tearing ; pale urine followed by thick, whit- 
ish, purulent matter, with violent, burning pain; spasmodic retention of 
urine ; constipation, with ineffectual urging; after drugs, or suppressed gonor- 
rhoea. 

Pareira brava, constant urging to urinate, with violent pain in the 
glans penis and straining ; the pain is so great that it extorts loud screams 
from the patient; "he can emit urine only when he goes on his knees, press- 
ing his head firmly against the floor; remaining in this position from ten to 
twenty minutes, perspiration breaks out, and finally the urine begins to drop 
off with interruptions, with great pain at point of penis." (Lippe.) Always 
worse after midnight till morning ; the urine has a strong ammoniacal smell, 
and contains large quantities of thick, tough mucus. 

Phosph. ac, when the urine looks like milk, and quickly becomes de- 
composed. 

Popul., chronic catarrh; chronic gleet; elderly persons. 

Pulsat., after exposure to cold, the urine deposits a slimy sediment, 
which sticks to the vessel ; tenesmus and stinging in the neck of the bladder ; 
the pain continuing a while after micturition. 

Senega, urging and scalding before and after micturition; urine 
loaded with mucous shreds. 

Sepia, in chronic cases; distention of the lower portion of the abdo- 
men ; annoying, itching sensation in the region of the bladder, with urging 
to urinate, especially in the night ; the urine does not flow until sitting on 
the vessel for some time ; during and after micturition chilliness and heat in 
the head; the discharge of mucus does not take place at each evacuation of 
urine, but comes on periodically; sometimes pieces of coagulated mucus 



CALCULI VESICA. 677 

clog up the urethra ; admixture of a kind of dark brown pigment ; constipa- 
tion. 

Sulphur, constant desire to urinate, day and night; the urine drops 
slowly out of the urethra ; it deposits thick, tough mucus, which sticks to the 
bottom of the vessel; purulent sediment; after micturition, the pain con- 
tinues in the urethra until a new urging ensues; stools likewise painful; 
feverish and sleepless through the night; cutaneous eruptions here and there 
on the body; suppressed itch; gonorrheal discharges; hemorrhoidal dis- 
position. 

Tereb., sensitiveness of hypogastrium ; tenesmus of bladder ; stran- 
gury; burning in region of kidneys; urine deposits a slimy, thick, muddy 
sediment. After drinking cold water while being heated. 

Uva ursi, frequent urging with a little discharge, and a burning, cut- 
ting pain afterwards; the urine is yellow, but deposits a tough mucus; some- 
times blood and mucus are voided at the same time with great straining ; se- 
vere spasm of bladder before micturition; at all times burning and tearing 
pain in region of bladder ; constipation. 

A number of other remedies may present themselves for consideration: 
Calc. carb., Capsic, Conium, Eriger., Graphit., Hepar., Nitr. ac, Phosphor., 
Sarsap. 

Compare also the remedies mentioned under the head of Kidney 
Diseases. 



Calculi Vesicae, Stones in the Bladder. 

Calculi vary from the size of gravel to conglomerations of the size of a 
man's fist, and even larger. In shape they are either round, or flat, or 
rough, irregularly shaped. 

In regard to their chemical composition, they consist either of crystals 
of clear uric acid, or a combination of uric acid and ammonia, soda, magne- 
sia or lime. These are hard, heavy, brown, yellow or grayish-white, and are 
mostly smooth, roundish, rarely irregular in shape. 

Next in frequency are those which consist of phosphates. They are not 
so compact, but are brittle, crumbly and light, of a whitish, grayish, sel- 
dom yellowish color, and of a roundish shape, with a smooth but sandy 
surface. 

Still rarer are those which consist of oxalate of lime. They are the 
hardest and heaviest of all, have a dark brown or blackish appearance, an 
uneven, wart-like surface and are therefore called mulberry stones. 

Conglomerates which consist of carbonate of lime, or cystine, or xanthoxide 
are of very rare occurrence, while mixtures of urates and phosp>hates are quite 



678 BLADDER. 

frequently found. They generally present a striated appearance, or the one 
material forms nucleus and the other the periphery. 

Such urinary concretions may be very numerous. Liston extracted 
five hundred from one bladder. They are usually formed in the renal pel- 
vis, and work their way gradually through the ureters into the bladder, 
where they remain and increase in size. Stones which are formed primarily 
in the bladder are generally solitary. They are either movable in the blad- 
der or they are entangled between the folds of its mucous membrane, or 
they have formed by their weight an extension of the bladder, where they 
are held stationary, or they have originated in a cliverticle of the bladder. 

Those which roll about freely in the bladder are always of a roundish 
shape and smooth, while those which are stationary assume an uneven and 
jagged surface. Very large stones nearly fill the cavity of the bladder; they 
have been found to weigh from five to six pounds. 

Gravel passes away without much difficulty. Neither do smooth and 
movable stones, if not too large, cause much inconvenience. But when they 
are of larger size, and of a rough and irregular shape, they cause consider- 
able trouble. 

Symptoms. — 1. In rare cases the patient feels a heavy body in the bladder 
moving about when changing position. 

2. Pain in the neck of the bladder when walking, standing, sitting or 
during stool ; still worse when riding in a carriage or on horseback, but much 
less during rest, and especially while lying on the back or on the face. This 
symptom becomes quite characteristic when, after riding in a carriage or on 
horseback, there follows — 

3. A discharge of bloody urine and an increase of catarrhal inflammation 
of the bladder. 

4. Sometimes the pain is not felt in the bladder at all, but in the glans 
penis and along the urethra, which constantly tempts the patient to squeeze 
and pull at the penis. This constant irritation may lead boys to the habit 
of masturbation, and the frequently repeated pulling may produce an elonga- 
tion of the penis and hypertrophy of the prepuce. 

5. Strangury commences when the last drops of urine are voided and 
continues for a while afterwards. 

6. Sudden stoppage in the flow of urine (although the bladder be not 
emptied) by the rolling of a calculus before the opening of the bladder. In 
other positions, especially that of lying on the back, the urine flows again. 

7. Sometimes a distinct feeling, as though something were wedged into 
the neck of the bladder, causing difficulty in making water, when a calculus 
has been driven into the opening at the neck of the bladder. 

8. Reflected pains, as spasms in the rectum, vagina, testicles, kidneys, 
perineum, legs, etc. 



HYPERESTHESIA. 679 

9. In rare cases, when there are many stones in the bladder, on succus- 
sion of the body they may even be heard and felt rattling in the bladder. 

10. Examination by the metallic sound reveals a hard body, which, on 
being struck, gives a metallic sound. 

THERAPEUTIC HINTS.— Large stones, it is true, cannot be dis- 
solved again, but belong into the domain of surgery. But it is a question 
whether we cannot do something to prevent their formation. According to 
our records a number of remedies have shown themselves efficacious in ex- 
pelling gravel and in restoring a normal secretion of urine. If such be the 
case, is it not equal to preventing larger conglomerations? and is not one 
pound of prevention worth more than ten pounds of cure? 

Moreover it is true that all who suffer with gravel need not necessarily 
become affected with stone in the bladder; just as every one who falls need 
not necessarily break his neck. But who can tell beforehand the result in 
either case ? The remedies, after the use of which gravel and small stones 
have been observed to be discharged, are: Aspar., Berber., Calc. carb., Calc. 
urinaria, Cannab., Ipom. (Jeanes), Lycop., Lith. carb., Nitr. ac, Nux 
vom., Petrol., Phosphor., Pulsat., Sarsap., Sulphur, Tabac, Uva ursi. 

Among the new remedies are mentioned: Aln. rub., Chimaph., Collin., 
Corydal., Eriger., Eryng., Eupat. arom. and perf., Frasera, Galium, Gossyp., 
Podoph. 

For particulars, study Lithiasis Renalis, Catarrh of the Bladder and 
the Materia Medica. 



Hyperesthesia, or Irritability of the Bladder; Spasm of 

the Bladder. 

Hyperesthesia shows itself as an increasing intolerance, especially of 
the neck of the bladder, for the normal irritation of the urine, so that even 
a small quantity of urine excites a more or less painful urging to pass water. 
Such a condition may often be traced to a rapid fall of temperature, or to 
too often repeated sexual indulgence. 

Spasm of the sphincter is much severer; it is attended with strangury, 
that not a drop of urine is allowed to escape; or if by reflex action, the de- 
trusor urinre be alternately irritated, the urine is squirted out in jerks, with 
frequent interruptions, or passes slowly, drop by drop, with much trouble 
and pain. It is often attended with neuralgic pains in the hypogastrium and 
iu the ano-perineal region, which may spread to the urethra, glans, testes, 
clitoris, thighs, loins and inguinal region, aud upwards to the epigastrium 
and lowest ribs. These vesical spasms may occur at each attempt to pass 
water, or only occasionally; sometimes the urine escapes involuntarily. The 



G80 BLADDER. 

paroxysms may last from a few minutes to half an hour or more, and usually 
subside when the urine flows; when very severe, they may be accompanied 
by great excitement, anxiety, nausea, vomiting, clonic convulsions, small 
pulse and cold perspiration. In uncomplicated cases the urine is usually of 
a normal condition, at times remarkably pale, like urine in spasmodic affec- 
tions generally. 

Spasm of the bladder occurs in children and adults, and may be caused 
by mental excitement, excessive sexual indulgence, onanism; drugs, sour 
wine, young beer, sitting on damp and cold ground ; they may be connected 
with diseases of the rectum, such as fistulse, fissures, ulcers, haemorrhoids, etc., 
or with other neuralgic affections and various cerebro-spinal diseases. 

THERAPEUTIC HINTS —The irritability of the bladder is fre- 
quently met by : 

Arnica, feeling of great fulness of the bladder. 

Bryon., worse from moving. 

Colchic, gouty diathesis. 

Ferr. phosph., worse in daytime. 

Nux vom., after taking cold. 

Ox. ac, worse when thinking of it. 

Rhus tox., worse in the night and when at rest. 

Sabina, gouty diathesis. 

Sulphur, irresistible desire to urinate on seeing water running from 
the hydrant, similar to Canthar. and Lyssin. 

Spasms of the bladder principally: Bellad., Hyosc, Nux vom., 
Opium, Pulsat., Rhus tox., Ruta, Sulphur. Other remedies will be 
suggested by the causes and connections of this trouble. 

Atony, Paresis, Paralysis of the Bladder. 

The detrusor urince loses its power to contract, and in consequence the 
urine is only partially or not at all expelled. This causes great distention of 
the bladder. The patient complains that he can only make water slowly ; 
the desire to pass water becomes less frequent, is felt only when the bladder 
is greatly distended, and then only for a short time, if not soon attended to. 
The stream of the water grows feebler, is frequently interrupted, and at last 
voluntary efforts are unavailing, but the presence of the accumulated mass 
of urine becomes so great that the sphincter yields and the urine escapes in 
drops involuntarily, and has a disagreeable ammoniacal odor. By and by 
the paralysis also extends to the sphincter, and now the urine flows away un- 
interruptedly, which constitutes true Incontinentia urinae. But even in 
these cases the bladder is never fully emptied, and it occasionally happens 



PARALYSIS OF THE BLADDER. 681 

that, in consequence of this prolonged retention of urine, ursemic symptoms 
supervene. 

The Diagnosis is readily made out by percussing the region of the 
bladder, which will be found greatly distended, and by introducing the 
catheter, which will drain off immense quantities of urine. 

Paralysis of the bladder is found in diseases of the brain and spinal 
cord, in typhoid fever, in consequence of the bad habit of suppressing urgent 
calls to urinate, in old age, in diseases of the prostate, after injuries to the 
bladder or urethra, or spine. 

THERAPEUTIC HINTS.— Care should be taken to drain off, by the 
catheter, the accumulated urine in time, and, if possible, at regular hours. 

Arnica, feeling of fulness of the bladder with urging and impossibility 
to void urine. (Aegidi.) 

Arsen., urging in the bladder and bowels without success; great 
anxiety and restlessness; after taking cold. (Gauwerky.) Paralysis of 
bladder in old people. (Krummacher.) 

Canthar., after having retained the urine too long voluntarily. 

Caustic, from long retention of urine. 

Cicuta, paralysis of the bladder with great anxiety about it. 

Gelsem., constant dribbling of urine, but not a drop flows on making 
the greatest effort; bladder distended up to the navel; no pain, not even on 
pressure. 

Helleb., paralysis of the detrusor; oedema of the legs; vomiting of 
all he eats; constipation; sleeplessness; despair of getting well. (Moss- 
bauer.) 

Hyosc, after labor, and in children with affections of the head. 
(Small.) 

Iodium, incontinence of urine in the aged. 

Nux mosch., hysteria with strangury. 

Nux vom., after catching cold; after sexual excesses. 

Opium, retention of stool and urine. 

Phosphor., in spinal troubles. 

Staphis., involuntary discharge of urine, acrid and corroding, with 
burning ; worse from motion ; constipation ; straining or external pressure 
causes no discharge; after difficult confinement. (Wm. Gross.) 

Compare also: Bar. carb., Bellad., China, Ignat., Lycop., Natr. niur., 
Phosphor., Podoph., Rhus tox., Ruta. 



G32 BLADDER. 

Enuresis Nocturna. 

Wetting the bed may be a bad habit Avith some children, or the con- 
sequence of their sleeping too soundly, but in most cases it depends upon a 
local atony associated with increased sensitiveness of the neck of the bladder. 
It is more frequently found in boys than in girls, and it ceases on the average 
about the tenth or twelfth year, latest at puberty. 

THERAPEUTIC HINTS— Rough and harsh treatment will be of 
no avail. 

Amm. carb., enuresis occurring at any time at night; pale urine; red 
sediment. (Greeley.) 

Arg. nitr., incontinence of urine during the day. 

Bellad., starting in sleep; moaning and screaming during sleep ; scrofu- 
lous glandular swellings. 

Benz. ac, when the urine has a very penetrating smell. 

Calc. carb., scrofulous children, who sweat and catch cold easily. 

Caustic, enuresis during first sleep; chronic, periodic swelling of the 
tonsils; sequelae of itch; sweat on genitals; green halo around the candle- 
flame. (Wm. Gross.) Blepharitis ciliaris of herpetic nature. (Goullon.) 

Chamom., child cross, has to be carried; whooping-cough as a com- 
plication. (Miller.) 

Chloral, enuresis in the latter part of the night, even if they have 
urinated during the night and drank no water. (Oehme.) 

Cina, urine profuse and of strong ammoniacal odor; great appetite 
soon after leaving the table. (O. M. Pierson.) 

Equisetum, when there is no tangible cause except a habit. 

Ferr. met., when the child presents an anaemic appearance with pale 
face which flushes easily from excitement or pain. (Hering.) Frequent 
wetting the clothes during the day. 

Ferr. phosph., similar. 

Kreos., when it is very difficult to waken the child out of sleep. 
(Boenninghausen.) 

Plant ago, copious enuresis; atony of the sphincter. 

Sepia, follows well after Caustic; same symptoms. 

Silic, complication with worms or chorea. 

Sulphur, disagreeable sensation of hunger with flushes of heat about 
11 A.M. (Goodno.) Pale, lean children with large abdomen, who love sugar 
and higly seasoned food, and abhor to be washed. 

Thuja, when the urine is highly colored and of a strong smell; warts 
here and there. (Linsley.) 



RETENTION OE URINE. 683 

Retention of Urine, Ischuria Vesicalis, 

May be the consequence of spasm of the sphincter, of paralysis of the detrusor 
urine, of hemorrhoidal swellings about the sphincter, of clots of blood, or 
mucus, or calculi, obstructing the passages, of inflammation and consequent 
thickening of the bladder. We find the bladder distended above the pubis. 
In such cases it will often be necessary to introduce the catheter, and that 
may sometimes be attended with great difficulty, especially in men. The 
patient may be placed on his back, with a pillow under his head, holding his 
thighs slightly flexed upon the abdomen ; or he may sit up on the edge of 
the bed, slightly bent forward ; or he may stand up, leaning the body for- 
ward, and supporting himself on the back of a chair, or some other object. 
Sometimes the introduction of the catheter could be affected only in the 
standing position; the horizontal position is the one usually preferred. 

The catheter may be of metal or caoutchouc ; either kind may be prefer- 
able in certain cases; they are of various sizes, numbers 7, 8 and 9 of the 
English scale are those most frequently called for in grown persons. Before 
entering the catheter, it should be warmed and oiled; some fill the catheter 
with oil, so that it may lubricate the parts before it. Sometimes it will be 
well to inject first some oil, or warm water into the urethra, to make the 
parts more pliable. !N~ow the catheter should be held with the thumb and 
forefinger of the right hand on its handle, so that it is parallel with and 
touching almost the abdomen of the patient, on whose left side the operator 
is sittiug, while the thumb and forefinger of the left hand grasp the penis 
and draw it up toward the abdomen, so that the movable portion of the 
urethra is put on a stretch and the folds of the lining mucous membrane 
become obliterated. The instrument is now inserted and allowed to follow 
the urethral channel until it reaches the triangular ligament. Here we find 
often the first obstacle ; the instrument has to enter the fixed curve of the 
urethra, and the handle of the catheter should be held parallel to the linea 
alba, and gently raised from off the abdomen, so that its curved portion be 
brought in the direction of the fixed curve of the urethra, and be carried 
along in it. The next obstacle we will often find at the sphincter vesicae, 
especially when there is a spasmodic affection of the same ; a gentle, but per- 
sistent pressure exerted upon the instrument will gradually overcome it in 
many cases. Simple as this operation appears to be, it is nevertheless fre- 
quently attended with great difficulties, and even experienced surgeons have 
been foiled in the attempt; it requires great gentleness, dexterity and per- 
severance." (Helmuth.) 

In some cases the retention of urine may be overcome by the external 
application of wet, hot cloths to the genitals, or hot sitz-baths, or injections 
of hot (of course not scalding) water into the urethra. 



684 BLADDER. 

THERAPEUTIC HINTS— Aeon., common cases, especially in 
children, with frequent unsuccessful urging, crying, screaming, and putting 
the hands to the genitals ; no discharge, or scanty, dark and turbid discharge. 
Also in cases of hemorrhoidal patients, when there is great pain and burning 
and the urine passes off only in drops, sometimes bloody. (Hering.) 

Apis, after repelled eruptions, with stinging, burning and itching here 
and there ; abdomen is sore and tender to touch ; chilly from slightest motion, 
worse in evening ; heat without thirst ; yawning, but sleepless. (Hering.) 

Arnica, after a fall or knock upon the back or region of the bladder. 

Bellad., stitching pain from the back into the bladder; in spells with 
great anxiety, restlessness and colic. It is followed well by Hepar, if it 
only relieves but not cures. (Hering.) 

Camphora, after the abuse of fly-blisters ; also after measles. 

Cannab., Canthar., inflammatory states of the bladder with bloody 
urine. 

Coloc, thick, jelly-like urine, with labor-like pain in the abdomen, 
extending down into the thighs. 

Sepia, retention and suppression of urine often occurring in fevers, 
when there is delay in voiding, after the desire is felt, along with scanty, 
muddy discharge, the sediment of which sticks to the vessel and the odor of 
which is abominable. (Edw. Cranch.) 

Sulphur, often if Aeon, or Pulsat. have failed to relieve. 



ORGANS OF GENERATION. 

MALE GENITALS. 



VENEREAL DISEASES. 



"We understand by this term all those morbid affections of the genitals 
in particular, and of the whole system in general, which originate ex usu 
veneris in consequence of the absorption of a specific poison. The nature of 
this poison is as little known as that of small-pox, or of scarlet fever and 
measles ; only that it is not volatile, but fixed to the morbid secretion. As 
to the rest, like either of them, it produces, when introduced into a healthy 
organism, a certain series of symptoms specific in their nature, by which pro- 
cess the same virus is produced anew, capable of further propagation. The 
principal forms caused by this specific contagion are: gonorrhea, chancre, and 
constitutional syphilis in all its various forms. 

It lies entirely beyond the limits of this work to go into any details in 
regard to the different views about the identity or non-identity of the venereal 
virus and its effects, as have been set forth in the last fifteen years by a num- 
ber of renowned syphilodologists. Their works alone would make up a small 
library. I shall merely give what seems to be the result of these contro- 
versies adopted by the majority at present. 

Gonorrhoea. 

We understand by it a virulent catarrh of the genital organs, which in 
appearance is entirely analogous to any other catarrhal inflammation of any 
of the mucous membranes ; but which entirely differs from all the others by 
being the result of a specific virus, acquired during coition with an individual 
thus affected. 

Its seat is usually the fossa navicularis, and that portion of the urethra 
which lies back of the glans; sometimes, however, the inflammation extends 

(685) 



686 MALE GENITALS. 

further back to the bulbus, the membranous portion of the urethra, and even 
to the neck of the bladder. 

In women the inflammation and secretion extend over the vulva, vagina 
and urethra, sometimes spreading even into the womb. 

Symptoms. — The first symptoms generally appear from one to tw T o, 
rarely from six to eight clays or more, after the infection. They consist of a 
tickling sensation at the orifice of the urethra and in the fossa navicularis. 
Soon there is an increased secretion of mucus in the urethra, which pastes the 
lips of the orifice together; the tickling changes into burning, and the mucus, 
at first transparent, becomes thick, whitish, yellowish, greenish, or even 
bloody, and more or less profuse. The orifice of the urethra is inflamed, and 
swollen ; a tensive pain extends all along the urethra into the testicles and 
inguinal regions ; micturition is very painful and frequent. 

In some cases, the so-called synochal or phlegmonous gonorrhoea, the in- 
flammation extends into the parenchyma of the glans, which appears dark- 
ened and swollen; and into the corpus cavernosum, with exudation, which 
forms hard places in the penis. This gives rise to the so-called Chordee, by 
which, during erections, the penis is bent either downwards or sideways. The 
urine can be passed only drop by drop, with the most intense pain and great 
straining. The discharge becomes still more discolored — dark or bloody, 
even ichorous ; or it is not discharged at all, on account of the high state of 
inflammation. The prepuce is contracted and cannot be brought back over 
the glans — Phimosis ; or it is contracted behind the glans, and cannot be 
brou ght for w ard— Paraphimosi S . 

The inflammation spreads even to the neck of the bladder and the 
neighboring areolar tissue, in consequence of which abscesses may form and 
break through the perineum, giving rise to fistula urinse. 

Other cases, the so-called indolent or torpid gonorrhoea, are attended with 
very little pain; and the only symptom which is of any inconvenience to the 
patient is a more or less profuse mucous discharge. This indolent form is 
usually found in persons who have had the disease several times. It seems, 
that the system gets accustomed even to the most violent poisons, as may be 
seen in prostitutes. Yet, innocent as it seems, it is generally very obstinate, 
and is apt to become chronic ; and if transferred to other persons not quite 
so hardened, it may cause the most virulent symptoms. In still other cases — 
the so-called erysipelatous gonorrhoeas — the glans and prepuce are cedema- 
tously swollen and inflamed, as in erysipelas. The pain is not so great as in 
the synochal form, and the discharge is of a more watery, ichorous nature. 

Mild forms of acute genorrhcea are said to run their course in about five 
or six weeks; but most cases assume a chronic form and are then called 
Gonorrhea secundaria or Gleet. This form is usually without pain; 
when there is any, it is a fixed pain in the fossa navicularis. The discharge 



GONORRHOEA. 687 

is mostly watery, sometimes thick and yellowish. Usually there is only a 
single drop, and that to be seen in the morning; at other times the lips of 
the meatus urinarius merely stick together; sometimes, however, the dis- 
charge continues to he more or less profuse. This state of things may last, 
with various degrees of severity, for months, even years. 

In the female the symptoms of gonorrhoea are nearly the same ; gener- 
ally, however, they are less painful, because the vagina, the part principally 
affected, is wider and less sensitive than the urethra in the male. Still, in 
higher degrees of inflammation and when extending to the female urethra, 
the clitoris and the labia, it may become quite as painful. The discharge is 
then quite profuse and discolored, excoriating the external parts. Frequently 
it is associated with condylomata on the inside of the thighs and around the 
anus. Excoriations and ulcers also exist on the neck of the uterus, and 
sometimes the morbid process extends into the womb and ovaries, causing 
chronic catarrhal affections there. Its cause is, as stated above, an infection 
by a specific virus. 

Catarrhal inflammation of the mucous membrane of the sexual organs 
may be brought on by a variety of causes — irritation by foreign bodies, sexual 
excess, coitus with menstruating women, or such women as suffer with acrid 
leucoiThoea. Even drinking new 7 wine or sour beer may cause strangury and 
a gonorrhcea-like discharge. Such inflammations are of a much lighter 
nature, and cease in a few days without medication ; but as we cannot dis- 
tinguish between a chronic gonorrhoeal discharge and a mere acrid leucor- 
rhcea, it is very well to know that a gonorrhoea-like discharge may be caused 
by a mere acrid leucorrhoea, if for nothing more than to preserve the peace 
of a family. 

The gonorrhoeal virus is transferable by the mu co-purulent discharge of 
a gonorrhoeal patient whenever it comes in contact with the mucous mem- 
brane of the urethra or vagina of a healthy person. None are proof against 
the contagion, although some persons are more easily infected than others; 
and any one who has once had gonorrhoea is very liable to have it again. 

THERAPEUTIC HINTS.— The number of recommended remedies 
for this complaint is great, but yet the curing of it is often a difficult task. 
For its very first stage Grauvogl has recommended Katr. sulph. ; Jahr, 
Sepia; Wahle, Bryon.; Baehr, Merc, sol.; Kafka, Sulphur; a number of 
others, Cannab. Schiissler: Ferr. phosph., later Kali mur. and Kali sulph. 

In this, as well as in all other cases, we must closely individualize: 

Aeon., inflammatory stage. 

Agave Americana, excruciating, painful erection; chordee, stran- 
gury ; drawing in the spermatic cords and testicles, extending to the thighs, 
so violent that he wishes to die. 



688 MALE GENITALS. 

Agn. cast., gleet, yellow purulent discharge; old sinners with sexual 
inability. 

Alum. P. S., gleet. 

Ant. crud., urine mixed with blood; suppression of urine. 

Apis, "scanty, painful micturition, with a burning, stinging in the 
urethra, and a smarting in the meatus ; prepuce swollen, perhaps oedematous ; 
pus profuse." (Gilchrist.) 

Arg. nitr., burning in the urethra during micturition, with a feeling 
as though the urethra were swollen and sore inside; the last portion of the 
urine remains in the urethra; discharge of blood and pus from the urethra; 
chordee; sensation as if the urethra were drawn into knots; swelling of 
penis; feverishness. 

Arsen., "deficient discharge, but intense urethral inflammation, which 
seems to close the urethra; intense heat and burning in the parts; urine 
scalding hot; the whole penis swollen without erection, and hot." (Gil- 
christ.) 

Calc. carb., gleet, after Sulphur; fat, lymphatic persons. 

Camphora, sticking together of the meatus ; chordee ; testicles relaxed ; 
want of erections. 

Cann. ind., priapism; chordee; involuntary erections and emissions; 
nymphomania. 

Cann. sat., great swelling of the prepuce, approaching to phimosis; 
dark redness of glands and prepuce; light red spots on the glans, of the size 
of a lentil ; inflammatory stage with all its painful symptoms, especially vio- 
lent burning in the urethra during and after micturition. 

Canthar., when the inflammation has spread to the bladder, with 
intense tenesmus; bloody discharge and soreness of the urethra during the 
flow of gonorrhoeal mucus; violent and very painful erections at night. 

Capsic, white discharge like cream; cutting, stinging pain in the 
urethra without, burning during micturition ; chordee. 

Clemat., after great straining a few drops of urine pass away, which 
is followed by a full stream without pain ; after this sometimes dribbling of 
urine. 

Colonic, scanty, dark, albuminous urine; constant urging with burn- 
ing in urethra Avhen urinating; whitish, flocculent or purulent sediment in 
urine. 

Copaiva, soreness, smarting, itching and swelling of urethra; purulent 
discharge; violet smell of urine; eruption like measles, or urticaria with 
great itching. 

Cubeb., dark and reddish discharge as if mixed with blood; violet 
smell of urine; cutting and constriction after micturition. 

Doriph., glans swollen and bluish-red; gleet. 



GOXOEEHCEA. 689 

Ferrum, gleet, painless discharge like milk. 

Ferr. phosph., inflammatory stage. 

Fluor, ac, gleet, little discharge during the night, which makes a 
yellow stain on the linen; oily transpiration of the genitals with a penetrat- 
ing smell. 

Gelsem. , whitish discharge; severe erections ; burning when urinating ; 
rheumatism ; orchitis. 

Graphit., gluey, sticky discharge at the meatus urinarius. 

Hydrast., acute and chronic form; feeling of debility and faintness 
after each passage from the bowels. 

Kali bichr., a drop of urine seems to remain after micturition, which 
cannot be expelled and troubles for a long time. 

Kali mur., gleet combined with eczema (latent or visible) ; or a dis- 
position to glandular swellings. 

Matico, in acute and chronic forms — no particulars given. 

Mercur., when complicated with chancre; or in gleet, after Cannab., 
when the discharge is yellowish-green and purulent ; discharge more profuse 
at night than during the day. Phimosis, bloody pollutions. 

Mezer., gleet; hematuria during gonorrhoea; tearing pains from front 
to back. 

Millef., swollen penis; discharge of blood and watery slime. 

Natr. mur., after injections of nitrate of silver, in gleet; in gonorrhoea- 
like discharges from acrid menstrual discharges; cutting and burning after 
micturition. "Malarial combination; strong impulse of the heart ; irregular 
or intermitting pulse by clear sounds of the heart; often great prostration, 
lameness of the lower extremities, especially in the knees; dejected, tearful 
mood, frequently changing; anaemic state with thirst, horripilations. All 
worse in the forenoon, better towards evening ; pain in small of back, con- 
stipation, sleepiness during day; weak digestion ; pain in stomach better from 
eating." (Kunkel.) 

Nitr. ac, in complication with chancres, balanitis and fig-warts; small 
blisters on the orifice of the urethra and inner surface of the prepuce, form- 
ing chancre-like ulcers; painful brown spots of the glans; after mercurial 
treatment; gleet; ulcerating buboes; condylomata. 

Nux vom., after the use of copaiva and cubebs, and after allopathic 
treatment ; dull pain in the back part of the head ; hemorrhoidal disposition ; 
constipation; suppressed discharge, with swelling of the testicles; high 
living. 

Petrol., chronic cases with stricture of the urethra; prostatitis; fre- 
quent emissions and imperfect erections; itching and humid eczema on scro- 
tum, perineum, or between the scrotum and thighs. 

Petros., troublesome tickling and itching in the urethra, with constant 
44 



690 MALE GENITALS. 

desire to urinate, worse in the morning in bed; better when sitting or stand- 
ing, chronic cases; suitable for old persons; "intense, maddening, biting- 
itching, deep in the urethra, the patient being almost wild with it, and feels 
as if he must push some rough article down to the spot and rub it for relief. 
Profuse discharge, and chordee of common occurrence." (Gilchrist.) 

Phosphor. , gleet ; every morning a drop of watery fluid at the orifice of 
the urethra, sticking its lips together; also in case of hypertrophy of the 
prostata. 

Phosph. ac, gleet; every morning a few drops of a white discharge 
from the urethra, and in the evening discharge of prostatic juice. "Similar 
to Thuja." (Kunkel.) 

Pulsat., in consequence of suppression of a gonorrheal discharge, 
swelling of the testicles and prostate gland ; inflammation of the eyes. 

Sarsap., rheumatism of the joints after suppression. 

Sepia, gleet, no pain, no discharge, except through the night a drop or 
so, staining the linen yellowish; or milky or greenish discharge, attended 
with pain in the back; frequently quite important for women. 

Sulphur, the orifice of the urethra is red and feels hot; whitish dis- 
charge; no pain, or some slight burning in the urethra; rheumatic pains; 
chronic inflammation of the eyes; chronic prostatic affections ; hemorrhoidal 
disturbances; psoric cutaneous eruptions; gleet. 

Tar ant., chronic form; loss of memory; timidity; weakness; great 
nervous agitation; burning of soles of feet and palms of hands; shaking, 
twitching and incessant movements of legs, worse when quiet. 

Tereb., chordee; gleet; gon or rhoeal rheumatism. 

Thuja, gleet; condylomata; prostatic affections; discharge thin and 
greenish; red spots and erosions on the glans; sudden stitches along the 
urethra from back to front ; or a sensation as if a drop of urine were passing 
along the urethra with cutting pains; "dejected mood, prostration, weakness, 
lame feeling in lower extremities; sleeplessness. The next best following 
remedy is Phosph. ac." (Kunkel.) 

Besides these, a number of remedies are mentioned and praised by 
eclectics (see Hale's New Remedies), but without the slightest characteristic 
indications. 

Complications and Sequelae. 

1. Epididymitis; Orchitis. 

Usually only one side is affected at a time; but the inflammation some- 
times goes also to the other. The scrotum of the affected side becomes greatly 
enlarged, is hard, red, shining and very painful to the slightest touch or 



COMPLICATIONS AND SEQUL.E. 691 

move ; it is usually attended with fever, and follows either upon undue ex- 
ertions, taking cold, and most frequently after the suppression of gonorrhoeal 
discharges by injections. 

Compare Agn. cast., Aurum, Bromium, Clemat., Hamam., Mercur., 
Nitr. ac, Nux vom., Phytol., Pulsat., Rhodod., Rhus tox., Tussil. 

2. Prostatitis Gonorrhoica, Inflammation of the Prostata, 

Is of rare occurrence, and only in those cases in which the inflammation 
spreads to the neck of the bladder, or in consequence of suppression of the 
discharge by injections. It is attended with a sensation of heat in the peri- 
neum, in the region of the bladder and towards the rectum, and with tenes- 
mus in bladder and rectum. It may end in suppuration and the formation 
of an abscess, which may discharge its contents into the bladder or urethra, 
or through the perineum, or it may end in chronic induration of the prostatic 
gland. 

Compare Mercur., Nitr. ac. Phosphor., Pulsat., Selen., Sulphur, Thuja. 

3. Gonorrhoea Vesicae, 

That is, a transmission of the disease to the neck, or into the body of the 
bladder, consequent upon suppressing the discharge by injections. The pa- 
tient feels violent pains in the region of the bladder, the perineum and anus, 
with constant urging to urinate. By dint of the greatest straining, a few 
drops only of a turbid urine, mixed with blood and pus, are discharged. 
Main remedy: Canthar. Compare Cystitis. 

4. Buboes. 

Inflammatory swellings of the inguinal glands, which generally grow 
very slowly, and are brought on either by overexertion or suppression of the 
discharge. 

Compare Iodium, Laches., Mercur., Nitr. ac. 

5. Ophthalmia Gonorrhoica. 

One of the most dangerous inflammations of the eyes. The infection 
may be caused either by the direct contact of the poison with the eyes, by 
means of the fingers or soiled handkerchiefs, or by metastasis. 

Compare Aeon., Arsen., Bellad., Hepar, Merc. sol. and subl., Nitr. 
ac, Pulsat., Tussil. 

6. Gonorrhoea of the Rectum. 

Pain in the rectum; mucous membrane inflamed; sphincter spasmodi- 
cally closed ; discharge of purulent mucus mixed with blood. 



692 MALE GENITALS. 

Compare Mercur., Nux vom., Pulsat., Sepia, Sulphur, Thuja. 

7. Strictures of the Urethra. 

They consist of a fibrous or callous hardening of certain portions of the 
urethra, whereby the canal becomes narrowed and the passage of urine diffi- 
cult or altogether impossible. Their main seat is the membranous portion 
of the urethra and the fossa navicularis, although other parts may likewise 
adhere or become constricted in consequence of inflammation. 

The first and main symptom is difficulty in making water. The stream 
is thin, twisted, split and flows in jerks. The bladder cannot be fully emptied 
and there is a continued dribbling of urine for a great while after mictu- 
rition. 

They are caused frequently no doubt by the use of injections, misman- 
aged introductions of bougies, the long continuance of chronic gonorrhoea 
and excessive indulgence in sexual intercourse. 

Compare Clemat., Digit., Dulcam., Petrol., Pulsat., Rhus tox., Sulphur. 

Gradul dilatation by bougies. 

8. Gonorrhoea! Rheumatism. 

It is sometimes acute, attacking muscles and joints, and sometimes 
chronic. It has been frequently observed to follow the use of copaiva bal- 
sam, or the sudden suppression of the gonorrhoeal discharge by other means, 
and after taking cold. Those of a rheumatic or gouty disposition are, of 
course, the most subject to it. 

Compare Hepar, Mercur., Mezer., Phytol., Sarsap., Thuja. 

9. General Contamination of the System in Consequence of Gonorrhoea. 

Although modern writers deny such consequences of gonorrhoea upon 
the whole system, there is not the slightest doubt that a suppression of it is 
followed in many cases, by severe and deeply-seated ailments. We find cases 
on record where its suppression brought on tuberculosis ; in others dyspnoea, 
lasting for many years — until, under homoeopathic treatment, an old gonor- 
rhoeal discharge suddenly appeared again and the dyspnoea disappeared. 
Schoenlein, Autenrieth and others acknowledge this, whilst Ricord denies a 
specific gonorrhoea-virus altogether, which seems to be driving the thing 
rather to its smallest point, on which it cannot stand. Grauvogl, in his Pro- 
phylaxis, gives a whole list of constitutional disorders growing out of gonor- 
rhoea! poisoning, among which we find : glandular-like swellings upon the 
membranes of the brain, on the neck and tongue; in the axillae and ab- 
domen, and its viscera; deafness; paralysis and mental derangement, etc. 

The most important remedies which ought to be borne in mind, and 



CHANCRE. 693 

which cover this gonorrheal contamination of the system, as Sulphur does 
psoric, and Mercurius syphilitic affections, are, according to Grauvogl, Natr. 
sulph. and Thuja. 

Balanitis, Gonorrhoea Spuria or Praeputialis. 

This affection is a profuse secretion of mucus between the glans and 
prepuce, which is formed only in men with a long foreskin. It is sometimes 
associated with genuine gonorrhoea, but may just as well originate from un- 
cleanliness, friction, coitus with women who suffer with acrid fluor albus. In 
most cases it is altogether an innocent affair, although at times it may be of 
a j)oisonous nature. 

Symptoms. — Itching underneath the prepuce, which appears red and 
moist. In a few days there appear heat, pain and swelling of the prepuce, 
with considerable discharge of a yellowish, purulent mucus. Sometimes it is 
very difficult to push the prepuce back, in which case the glans appears ex- 
coriated. If allowed to remain, ulceration and adhesion may form between 
the glans and the prepuce and cause considerable trouble. If of an innocent 
nature, it is easily managed by cleanliness and perhaps one dose of Mercur. ; 
if it is in connection with gonorrhoea or chancre, it of course assumes the 
nature of its companions, and requires the same treatment. 

Chancre. 

The name chancre is derived from cancer, meaning a corroding ulcer, 
with hard bottom and callous edges. Its seat is at the point where the poison 
gained access, in men chiefly the glans, prepuce, framum, front part of urethra, 
the penis externally, the scrotum, or the groins; in females the labia, vagina, 
urethra, or the neck of the uterus. But the poison may also be transferred 
to other parts, such as the lips, tongue, nipples, or fingers, if through wounds, 
cracks, or denudations, it can enter into the circulation. 

There are two theories about the nature of chancre-poison. The one 
maintains that all is but one kind, which may or may not produce constitu- 
tional syphilis ; the other has tried to prove a duality of the chancre-virus, 
meaning that there are in reality two totally different kinds of sores, of 
which each propagates only its own kind. These two different kinds of 
chancre have become known under the name of soft and indurated or Hun- 
ter's chancre. 

The soft chancre is according to this theory only a local affection, and 
inoculable upon the bearer, and upon others, both healthy and syphilitic, to 
an almost unlimited extent. It develops ivithout incubation in twenty-four 
hours. Through resorption an irritation of the adjacent glands takes place, 



694 MALE GENITALS. 

which has an acute inflammatory character and usually leads to suppuration, 
but is not followed by constitutional syphilis. The pus of the glandular 
suppuration has the same properties as the chancre pus. 

The hard chancre produces and is produced by true syphilitic poison ; it 
is, notwithstandiug the assertions of Ricord, inoculable upon the bearer and 
upon others syphilitic, but produces then a soft chancre, to which Clerc, as 
Maratray had done before him, gave the name of "chancroid." Whether 
the poison of this chancroid, when communicated to a healthy person, is 
capable of producing syphilis, or only local sores, has not been positively de- 
termined. The syphilitic poison (of a hard chancre) when inoculated upon 
healthy subjects, causes after a period of incubation of three to four weeks, a 
papule, which gradually hardens or superficially ulcerates, or at other times 
immediately inflames and ulcerates, as in the soft chancre, being followed 
later by induration together with general syphilis. 

The minute anatomy of chancre does not show any marked differences 
between the two; the one thing common to both is a dense cellular infiltra- 
tion of the tissue of the cutis or mucous membrane. Induration, therefore, 
will not hold good as a positive distinction between the two, especially in the 
female genitals, where it may be very inconsiderable, even in so-called genuine 
hard chancres. Only if an affection is seen to begin as a papule, at a certain 
time after a possible occasion for infection, and afterwards gradually enlarg- 
ing, it may be considered as true syphilis ; but if, following immediately after 
an infection, a pustule appears, with subsequent ulceration, which is, perhaps, 
afterwards neglected by the patient, or irritated in various ways, as by im- 
proper treatment, it should be classed under the soft chancres, but in such 
cases it is often impossible to decide whether it is a specific induration or a 
mere inflammatory infiltration, because the beginning of it has not come 
under observation; and if we add to this what has been stated before, that a 
syphilitic or so-called hard chancre or ulcer may originate immediately after 
infection like a so-called soft chancre, the diagnosis between the two becomes 
a complete conundrum. Neither hardness nor incubation prove to be entirely 
satisfactory. There remains only the subsequent development of constitu- 
tional syphilis for a distinction between the two ; but then the chancre has 
usually disappeared, and our wisdom comes post festum. In praxi then the 
so-called soft and hard chancre resemble each other frequently very closely, 
at least while being under observation ; but even if we consider the theory 
of duality of chancre poison as true above all doubt, this conviction can 
have no other use, than to confirm physicians who believe in mere local affec- 
tions, in the bad practice of cauterizing, burning and slashing away, which is 
not in accord with the spirit of Homoeopathy. 

The external appearance of chancre varies. It may, as stated before, 
commence at the infected point as a papule or a pustule, which by degress, en- 



CHANCRE. 695 

larges, becomes harder, and at last ulcerates, secreting a gray, slimy pus, which 
adheres to the bottom. This sore at times remains quite superficial, at other 
times the middle of the tubercle becomes excavated, and at still other times 
the surrounding tissues become involved in a wide-spread destruction of tissue, 
when it is called phagedenic chancre. If sores form on the inside of the 
prepuce, or far back on the glans, it soon becomes impossible to retract the 
foreskin; the ensuing phagedenic process may possibly cause a destruction 
of the entire prepuce, and eyen of the glans, in a short time. On the mucous 
membrane of the female genitals chancres appear as simple erosions, which 
the patient hardly notices, with parchment-like thickening; real tubercular 
indurations are rare. From being constantly moistened and irritated when 
on the labia majora or minora, they are gradually transformed into moist 
hyperplastic growths — the condylomata lata. 

The syphilitic poison is contained in the primary ulcers, in the condylo- 
mata lata, in the blood of syphilitic persons, in the semen of a man with latent 
syphilis. Whether the milk, saliva, urine and perspiration of syphilitic per- 
sons be also carriers of the poison, is doubtful; but pathological secretions, 
such, for instance, as contained in the vaccine pustules, have, unfortunately, 
too often proved their infectious nature. 

The transmission of syphilis by inheritance, is another well established 
fact. It may be transferred by the semen to a healthy ovule ; or by the ovule 
developed in the ovary of a syphilitic woman, or later during the time of 
gestation, if the mother acquires syphilis during that time. Whether 
syphilis be transmissible into the third generation, remains still an open 
question. 

Infection takes place when the syphilitic poison gets underneath the epi- 
dermis or beneath the epithelium of the mucous membrane of a healthy 
person. This may be effected in direct ways, by sexual intercourse, by kiss- 
ing, by wet-nurses, by vaccination, by obstetrical examinations; in mediate 
ways, by the use of articles which have been soiled by syphilitic poison, such 
as eating and drinking utensils, tobacco-pipes, cigar-holders, cigars, blow- 
pipes, surgical instruments, etc. 

The susceptibility to the syphilitic poison seems in some cases to be 
diminished by previous infection, but immunity by it is by no means so ab- 
solute as Ricord claimed; neither is inherited syphilis a shield against infec- 
tion. Age does not essentially modify the susceptibility to the syphilitic 
virus. 

For practical purposes there may be made a division of the symptoms 
of syphilis into groups, according to the order in which they gradually 
develop, if not checked by proper treatment. 

The first or primary stage comprises the gradual development of the 
local symptoms at the point of infection, and the indolent swelling of glands in 



696 MALE GENITALS. 

the vicinity. Some six or eight weeks from the first appearance of the 
primary affection, signs of 

Constitutional Syphilis 

Or general blood-poisoning make their appearance, frequently accompanied 
by an eruptive fever. These signs of the secondary stage consist of: " super- 
ficial eruptions of the skin and mucous membrane, distributed symmetrically 
over both halves of the body ; falling out of the hair and disease of the nails ; 
often anaemia; lymphadenitis universalis; irritative processes in the peri- 
osteum and interstitial cellular tissue of internal organs, which subside spon- 
taneously without loss of tissue," or terminate sometimes in permanent de- 
rangements of functions through adhesions and contractions. The duration 
of this stage varies from several months to a year, being followed by an 
intermediate stage of uncertain duration, during which the disease remains 
either entirely latent or shows itself from time to time in various eruptions 
upon the skin and mucous membrane, but of less extent and intensity than 
in the previous stage. The blood-poisoning still existing, is transmissible to 
the offspring. 

The tertiary stage is characterized by " local affections, for the most part 
asymmetrical, often occasioned by external causes, and consisting in cell- 
growth, having a tendency either to disintegrate or to become encysted with 
caseous metamorphosis and new formation of connective tissue. Gummata 
of the various organs, ulceration, necrosis, and caries of the skin and bone. 
General state of nutrition usually, though not always, bad." Its limits are 
uncertain; in some cases it may be mixed up with the secondary stage; as a 
rule, many years intervene between the infection and its outbreak ; it at last 
develops into confirmed syphilitic marasmus, where irremediable changes, as 
amyloid degeneration, .destructive caseous pneumonias, dysenteric and other 
ulcerative processes, have taken place. 

THERAPEUTIC HINTS for Chancre.— Merc, sol., ulcer the size 
of a pea on the glans near the frsenum; painful itching, sore to the touch, 
and discharging offensive pus ; or several painful ulcers on the glans, on both 
sides of the frseuum, bleeding easily on retracting the prepuce or handling 
the parts ; pain in the inguinal region on walking or on pressure upon the 
parts ; or, ulcer the size and shape of a small bean on the glans near the 
frsenum of some depth, and its base covered with a thin layer of yellow pus ; 
painful to the touch ; prepuce red and swollen. (A. Fellger.) 

Merc, cinnab., the ulcer on the glans is surrounded by a red-yellow- 
ish or red ring ; there are lentil-sized red-yellowish, or scarlet-red spots on 
the glans and prepuce. (A. Fellger.) Also in old, neglected or badly 



CONSTITUTIONAL SYPHILIS. 697 

treated indurated chancres, where Prsec. rub. was of no avail; elevated 
chancres; exuberant granulations of the base of the ulcers; hard, callous, 
raised, indolent edges of the ulcer; mucous condylomata on the genitals, 
anus and lips ; indolent buboes, 

Merc, praec. rub., when Solubilis affects no change within eight or 
ten days; indurated, old, obstinate chancres; indurations after cauterization; 
excoriations on the glans ; extuberances of the ulcers ; inflamed buboes. 

Merc, prot., painless chancres with great swelling of the inguinal 
glands, without disposition to suppurate; swelling of tonsils; affection of tes- 
ticles ; also secondary eruptions. (J. H. McClelland.) 

Merc, biniod., chancre and bubo particularly indolent; other symp- 
toms corresponding to the preceding. (J. H. McClelland.) Hard, red swell- 
ing of front of prepuce, appearing as thick and hard as a lead-pencil, with 
a hard chancre in its centre, entirely painless. (A. Fellger.) 

Merc. subl. corr., phagedenic chancre, secreting a thin, ichorous pus. 

Merc, nitr., in old obstinate cases; dry fig-warts on thread-like 
pedicles; soft, pointed condylomata. 

Mercury, its oxide and chloride corresponds to chancres with steep, 
sharp cut edges ; the bottom of the ulcer appears lardaceous ; hard infiltra- 
tion of the surrounding tissue. (Von Villers.) 

Arg. nitr., little ulcers on prepuce, spreading and becoming covered 
with a tallowy substance. 

Arsen., gangrenous degeneration with burning, restlessness and thirst. 

Caustic, acrid corrosive secretion or watery and greenish; complica- 
tion with eruptions, gout or scurvy. 

Ccrall. rubr., ulcers flat and extremely sensitive to touch, sometimes 
bleeding; chancres on any part of the penis, or scrotum, very sensitive to 
touch. (A. Fellger.) 

Hepar, chancres secreting watery pus with diffuse borders and red 
bottoms, elevated above the surface. (Von Villers.) Is indispensable where 
Mercury has been abused. 

Kali bichr., when the ulcer is round and deep, as if chiseled out by a 
sharp instrument. 

Kreos., the prepuce becomes blue and black with haemorrhage and 
gangrene. Let the penis remain hanging in a vessel filled with water, which 
is medicated by a drop or two of the first or second dilution. 

Laches., the areola of the ulcer assumes a purplish color; phagedenic 
chancres. 

Nitr. ac, ulcers are painful on slightest touch as if sticks were jagging 
them. (A. Fellger.) Chancres with raised edges and a disposition to bleed 
easily and profusely ; inclined to spread in circumference with tendency to 
fungous growth ; pains as of splinters ; corrosive discharge ; buboes threaten 



698 MALE GENITALS. 

to suppurate. (J. H. McClelland.) Chancres with rhagades, characterized 
by fetor. (Von Villers.) After the abuse of Mercury ; unpainful ulcers, 
with gray, wasted edges, easily bleeding; or superficial or elevated ulcers, 
with zig-zag edges ; or ulcers with hard, callous edges ; or ulcers with a dark 
bluish, dirty basis, covered with a crust from underneath of which ichor 
issues, or with exuberant granulations, forming a red, spongy basis, like raw 
flesh ; mucous, moist and other condylomata, like cauliflowers or pin-heads 
on thin pedicles; or phagedenic, ulcerated condition of the entire surface; 
fistulous ulcer into the urethra; inflamed buboes. 

Silic, excessive discharge, foul-smelling diarrhoea, bloody and thin; 
inflamed, irritable, sore, with unhealthy granulation. 

Sulphur, chancres with board-like hardness of the red and swollen 
prepuce ; intermediate remedy in psoric persons. 

Thuja, round, unclean, elevated ulcers, surrounded with redness, usually 
moist and painful ; condylomatous excrescences. (A. Fellger.) Moist con- 
dylomata; elevated ulcers, with exuberant granulations; after Nitr. ac, 
erosions on the female genitals, with abundant mucous secretions ; erosions 
and rawness between the, legs and on the sides of the scrotum ; constantly 
oozing of moisture; ulcers on the penis, cavity of mouth and throat. 

Besides, the following are recommended: Jacaranda caraba, Myrica 
cerifera, Phytol., Sanguin. 

THERAPEUTIC HIISTTS for Constitutional Syphilis.— Arg. 

nitr., chancre-like ulcer on the prepuce; urethra swollen, hard and knotty; 
sexual desire gone, the genital organs having become shrivelled; cock's- 
comb-like fig-warts around the vulva; horn-like excrescences. 

Arsen., gangrenous and serpiginous ulcers; tubercular syphilitic skin 
diseases. 

Asaf., affections of the long bones with severe nocturnal pains. 

Aur. fol. and mur., after the abuse of mercury; secondary ulcers on 
the scrotum; nightly pain in the bones; swelling of the skull-bones; swelling 
of the periosteum of the forearms and shin-bones ; caries of the roof of the 
mouth and nose; ulcers on the tongue; falling out of the hair and great 
nervous weakness ; utter despair and prostration of soul and body ; attempts 
at suicide. 

Badiaga, whole convolutes of hard glandular swellings ; buboes. 

Carb. an., buboes becoming phagedenic; gummata; skin tubercles. 

Carb. veg., suppuration of bubo; the parts are livid and mottled; 
partial falling off of hair, with furfuraceous desquamation; yellow skin; 
pain in liver and spleen ; palpitation of heart. (J. H. McClelland.) 

Caustic. , fistulous ulcers ; corrosive ulceration of skin tubercles ; lupus ; 
complication with gout and scurvy. 



CONSTITUTIONAL SYPHILIS. 699 

Conium, syphilitic sarcocele. 

Corall. rubr., syphilitic erosions, exuding a thin, badly-smelling ichor; 
constant trickling of mucus from the posterior nares into the fauces; smooth, 
copper-colored spots on palm of hand and finger. 

Coryd., nodes on skull; ulceration of fauces; profuse secretion of 
mucus; fetid breath. 

Euphras., old, broad condylomata at the anus, with much burning; 
especially at night. 

Ferr. iod., recommended for mercurial cachexia, 

Fluor, ac, skin tubercles on the forehead and face, even when ulcer- 
ating ; elevated red blotches on palm of hands ; squamous eruptions on the 
body (psoriasis guttata); syphilitic erosions, mucous tubercles; exostoses and 
nightly pains in the bones. 

Guaiac, tearing and stinging in the limbs; aching in the bones with 
swelling; tearing pains in the skull and bones of the nose; itching, tetter- 
like eruptions. 

Heel a lava, destructive ulceration of the nasal bones. 

Hepar, after the abuse of mercury: falling^ out of the hair; painful 
lumps on the head, and nightly pain in the skull-bones ; soreness of the nose 
on pressure, with red, inflamed eyes; eruptions around the mouth; ulcerated 
gums, with flow of saliva; swollen tonsils and hard glandular swellings on 
the neck, with sticking when swallowing, coughing, breathing, or turning the 
neck, as though a fish-bone had stuck fast ; suppurating buboes in the in- 
guinal region and axilla ; green, slimy, bloody stools; inflammatory swellings 
of the knees, hands, and fingers; ulcers, with nightly burning, throbbing 
and stinging, bleeding easily; nightly pain in the limbs, with chilliness; 
great nervous weakness. 

Iodium, mercurial cachexia; salivation; ulcers in the throat; chronic 
buboes very hard. 

Kali bichr., deep ulcer on the edge of the tongue; ulcer on the velum 
palati, eating through ; fetid discharge from the nose ; caries of the bones of 
the nose, with profuse purulent discharge from the nose ; suppurating, solitary 
skin-tubercles, forming deep holes. 

Kali hydr., bubo very hard with a curdy, offensive discharge, if suppu- 
rating; thickening of the spermatic cord; ulceration of nose, mouth and 
throat with corroding, burning discharge; lancinating pains in throat; system 
depressed; effusion of serum into the cellular tissue; induration of liver. 
(J. H. McClelland.) After abuse of mercury; tuberculous pustules in the 
face; roseola on chest and extremities; discolored, large ulcers on the skin; 
swelling of the bones; nightly bone-pain; bloody stools, with tenesmus; 
falling out of the hair. 

Laches., mercurial syphilis, with ulcerated sore throat, causing a con- 



700 MALE GENITALS. 

stant provocation to cough, with retching; painful deglutition; regurgitation 
of drink through the nose; earthy, yellowish appearance of the face, with 
small red blood-vessels shining through the skin ; coryza, nose red and sore ; 
terrible headache ; nightly pain in the limbs. 

Lycop., secondary, tettery-like eruptions and ulcers in the throat of a 
dark, yellowish-gray color; cough and hoarseness, from similar affection of 
the larynx; coppery eruptions on the forehead, and cachectic appearance of 
the face; dry, pediculated, painless condylomata on the sexual organs; 
nightly pain in the limbs during wet weather; low-spirited; despdnding; 
nervous weakness. 

Mercurial preparations, compare Chancre. 

Mezer., mercurial syphilis, with or without affection of the bones; 
chronic sore throat; dark redness of the fauces; worse every winter, with 
burning dryness extending into the larynx; hoarseness; hawking of phlegm. 

Natr. mur., if the primary sores have been burnt by nitrate of silver 
or lunar caustic. 

Natr. sulph., granulated inflammation of the inside of the eyelids; 
swelling and suppuration of the axillary glands; ulcer on the outer side of 
the thigh ; knotty, wart-like eruption on the anus, between the thighs, on the 
forehead, scalp, back of the neck and chest ; swelling of the ribs near the 
sternum; stiffness of knees, and cracking of joints; pain in the bones. Com- 
pare Thuja. 

Nitr. ac, mercurial syphilis; tonsils red and swollen, uneven, covered 
with little ulcers of the size of a pin's head; soft palate, highly inflamed; 
deep, irregular-shaped ulcer on the edge of the tongue ; foul breath ; single, 
moist sores on the scalp, burning ; suppurating pustules all over the face, 
with broad red circumference, forming crusts; large, soft protuberance on 
the wings of the nose, covered with a crust; brown spots on the glans, of the 
size of a lentil, peeling off; squamous eruption, like psoriasis ; hard, brownish, 
little knots on the scrotum and perineum, which suppurate. 

Petrol., brown spots on the arms, neck, chest and lower limbs; falling 
off of hair ; rheumatic stiffness of shoulders and ankles. (Bell.) 

Phosph. ac., mercurial syphilis; ulceration of the lips, the gums, and 
the soft palate; swelling of the bones; pain in the bones; condylomata; 
carbuncle-like ulcers of the skin, with a copper-colored circumference. 

Phosphor., falling out of the hair, leaving exposed ulcers on the scalp, 
implicating the cranial bones; syphilitic psoriasis in the palms of the hands 
and the soles of the feet; syphilitic roseola; squamous eruptions; mercurio- 
syphilitic ulcers on the prepuce; bone-pain and exostosis. 

Phytol., sore throat; ulcers on the genitals; severe pains in the arms 
and legs, from the elbows and knees down to the fingers and toes, with oedem- 
atous swelling of the affected parts; pain aggravated by motion and con- 



DIGEST TO CHANCRE AND CONSTITUTIONAL SYPHILIS. 



701 



tact; feet and legs covered with pale, red spots, about the size of a dime; 
more scattered on the arms, face and neck ; previous use of mercury. 

Psorin., moist, itching and burning condylomata on the prepuce; sore 
corners of the mouth ; dry, tetter-like eruptions in the hollow of the knees. 

Sabina, fig-warts with intolerable itching and burning; exuberant 
granulations. 

Sanguin., roundish or oval, whitish and raised patches on the mucous 
membrane of the mouth, nose, prepuce and anus; a diphtheritic exudation, 
which, when wiped off, leaves a raw surface behind; congestion of the head; 
throbbing headache from the nape of the neck to the head ; swollen veins in 
the temples. 

Sarsap., mercurial syphilis; squamous eruptions ; bone-pain. 

Sepia, syphilitic erosions in women. 

Silic, mercurio-syphilitic ulceration of skin and bones. 

Staphis., mercurial syphilis; dry, pediculated fig-warts and mucous 
tubercles; nervous weakness. 

Stillin., extreme bone-pains; nodes on head and legs. 

Sulphur, mercurial syphilis; itching ulcers, which are soon covered 
with a crust, discharging pus from underneath ; cock's-comb-like excrescences 
on glans, soft, spongy, easily bleeding; excoriations on the genitals, with 
burning; copper-colored spots on forehead; hard, large and inflamed buboes. 

Thuja, erosions in the female genitals, with profuse gonorrhceal dis- 
charges; erosions between the thighs and on scrotum; in the fauces, with 
mucous tubercles; condylomata; tubercula mucosa; decay of teeth near 
the gums. 



Digest to Chancre and Constitutional Syphilis. 



Low-spirited, desponding: Lycop. 
Despair; attempts of suicide; prostration 

of soul and body: Aurum. 
Nervous weakness: Aurum, Hepar, 

Lycop., Staphis. 



Congestion of head, with throbbing 

headache from nape of neck up to head : 

Sanguin. 
Headache, terrible: Laches. 
Tearing pain in skull and bones of nose: 

Ouajac. 
Pains in sknll-bones, in night : Hepar. 
Painful lumps or nodes on skull : Coryd., 

Hepar, Stilling. 
Swelling of skull-bones: Aur. fol, and 



Single, moist sores on scalp, burning: 
Nitr. ac. 

Knotty, wart-like eruption on scalp: 
Natr. sulph. 

Hair, falling out of: Aurum, Hepar, Kali 
hydr., Petrol. 

, with furfuraceous desquamation: 

Carb. veg. 

, leaving exposed ulcers on scalp, im- 
plicating the cranial bones: Phosphor. 

Eyelids granulated: Natr. sulph. 
Eyes red, inflamed : Hepar. 

Nose red and sore, coryza : Laches. 

, fetid discharge from: Kalibichr. 

, burning discharge from ulceration 

of: Kali hydr. 



702 



MALE GENITALS. 



Nose, trickling of mucus from posterior 

nares into fauces : Corall. 

, soreness of: Hepar. 

large, soft protuberance on wings of, 

covered with a crust : Nitr. ac. 

, pains in bones of: Guajac. 

, caries, ulceration of bones of: Aurum, 

Hecla lava. 
■ , , , with purulent discharge : 

Kali bichr. 
, roundish, whitish and raised patches 

on mucous membrane of: Sanguin. 



Face earthy, yellowish, with small blood- 
vessels shining through the skin: Laches. 

cachectic: Lycop. 

, pale red spots on, and neck : Phytol. 

, tuberculous pustules in : Kali hydr. 

, suppurating pustules with broad, red 

circumference, forming crusts : Nitr. ac. 

■ , lupus: Caustic. 

Forehead, copper-colored spots on: Ly- 
cop., Sulphur. 

and back of neck, wart-like eruptions 

on : Natr. sulph. 

Temples, swollen veins on : Sanguin. 



Mouth, eruptions around: Hepar. 

, sore corners of: Psorin. 

Lips, ulceration of: Phosph. ac. 

, mucous condylomata: Cinnab. 

Gums, ulceration of: Phosph. ac. 

, , with flow of saliva : Hepar. 

, scurvy: Caustic. 

Teeth, decay of, near the gums: Thuja. 

Tongue, deep ulcer on edge of: Kali 
bichr. 

, , irregularly shaped : Nitr. ac. 

, ulcers on : Aurum. 

Tonsils swollen : Merc. prot. 

, hard, with stitching pain on swal- 
lowing: Hepar. 

, red, covered with little ulcers: Nitr. 

ac. 

Soft palate, ulceration: Phosph. ac. 

, , eating through : Kali bichr. 

, highly inflamed : Nitr. ac. 

Mucous membrane, roundish, whitish 



patches, when wiped off leaving a raw 

surface: Sanguin. 
Mucous membrane, ulceration of, and 

throat: Thuja. 
, , with corroding, burning dis- 
charge : Kali hydr. 
Throat, lancinating pain in : Kali hydr. 

sore: Mezer., Phytol. 

, ulcers in, and salivation: Iodium. 

, , causing cough with retching: 

Laches., Lycop. 
Fauces, dark redness of, with burning 

dryness, extending to larynx, worse every 

winter: Mezer. 

, erosions : Thuja. 

, ulceration of: Coryd. 

, , and tettery-like eruptions of a 

dark, yellowish-gray color: Lycop. 
Phlegm, hawking of: Mezer. 

, profuse secretion of: Coryd. 

Deglutition painful, with regurgitation 

of drink through the nose : Laches. 
Breath fetid : Coryd. 
foul : Nitr. ac. 



Hoarseness : Lycop., Mezer. 

Cough from ulceration in larynx : Lycop. 



Liver indurated : Kali hydr. 

and spleen, pain in : Carb. veg. 

Stools foul-smelling, bloody and thin 
Silic. 

green, bloody : Hepar. 

bloody, with tenesm us : Kali hydr. 



Heart, palpitation of: Carb. veg. 



Genitals, chancres or ulcers on prepuce : 

Arg. nitr., Phosphor. 

gangrenous : Arsen., Kreos. 

phagedenic : Laches., Merc. subl. corr., 

Nitr. ac., Thuja. 

secondary on scrotum : Aurum. 

on outer side of thigh : Natr. 

sulph. 
Basis exuberant: Cinnab., Merc, prcec. 

rub., Nitr. ac, Sabina, Silic, Thuja. 

red, elevated : Hepar. 

lardaceous: Oxide and Chloride of 

Merc. 



DIGEST TO CHANCRE AND CONSTITUTIONAL SYPHILIS. 



703 



Basis covered with a tallowy substance: 

Arg. nitr. 
covered with a thin layer of pus : 

Merc. sol. 

dark bluish, dirty, covered with a 

crust : Nitr. ac. 

Edges steep, sharp cut : Kali bichr., Mere. 

oxide and chloride. 

fistulous : Caustic. 

zig-zag, superficial or elevated ulcers : 

Nitr. ac. 

hard, callous : Cinnab., Nitr. ac. 

raised, easily bleeding : Nitr. ac. 

raised, gray, easily bleeding : Nitr. 

ac. 

diffuse, with red bottoms : Hepar. 

Areola of ulcer red : Thuja. 

red or red-yellowish : Cinnab. 

purplish : Laches. 

Surrounding tissue hard, swollen: 

Mere, binj., Merc, prose, rub., Oxide and 

Chloride of Merc, Sulphur. 
with rhagades, characterized by fetor: 

Nitr. ac. 
prepuce, black and blue, with haemor- 
rhage: Kreos. 

, red and swollen: Merc. sol. 

Ulcers discharging excessively: Silic. 

watery pus : Hepar. 

offensive pus : Merc. sol. 

greenish, corrosive secretion: 

Caustic. 

thin, ichorous pus : Merc. subl. 

corr., Nitr. ac. 

moisture : Thuja. 

easily bleeding: Corall. rub., Hepar, 

Merc, sol., Nitr. ac. 

painless: Cinnab., Merc, binj., Nitr. 

ac, Merc prot. 

painful : Merc, sol, Thuja. 

, as of splinters: Nitr. ac. 

nightly burning, throbbing, stinging : 

Hepar. 
sensitive to touch : Corall. rub., Merc 

sol, Nitr. ac. 

itching: Merc sol., Sulphur. 

Condylomata, fig-warts: Phosph. ac, 

Thuja. 
, , and anus : Cinnab. 



Condylomata, at anus, old, broad, with 
burning, worse at night: Euphras. 

, , with intolerable itching and 

burning: Sabina. 

, , pointed : Merc. nitr. 

, , tubercula mucosa: Thuja. 

, , moist : Nitr. ac, Thuja. 

, , moist on prepuce, itching and 

burning: Psorin. 

, , dry, pediculated : Lycop., Merc. 

nitr., Staphis. 

Excrescences, cock's-comb-like around 
vulva: Arg. nitr. 

, on glans, easily bleeding: Sul- 
phur. 

, like cauliflowers, or pin-heads on thin 

pedicles: Nitr. ac 

, horn-like: Arg. nitr. 

Spots, lentil-sized, red-yellowish, or scar- 
let-red on glans and prepuce : Cinnab. 

, , brown, glans peeling off: Nitr. 

ac. 

Erosions : Fluor, ac. 

, in women: Sepia. 

, , with abundant mucous secre- 
tion: Thuja. 

, exuding a thin, badly-smelling ichor : 

Corall. rub. 

between thighs and on scrotum, with 

mucous tubercles : Thuja. 

Excoriations, with burning: Sulphur. 

on the glans : Merc prazc rub. 

Patches, roundish, whitish, raised, on 
prepuce and anus: Sanguin. 

Urethra swollen, hard and knotty : Arg. 
nitr. 

, fistulous ulcers in : Nitr. ac 

Knots, hard, brownish, suppurating on 
scrotum and perineum: Nitr. ac 

Testicles affected: Merc. prot. 

and genital organs shrivelled: Arg. 

nitr. 

, syphilitic sarcocele: Conium. 

Spermatic cord thickened: Kali hydr. 



Inguinal region painful on walking or 

pressure: Merc sol. 
Buboes inflamed: Merc prazc. rub., Nitr. 

ac. 



704 



MALE GENITALS. 



Buboes inflamed, hard and large : Sulphur. 

threaten to suppurate: Nitr. ac. 

suppurate : Carb. veg. 

in inguinal region and axilla : 

Hepar. 

axillary glands : 

, with curdy, offensive discharge: 

Kali hydr. 
without disposition to suppurate: 

Merc. prot. 

indolent : Cinnab. 

chronic and very hard : Iodium. 

becoming phagedenic : Carb. an. 

, whole convolutes of hard glandular 

swellings: Badiaga. 



Bones aching: Guajac, Natr. sulph., Phos- 
phor., Phosph. ac, Sarsap. 

nightly: Asaf., Aur. fol. and 

mur., Fluor, ac, Kali hydr. 

, swelling, exostosis of: Fluor, ac, Gua- 
jac, Kali hydr., Phosphor., Phosph. ac. 

. of ribs near sternum: Natr. 



, ulceration of skin and : Silic. 

Periosteum of forearms and shin-bones: 
Aur. fol. and mur. 



Limbs, pain in, worse from motion and 
contact: Phytol. 

, , nightly : Laches., Lycop. 

, tearing and stinging in: Guajac 

, gout and scurvy : Caustic 

Shoulders and ankles, stiffness in : Petrol. 

Hands and fingers, and knees, inflamma- 
tory swelling : Hepar. 

Arms and legs, pain and cedematous 
swelling: Phytol. 

Knees, stiff, and cracking of joints: Natr. 
sulph. 

Legs, nodes on: Stilling. 



Skin yellow : Carb. veg. 

swollen from effusion : Kali hydr. 

, eruptions, secondary : Merc. prot. 



Skin squamous, like psoriasis: Fluor, ac, 

Nitr. ac, Phosphor., Sarsap. 

, tetter-like, itching : Guajac 

, , dry in hollow of knees : 

Psorin. 

, roseola: Phosphor. 

, — — on chest and extremities: Kali 

hydr. 
, spots pale, red on feet, legs, arms: 

Phytol. 
, spots copper-colored, smooth, on 

palms and fingers: Corall. 
, spots brown, on arms, neck, chest, 

lower limbs : Petrol. 
, blotches, elevated, red on palms: 

Fluor, ac 
, knotty, wart-like eruptions on anus, 

between thighs: Natr. sulph. 

, tubercles: Arsen., Carb. an. 

, on forehead and face : Fluor, ac 

, , mucous : Fluor, ac, Staphis. 

, , ulcerating : Caustic, Fluor, ac 

, , , forming deep holes: Kali 

bichr. 

, ulcers, large: Kali hydr. 

, , carbuncle-like, with copper- 
colored circumference : Phosph. ac 
, ulceration of skin and bones : Silic 



Mercurial syphilis cachexia: Aur. fol. 
and mur., Ferr.jod., Hepar, Iodium, Kali 
hydr., Laches., Mezer., Nitr. ac, Phosphor., 
Phosph. ac, Phytol., Sarsap., Silic, Sta- 
phis., Sulphur. 

Cauterization, after: Merc, prcec rub., 
Natr. mur., Nitr. ac 

Psoric persons: Sulphur. 

Merc, praec. rub., when Solubilis has 
failed. 

Cinnabaris, when Merc prcec rub. has 
failed. 

Natrum sulph., similar to Thuja. 



Besides, the following are recommended : 
Jacaranda caraba, Myrica cerifera. 



CONDYLOMATA, SYCOSIS, FIG-WARTS. 705 

Condylomata, Sycosis, Fig-warts. 

These excrescences are a morbid growth of the skin and mucous mem- 
brane, or, better denned, of the subcutaneous and submucous cellular tissue. 
They are of different external appearance, according to their coating. When 
they are covered by the epidermis, they appear dry, hard, horny, like com- 
mon warts; when covered with thin epithelium, or when they are entirely 
bare and excoriated, they appear soft, moist and secrete more or less of a 
slimy, acrid, badly-smelling fluid. These latter are the genuine syphilitic 
condylomata or tubercula mucosa. 

Their forms are likewise various; some are flat, upon a broad basis; 
others are conical, growing on a pedicle; others appear like a cock's-comb. 
The fiat fig-warts are chiefly found around the anus, between the glutseus 
muscles ; on the perineum, scrotum, external skin of the penis, glans penis 
and on the external surface of the labia in women ; whilst the conical and 
pediculated are usually found in the entrance of the vagina, on the clitoris 
and even far back in the vagina, and on the neck of the womb ; in males on 
the interior surface of the prepuce; also between the nates. They some- 
times grow so luxuriantly that the whole vagina and interior surface of the 
prepuce is covered by them. A third kind is quite small, in the shape of 
pin-heads, which are generally found around the corona in men, and on the 
interior surfaces of the labia in women. In secondary syphilis they appear 
also in other localities, especially on the tongue, corners of the mouth, chin, 
face, forehead, eyelids, iris, scalp, meatus auditorius, axillae, nipples and be- 
tween the toes, Soon after the outbreak of this pest in the middle ages we 
read of condylomatous excrescences in the face, which were of a finger's 
length, and which caused for their bearers more ridicule than compassion. 

THERAPEUTIC HINTS.— For the mucous tubercles the main reme- 
dies are: Cinnab., Sublim., Nitr. ac, Thuja. 

Fig-warts, when complicated with gonorrhoea, require Thuja, Sublim., 
Cinnab., Xitr. ac, Sulphur, Lycop. 

When complicated with chancre, Cinnab., Nitr. ac, Phosph. ac, Staphis., 
Thuja. 

When flat, Magnes., Nitr. ac. 

"When exuberant, like cauliflowers or mulberries, Thuja, Staphis. 

"When fan-shaped, Cinnab. 

When growing on pedicles, Lycop., Nitr. ac 

When conical, Solub. 

When dry, Thuja, Staphis., Solub., Sublim., Nitr. ac, Lycop. 

When moist, suppurating, Nitr. ac, Thuja, Sulphur, Euphras. 
45 



706 MALE GENITALS. 

When soft, spongy, Sulphur. 

When intolerably burning and itching, Sabina. 

The Inguinal Bubo 

Consists of a swelling of the inguinal lymphatic glands, with a tendency to 
form abscesses in consequence of syphilitic infection. As chancres may ap- 
pear on other parts than the genitals, so, also, may buboes appear in other 
parts : in the axilla, under the maxilla, on the neck. Buboes may also form 
primarily (without previous chancre on the penis) by immediate absorp- 
tion of the syphilitic virus. The period of time which elapses between the 
first appearance of chancre and that of bubo varies from eight days to six 
weeks. 

Symptoms. — Before any thing can be seen the patient experiences a 
painful tension in the inguinal region, which sometimes extends into the 
thigh, making walking quite difficult; soon after the patient feels feverish, 
chilly, and there appears a roundish swelling in the inguinal region, which 
is painful to contact and motion. It is usually hard, grows in the course of 
some days, to the size of a pigeon's egg, and larger, and becomes dark red. 
If not arrested in this stage it soon commences to assume a more doughy feel 
w T ith paiuful throbbing; finally it fluctuates, breaks, and discharges a quan. 
tity of thick pus, which at last becomes watery ; now it heals, either like any 
other abscess, or the wound assumes a chancre-like aspect, with hard, callous 
edges. In bad cases it may even assume a phagedenic or gangrenous form, 
and cause terrible destruction of the surrounding parts. 

All buboes do not run this acute course. The so-called indolent, torpid 
or atonic buboes form quite slowly, without pain or fever, and continue so 
until they reach a certain size, which they retain in a seemingly unaltered 
condition for weeks, or even months, until they finally suppurate and dis- 
charge. The so-called scirrhous bubo may remain for years in the same 
condition. 

Its Diagnosis is easy enough, if we ascertain the pre-existence of 
chancre. It may, however, be coufounded with an incarcerated testicle 
within the abdominal ring; therefore Ricord advises first, to count the tes- 
ticles before pronouncing an inguinal swelling a bubo. The inguinal glands 
may swell from other causes. In children scrofulous swellings of these glands 
are not unfrequent. We shall, in some cases, no doubt, have to fall back on 
the history of the case, which may tax our skill in cross-examination. 

THERAPEUTIC HINTS— Apis, red, hot, shining swelling, with 
great stinging jDain and sensitiveness. 

Arsen., when the open bubo assumes a greenish aspect. 



SYPHILITIC SKIN DISEASES. 707 

Aurum, after the abuse of mercury, with nightly pains in the bones. 

Badiaga, bubo stone-hard and uneven, a conglomeration of indurated 
glands ; violent stitching pain through it at night, as though a red-hot needle 
were thrust into it. Suppressed chancre by cauterization and mercurial oint- 
ments, leaving elevated and discolored cicatrices; general cachectic appear- 
ance and rhagades of the skin, here and there. 

Carb. an., for hard buboes which threaten to suppurate; it causes re- 
sorption where there is even some fluctuation discoverable; old, maltreated 
buboes, cut open or cauterized, presenting large, terrible ulcers, with callous 
edges and a secretion of offensive ichor. 

Hepar, after the abuse of mercury, for open buboes, which do not heal, 
and when there is a psoric taint of the system. 

Kali hydr., after mercurial treatment; ulcerating bubo, with fistulous 
openings, and discharge of dark, thin, offensive and corroding ichor; scrofu- 
lous individuals. 

Laches., old protracted syphilitic mercurial buboes; hectic fever, sore 
throat and the most violent headache, either in the back or front of the head. 

Mercurial preparations, compare what has been said under the 
chapter on Chancre. 

Nitr. ac, after the abuse of mercury, when Carb. an. has not been 
sufficient to reabsorb the swelling, and especially if the still existing chancre 
presents exuberant granulations on its base. 

Sulphur and Silic. are especially indicated for old, discharging buboes 
which do not heal, although other syphilitic symptoms have disappeared. 

Besides these remedies, there have been recommended Buboin, Phytol., 
Sancruin. 



Syphilitic Skin Diseases. 

The various affections of the skin in consequence of syphilis go under 
the name of Svphilides. Syphilides as a rule are characterized by a pecu- 
liar red color, which is perhaps best designated by the term "coppery red" 
It is most pronounced in persons with dark complexions ; in persons with 
very pale, anaemic skin it may at first be wholly wanting, or appear only as 
the exanthem begins to wane with a yellowish color. 

The syphilides consist of a cellular infiltration proceeding from the 
blood-vessels ; but developing only gradually and at different localities, they 
appear frequently in different forms, so that w T e see macules, papules, vesicles 
and pustules side by side in one person, as different stages of development, 
all of which may ultimately assume the form of ulcers. This polymorphous 
character, however, belongs not exclusively to syphilides, we find it also, 
though in a less degree, in eczema and scabies. 



708 MALE GENITALS. 

Another characteristic mark of the syphilicles is their annular form, 
similar to that observed in herpes circinatus. It is often very distinct, too, 
on the mucous membrane, especially on the tongue, on the hard and soft 
palate, and on the glans penis. 

Syphilides finally are characterized by an absence of itching, or any other 
sensation, although exceptions do occur, especially when the exantheni comes 
on very acutely. 

The various forms of syphilides are : 

1. The Macular syphilide, or Roseola syphilitica consists of a cir- 
cumscribed hypersemia with but slight infiltration, and appears in perfectly 
even, rose-colored, or darker colored spots, of a size varying usually from 
that of a lentil to that of a pea, with a roundish or irregular shape. After 
it has existed for several days it leaves under pressure a yellowish stain, and 
gradually assumes a coppery hue. When the spots are elevated it is called 
erythema papidatum. 

Koseola syphilitica is usually the first of all skin affections, and some- 
times the sole eruption that occurs during the earlier course of the disease. 
It may appear in only a few spots upon the sides of the chest and in the 
groin, and again it may be disseminated over the whole body like an erup- 
tion of measles. 

2. The Papular Syphilide consists of a circumscribed infiltration of 
the papillary bodies of the cutis. It varies from the size of a barley-corn to 
that of a split pea, and in color from red to brownish-red; it is hard to the 
touch, but smooth upon the surface. Later its epidermis loosens and is rub- 
bed off when its summit presents a dark red and shining appearance, which 
again is covered by a thin crust from the oozing of a little serum. In the 
palms of the hands and the soles of the feet the papules are not very promi- 
nent on account of the thickness of skin, but they appear only as red circular 
spots, which become denuded of their epidermis, and which are usually desig- 
nated by the name psoriasis palmaris and plantaris. 

The papular syphilide may appear anywhere upon the surface of the 
skin, but is mostly seen on the borders of the scalp, on the forehead (corona 
veneris), on the back of the neck, especially in women, and in all places where 
the skin forms folds or depressions, for instance on the chin, between the 
nose-wings and cheeks, behind the ears, on the borders of the axillse, in the 
elbows and in the hollows of the knees. Where these folds of the skin are 
in continual contact with each other, for instance on the external female 
organs, the scrotum, beneath the dependent breasts, in the navel, about the 
anus, at the preputial orifice, the angles of the mouth, between the fingers 
and toes, these papules are very apt to assume the form of condylomata lata. 

The eruption of the papular syphilide is often attended with fever, thus 
simulating somewhat an outbreak of small-pox, wherefore syphilis received 



SYPHILITIC SKIN DISEASES. 709 

from the French the name of verole grass or verole. It is either one of the 
first constitutional signs of syphilis or develops gradually from a roseola 
syphilitica, or does not appear until some weeks after this has disappeared. 
It is often accompanied by violent pains in the bones or iritis. 

3. The Squamous Syphilide consists of a coalescence of several pap- 
ules, or a gradual enlargement of a single papule with desquamation of the 
epidermis, thus bearing close resemblance to the patches of a common psoria- 
sis. However, it is covered, especially towards the borders, with loose epi- 
dermic scales, or rather thin yellow crusts, by which it may be distinguished 
from the white thick desquamation of psoriasis vulgaris. Besides, it does 
not appear on the knees or elbows, which is the favorite seat of common 
psoriasis. 

The squamous syphilide also becomes transformed into flat condylomata 
in favorable situations. 

• 4. The Lichen syphiliticus consists of an infiltration of the follicular 
walls, with only scanty, or no exudation in the follicles. In their simplest 
form they resemble those enlargements of the follicles which occur in many 
persons upon the dorsal surface of the upper arm, in consequence of an ac- 
cumulation and desiccation of the secretion, as hard granules like dried 
gum, which can be excavated with the finger-nail. 

The lichen appears usually in groups, at first slightly reddened, assumes 
soon a yellowish color, peals off and leaves no pigment spots behind (Miliary 
papular syphilide). When there is exudation into the follicle, groups of 
little vesicles form, which turn into pustules. These crust over and, after 
drying, leave small, dark scars behind (Herpes syphil.). Or the infiltra- 
tion spreads further around, and causes the entire surface of the skin, which 
was occupied by the papular group, to be converted into a desquamating, 
psoriasis-like group (Eczema Syph.). Or, there is an acute suppuration in 
the follicle in connection with the infiltration, causing acuminate pustules 
upon a red or copper-colored base (Acne syphilitica). This form is so 
similar to common acne that the distinction between the two must be based 
upon other syphilitic symptoms present or past. 

5. The Pustular Syphilide consists of an infiltration with subepithelial 
suppuration and superficial ulceration. The pus in these eruptions is not 
situated in the follicles, but underneath the epidermis, independently of the 
follicles. The pustules develop rapidly in places where the skin is tender, 
namely, beside the face, in the flexor surfaces of the extremities, on the sides 
of the trunk, and in the palm of the hand where there are no follicles. They 
are also more superficial and leave only very shallow depressions, even im- 
mediately after the crusts have fallen off (Pemphigus syphiliticus). 
Sometimes the epidermis is raised by a cloudy fluid, which soon becomes 
purulent and is often tinged with blood, over a reddened base. Such bulke 



710 MALE GENITALS. 

apj3ear in isolated spots, in preference on the legs below the knees (Ecthyma 
Syphiliticum). After desiccation there forms at times superficial excoria- 
tions beneath the scabs, and at other times deep ulcers, which extend at the 
edges and occasionally assume a serpiginous form (Ecthyma Sliperficiale 
and profundum). It is a manifestation of the later periods of syphilis and 
an evidence of a poor constitution. When the epidermis of a bulla forms a 
scab, while the ulcerative process underneath advances slowly beyond its 
edge, there gradually is produced a large, dirty, brownish-green, stratified 
crust in the shape of a cone, which rests upon a flat, ulcerated surface 
(Klipia syphilitica). Such ulcers, proceeding from rupia, may continue to 
extend for years, and convert extensive tracts of skin into cicatricial tissue. 
Kupia is often a manifestation of the later periods of syphilis, though it 
may break out within the first six months after infection. 

6. The Tubercular syphilide consists of deep infiltration and disinte- 
gration, or a gummous formation. At the commencement only a papule is 
felt in the skin, without redness. Gradually the papillary body becomes 
likewise involved, and the tubercle approaches the surface, when it causes 
redness of the skin, desquamation of the epidermis or scanty serous exuda- 
tion, which, on drying, forms a small crust upon the summit of the tubercle. 
These tubercles often develop in groups of a circular or semi-circular form 
(Dry tubercles). Or, the epidermis above the tubercle is raised in the 
form of a pustule which quickly desiccates, while underneath ulceration pro- 
ceeds, simulating a rupia or assuming at once the form of a serpiginous ulcer. 
Or, the process of softening may be similar to the development of a furuncle; 
it gradually becomes bluish-red, and when it breaks discharges a grayish- 
yellow, gummy-like matter, instead of a core of connective tissue, as in the 
true furuncle. The remaining cavity gradually either granulates and cica- 
trizes, or enlarges and assumes a serpiginous character (Softening and 
Disintegrating tubercles). These forms of the syphilitic tubercles present 
a marked similarity to different forms of lupus, whence the name Lupus 
Syphiliticus. The tubercular syphilide belongs to the tertiary group of 
syphilis. 

7. The LOSS of hair, Alopecia, occurs without any visible change in 
the skin. The hair merely loses its lustre, becomes dry, and often discolored, 
and falls out in large quantities when combed. It is an early symptom of 
constitutional syphilis, but may not occur until in the later stages. 

8. Alterations of the nails, such as growing thinner, becoming fur- 
rowed or brittle, may take place without any obvious affection of the matrix ; 
but deformities of the same may also be brought on by various syphilides 
attacking the matrix. 

THERAPEUTIC HINTS.— Mercurial preparations, Nitr. ac, 



SYPHILITIC AFFECTIONS OF THE MUCOUS MEMBRANES. 711 

Thuja, Aurum, Lycop., Staphis., Kali hydr., Laches., Sulphur, Hepar, Sar- 
sap., Petrol., Cuprum, Corall. rubr., Arseu., Graphit., and many more. 



Syphilitic Affections of the Mucous Membranes. 

Some of the just described syphilides may also affect the mucous mem- 
branes, for instance : 

The Erythematous Syphilide occurs in the throat in the form of a 
diffuse reduess, sometimes accompanied by a slight oedema of the mucous 
membrane. 

The Papular Syphilide appears as moist or mucous patches in the 
mouth and throat, bearing the greatest resemblance to the effect produced by 
a very superficial cauterization of the mucous membrane by nitrate of silver. 
Upon the tongue the syphilitic papule forms usually round level spots which 
often enlarge in circumference while receding in the centre, and thus assume 
the annular form. The same occurs on the hard palate. In the female 
genitals and in places where surfaces lie in contact with each other, the 
mucous patches become flat condylomata, which often are converted into 
condylomatous ulcers, simulating closely the primary affection. The secretion 
of the flat condylomata is in the highest degree infectious. 

The Squamous syphilide also becomes often transformed, in favor- 
able situations, into flat condylomata. 

The Ecthyma is often accompanied with aphthous-like sores in the 
mouth, deep ulcers of the tonsils, or destructive ulcerations upon the soft 
palate. 

The Syphilitic tubercles of the mucous membrane of the mouth and 
throat are usually not seen until ulceration has taken place. The ulcers have 
sharply cut edges, a yellowish purulent base with great swelling and redness 
around them ; they spread often extensively upon the posterior pharyngeal 
wall ; they occur also in the large intestine, especially in the lower part of 
the rectum and in the trachea. 

THEKAPELTIC HINTS.— Mercurial preparations, Aurum, Kali 
bichr., Kali hydr., Laches., Lycop., Mezer., Nitr. ac, Sanguin., Thuja. 

Syphilitic Affections of the Periosteum, of the Bones and 

Cartilages. 

They are always attended with severe pains in the bones, of a boring, 
grinding nature, and always worse at night from evening till towards morn- 
ing, when, with a slight perspiration, they usually abate. Gradually a struc- 



712 MALE GENITALS. 

tural change is observable; the periosteum commences to swell, forming so- 
called tophi, and when the inflammation spreads to the bones, causing swelling 
of the bones (exostosis), which maj r terminate in necrosis and caries. Such 
structural changes attack the skull-bones, which, when they are on the inside, 
may cause convulsions, paralysis, amaurosis and deafness. Those which 
attack the bones of the nose cause horrible disfigurations of the face. It also 
attacks the vertebrae, destroying portions of them, and the cartilages, although 
not so frequently. The cartilage of the nose is destroyed as well as the 
bones, and so have the cartilage of the sternum and the cartilages of the 
larynx been found destroyed. 

THERAPEUTIC HINTS.— Pain in the bones: Arsen., Aurum, Fluor, 
ac, Guaiac, Laches., Mercur., Mezer., Nitr. ac, Phosphor., Phosph. ac, 
Phytol., Staphis., Stilling., Sulphur. 

Tophi and exostosis: Asaf., Aurum, Fluor, ac, Lycop., Mezer., Phos- 
phor., Phosph. ac, Ruta, Sabina, Silic, Staphis., Sulphur. 

Caries and necrosis: Asaf., Aurum, Calc carb. and jod., Fluor, ac, 
Hepar, Kali hydr., Lycop., Mercur., Mezer., Nitr. ac, Phosphor., Silic, 
Sulphur. 

Syphilitic Contractions of Muscles and Tendons. 

These take place in rare cases, where the syphilitic virus attacks the 
muscles and tendons, causing plastic exudation within and around them, and 
thus shortening them. 

Gummata in the Subcutaneous and Submucous Cellular 

Tissue. 

These usually form at a later period, and appear as little, painless, mov- 
able kernels under the skin. They grow slowly and commence finally to 
suppurate, leaving deep, cicatrized holes, or chronic ulcers. 

Arsen., Aurum, Bellad., Calc. carb., Carb. veg., China, Graphit., Mer- 
cur., Mezer., Phosph. ac, Plumbum, Ruta. 

Syphilitic Affections of Inner Organs. 

a. Brain Affections. They manifest themselves in various ways, as, 
violent headaches, hemicrania, sleeplessness, dizziness ; or as hemiplegia, im- 
becility of mind, amaurosis, deafness, epilepsy, catalepsy, and are caused 
either by chronic inflammation of the membranes, or formations of tubercu- 
lar masses, or syphilitic exostosis on the inner plate of the skull-bones. 



SYPHILIS CONGENITA SIYE HEREDITARIA. 713 

The diagnosis is difficult. We may suspect such changes, if we find a 
right to do so from the history of the case. 

b. Lllllg Affections set in frequently in consequence of suppressed 
chancres, either as ulcerative processes, as bronchitis and asthma. 

c Liver, Spleen, Intestinal Affections are of various kinds and have 
been spoken of under the corresponding chapters. 

Syphilis Congenita sive Hereditaria. 

In some cases the child is destroyed by syphilitic infection while yet a 
foetus ; or it may be born alive prematurely ; or be still-born at full term ; or be 
born at full term apparently healthy, when some time afterwards the consti- 
tutional taint develops itself. 

The infection may have been transmitted, as stated before, by the semen, 
by the ovule, or later during gestation. The more recent the syphilis in the 
parents at the time of conception, the greater will be the liability to abortion. 
When the foetus dies in utero, it is usually born in a state of maceration ; if 
carried nearly its full term, it shows the syphilitic signs either on the surface 
of the body, or in internal organs, and invariably in the epiphysis of the 
long bones, where the cartilage layer is enlarged and softened, the zone of 
ossification is thickened, projecting with irregular prolongations into the 
cartilage layer, whereby the union of the two becomes less firm, so that the 
epiphysis is liable to separate entirely from the shaft of the bone, or the rib 
from its cartilage. 

When the child is born alive, it usually is small, undeveloped and pre- 
sents a peculiar oldish appearance, has a weak, plaintive voice, a stoppage 
of the nose, sore corners of the mouth, and its skin is either already covered 
with a rash, or shows, in a few days, papules or pemphigus. Such children 
perish in a short time from diarrhoea, or suppurations with all signs of 
marasmus. 

Sometimes the only apparent symptom of a seemingly healthy child is 
a nasal catarrh with stoppage of the nose, and coincident with it or following 
soon after a macular, or oftener a papular eruption, which may be limited 
to a few bright red papules upon the buttocks, or cover the entire body, but 
especially the face, acquiring by degrees the coppery tint. By and by the 
nasal discharge becomes purulent and excoriates the neighboring parts, and 
in the mouth and throat mucous patches appear. Bad cases soon lead to 
destruction; mild cases may improve, but develop a most striking depression 
or flattening of the nasal ridge and a marked prominence of the frontal pro- 
tuberances with symptoms of hydrocephalus. The children become very 
restless, cry a great deal, especially at night; later manifest themselves a 
want of proper intellectual unfoldnient and striking idiosyncrasies of charac- 



714 TESTES. 

ter, arid the upper permanent incisor teeth appear as if they were scooped 
out at their lower surface. 

The outbreak of these symptoms is very uncertain ; the latest period, as 
stated by different observers, is at from one week to several months, occurs 
most frequently, however, from the fifth to the eighth week after birth. The 
sooner the symptoms appear, the worse for the child. If it live through the 
acute stage there may occur, commonly during the period of the second den- 
tition, or at the time of puberty, especially in girls, another train of symp- 
toms of which may be mentioned : interstitial keratitis, eruptions, serpiginous 
ulcerations of the skin, or affections of the bones, epilepsy, chorea, paralysis. 
The treatment find under Constitutional Syphilis. 

DISEASES OF THE TESTES. 
Hydrocele. 

The testicles and epididymis are enclosed within a serous membrane, 
like the peritoneum, from which, in fact, it is a mere continuation. As such, 
it is a closed sac, and consists, like the pleura and the peritoneum, of two 
blades, the tunica vaginalis propria and the tunica vaginalis reflexa. Like 
all serous membranes, it is liable to exudation, and if that takes place, it 
constitutes what is called hydrocele or dropsy of the scrotum. 

It is either a symptom of general dropsical disposition, in consequence 
of hydremia, as found in old age, or in consequence of tuberculosis or other 
chronic diseases, corresponding entirely to hydrothorax and ascites ; or it is 
the result of some inflammatory or mechanical irritation, in consequence of 
orchitis, urethritis, or in consequence of external injuries — a bruise, a fall, a 
kick, etc., as found in otherwise healthy and young persons, even in children, 
and then it corresponds to pleuritic and peritoneal effusions. This latter may 
become chronic, and the secretion of serum continue so that the swelling 
attains the size of a head. The scrotum then appears smooth, teuse, glisten- 
ing; the testicle is compressed, becomes atrophied, and may gradually dis- 
appear ; then it presents the appearance of a transparent bladder. In con- 
sequence of undue irritation, the testicle may grow larger, become indurated, 
form into cysts ; the exuded fluid may coagulate, become turbid by the ad- 
mixture of blood or pus globules ; adhesions may form, etc. All these are 
circumstances by which the original nature of the disease may become deeply 
concealed. The exuded fluid consists chiefly of a colorless, clear or yellowish 
fluid, which, however, now and then becomes turbid by admixture of pig- 
ment, blood, fibrine, fat, mucus, epithelium and semen, so that it assumes 
different colors, greenish, dark green, brown and even black. 

The presence of semen is a remarkable phenomenon, the solution of 



ORCHITIS. 715 

-which has been found only by the latest researches of Luschka, on the ap- 
pendices of the testicles. According to Luschka, there is, under the head of 
the epididymis, a roundish vesicle of the size of a pea, which stands in im- 
mediate connection with the seminiferous tubuli of the epididymis. It there- 
fore almost always contains seminal fluid. The vesicle or cyst now seems, 
under certain circumstances, to enlarge to such a degree that it forms an en- 
cysted, spermatic hydrocele ; or it bursts, and diffuses its seminal fluid into 
the already-existing collection of serous fluid. 

In an ordinary hydrocele, the testicle always lies in the upper and pos- 
terior part of the scrotum, whilst the lower cavity of the scrotum is filled 
with the resj^ective fluid. In exceptional cases, however, a previous inflam- 
mation may have caused adhesion between the testicles and the lower part of 
the scrotum ; then, of course, the testicle is fastened down and the collection 
of fluids gathers above it. It is well to bear this in mind. The diagnosis 
rests on these points which have been detailed. In external appearance it 
resembles mostly a scrotal hernia; but is easily distinguished from it, if Ave 
compare the history of both ; the neck of the hernia, which is traceable into 
the abdominal ring; the impulse which is felt in a hernia when coughing; 
the symptoms of strangulated hernia, etc. ; so that hesitation between the 
two is scarcely possible. 

Hydroceles which are dependent upon a general hydrcemic state of the 
blood must be treated with reference to this whole general state and its 
symptoms. Hydrocele, in consequence of a blow, require Arnica, Conium, 
Pulsat. 

Those of unknown causes, Apis, Aurum, Calc. carb., Digit., Graphit., 
Iodium, Kali hydr., Mercur., Psorin., Pulsat., Rhodod'., Rhus tox., Silic, 
Sulphur. 

Orchitis, Inflammation of the Testicles. 

Pathologically speaking, the inflammation may attack the testicle itself, 
or the epididymis, or their lining, the tunica vaginalis. 

It may be caused either by external violence or by an extension of in- 
flammatory processes of related organs, such as the prostata, the neck of the 
bladder, the urethra, or, what is most frequently the case, by gonorrhoea or 
syphilis. There is also an orchitis caused by a metastasis in parotitis or 
mumps. 

The product of inflammation is either: 1, A serous exudation, especially 
in epididymitis and vaginalitis, and it is the, same thing with the above- 
described acute serous hydrocele; or, 2, A fibrous, plastic exudation, which 
causes infiltration, swelling and induration of the epididymis; or, 3, A serous 



716 TESTES. 

hemorrhagic exudation in acute specific inflammations; or, 4, A purulent 
exudation, which takes place in the parenchyma of the testicle itself. 

The plastic exudation generally gives rise to chronic enlargements of 
the epididymis, which may reach a considerable size and hardness. 

The puruleut exudation may be reabsorbed, or may form abscesses, 
which gradually break through the scrotum. Such abscesses heal only very 
slowly, usually forming fistulous openings. 

A genuine orchitis very much resembles an incarcerated scrotal hernia. 
The pain is very acute, running along the spermatic cord, causing colicky 
pains and vomiting. We have in such cases to ascertain where the swelling 
commenced. In orchitis it grows from below upwards; in heruia it comes 
from above down. 

Sarcocele, Hydrosarcocele is a chronic inflammation of the testicles, 
with infiltration of the parenchymal substance, in consequence of which the 
tubuli seminiferi become obliterated. It is slow in growing, usually without 
pain, and may involve the epididymis or start from it. In appearance it is 
an inelastic, smooth, oval tumor which, upon pressure, does not show any 
sensitiveness so natural to the healthy organ. In the later stages of its de- 
velopment it is sometimes accompanied with an effusion within the tunica 
vaginalis, constituting what is called hydrosarcocele. It may be the result of 
an incomplete resolution of an acute orchitis, or the consequence of gonor- 
rhoea. The syphilitic form often attacks both testicles, one after the other. 

THERAPEUTIC HINTS.— Inflammation in general: Aeon., Arnica, 
Aurum, Bellad., Qhina, Clemat., Euphras., Mercur., Nux vom., Pulsat., 
Rhodod., Rhus tox., Staphis., Spongia, Zincum ; from bruises: Arnica, Baryta, 
Pulsat., Zincum; from taking cold: Clemat., Pulsat., Rhus tox.; from gonor- 
rhea: Cannab., Clemat., Gelsem., Mercur., Pulsat. ; looking bright red: Bel- 
lad.; dark red: Euphorb., Rhus tox.; chronic hardening and swelling: 
Arsen., Aurum, Baryta, Bellad., Calc. carb., Carb. an., Clemat., Conium, 
Graphit., Iodium, Kali carb., Kali hydr., Lycop., Nitr. ac, Plumbum, 
Spongia, Thuja. 

Carcinoma Testis. 

The most frequent form is the medullary cancer, which generally attacks 
young persons, even children. The fibrous cancer, or scirrhus testis, is found 
more in old age. 

Cancer usually attacks but one testicle. Its causes are not known. 
Bellad.? Carb. an.? Conium? Phosphor? Phytol? Thuja? 



VARICOCELE — SPERMATOCELE — PROSTATITIS. 71 7 

Varicocele. 

This consists of a varicose enlargement of the veins of the spermatic 
cord, epididymis and testicle, and gives rise to a knotty swelling, which feels 
between the fingers like a convolution of earth-worms. It gets smaller under 
compression or in a horizontal position, and enlarges again on standing up- 
right. It is almost always found on the left side, because the spermatic vein 
of that side has a longer and more tortuous course than that of the right 
side, and is also more liable to compression by accumulation of feces in the 
sigmoid flexure. The affection is therefore similar to the varicose state of 
the hemorrhoidal veins, and may have similar causes. In some cases it pro- 
duces no inconvenience; in others it is very troublesome, producing a draw- 
ing, dragging sensation, extending from the loins into the limb, especially 
when walking or standing, and in hot weather; also weakness, prostration, 
paleness and great dejection of spirits. 

Arnica, Bellad., Calc. carb., Collins., Fluor ac, Hamam., Laches., 
Lycop., Xux vom., Pulsat., Sepia, Sulphur. 

Spermatocele 

Is a swelling of the spermatic cord and especially of the epididymis in con- 
sequence of a retention and collection of semen in persons who have been 
addicted to excesses in venere or masturbation, and suddenly stop this bad 
habit without being able to stop also their lascivious thoughts. The testicle 
is drawn up towards the abdominal ring, the epididymis and spermatic cord 
is swollen, and painful to touch, also on standing and walking. The penis 
is usually in a state of semi-erection. All may pass off in the course of sev- 
eral hours, when the mind is differently employed, but the swelling may 
become stationary by frequent repetitions, and then it is often accompanied 
with varicocele. 

Pulsat. is often of use, also cool sitz-baths. 



DISEASES OF THE PROSTATA. 

Prostatitis, Inflammation of the Prostate Gland. 

Primarily it is of rare occurrence, but it is occasionally brought on by 
traumatic causes, as a blow, riding on horseback upon a hard saddle, or by 
sudden suppression of perspiration, excesses in venere, masturbation. 

Secondary forms are much more frequent, and are then an extension of 
inflammatory processes from neighboring organs; for example urethritis, 
stone in the bladder, gout, rheumatism. Its most frequent cause, however, 



718 PROSTATA. 

is gonorrhea, and the abuse of irritating medicines, like cubebs, balsam co- 
paiva, turpentine, etc. 

Symptoms. — Pain in the region of the neck of the bladder ; heat, press- 
ure, throbbing in the perineum and rectum ; frequent stitches from the peri- 
neum into the pubic and lumbar regions and down into the limbs. Constant 
desire to urinate, with annoying, sharp pains around the corona glandis; the 
urine, after long straining, flows slowly, drop after drop, a quantity remaining 
still in the bladder, and, therefore, micturition is never attended with a feeling 
of entire relief. Severe cases cause perfect retention of urine. The dis- 
charges from the bowels are likewise painful and difficult, especially hard 
stools, on account of the swollen and inflamed gland pressing upon the 
rectum, where it may easily be detected by the introduction of a finger per 
anum. 

In favorable cases prostatitis ends in resolution. Badly-managed cases 
suppurate and form abscesses, which perforate, either into the rectum, bladder, 
or urethra, and discharge accordingly. 

THERAPEUTIC HINTS.— Arnica, after injuries. 

Arg. nitr. 

Bellad., with severe pain, or 
Atrop. sulph., if Bellad. does not relieve. 
Mercur., for promoting resolution. 
Thuja. 

Bellad., Canthar., Hyosc, Stramon., in case of retention of urine. 
(Kafka.) 

Enlargement and Tumors of the Prostata. 

The gland may, in consequence of infiltration or deposition of tubercles, 
or calcareous substances, become in whole or in part enlarged. A total 
hypertrophy may reach the size of a fist or more, whilst the normal gland is 
not larger than a Spanish chestnut ; it may be so uniform that the normal 
shape of the gland remains unaltered, or it may become quite considerably 
deformed. Partial hypertrophy alters in size and shape only single lobes of 
the gland. 

As the prostate gland surrounds the urethra, reaching, with its base, 
over the neck of the bladder, and with its anterior extremity to the pars 
membranacea of the urethra, it is obvious that an increase of its size or an 
alteration of its form must likewise modify the mechanical proportions and 
relations of the prostatic portion of the urethra, of the neck of the bladder 
and the ejaculatory ducts. For example, an uniform enlargement of the 
gland necessarily pushes the bladder further back and upwards, elongating, 



ENLARGEMENT AND TUMORS OF PROSTATA. 719 

in this way, the involved part of the urethra quite considerably, which ex- 
plains the fact, that in old people sometimes the neck of the bladder is only 
with difficulty reached by the catheter. 

The enlargement of the lateral lobe, or an irregular enlargement of both 
lateral lobes, causes irregularities in the direction of the enclosed part of the 
urethra, compressing it more or less here and there, thus forming a kind of 
zig-zag passage. Or the posterior part of the enlarged lobe presses into the 
bladder, and thus shuts the neck of the bladder inside, or gives it an oblique 
turn. 

The enlargement of the middle lobe or isthmus, which is the deformity 
most frequently found in old age, is capable of closing the neck of the 
bladder partially or entirely, and preventing the passage of urine in part or 
entirely. 

Symptoms. — An examination per anuin reveals the swollen gland, and 
on introducing a catheter into the urethra, we find more or less obstruction 
in its prostatic portion. There is difficulty in urinating, which is sometimes 
possible only in a stooping posture with legs spread asunder; dribbling of 
urine, and frequent discharge of prostatic fluid during stool. The form of 
alvine discharges is often flat or irregular, instead of being cylindrical. Old 
age is particularly subject to chronic enlargement of this gland. 

THERAPEUTIC HIXTS according to Lippe: 

Pulsat., inflammatory origin, painfulness in the region of the bladder; 
frequent desire to urinate; dull stitch in the region of the neck of the bladder; 
after micturition spasmodic pains in the bladder, extending to the pelvis and 
thighs ; feces flat, of small size. 

Thuja, syphilitic origin, especially suppressed, or badly treated gonor- 
rhoea ; stitches in the urethra from behind ; also from the rectum into the 
bladder. 

Digit., fruitless effort to urinate, or discharge of only a few drops of 
urine, and continued fulness after micturition ; throbbing pain in the region 
of the neck of the bladder during the straining efforts to pass the water; in- 
creased desire to urinate after a few drops have passed, causing the patient to 
walk about in great distress, although motion increases the desire to urinate. 
Frequent desire to evacuate the bowels at the same time ; very small, soft 
stools are passed without relief. 

Cyclam., in and near the anus and in the perineum, drawing, pressing 
pain, as from subcutaneous ulceration of a small spot, while walking or 
sitting. 

Selen., while sitting, and also while walking, a drop of viscid, trans- 
parent fluid presses out of the urethra, occasioning a peculiarly disagreeable 
sensation ; the same sensation is experienced shortly before and after stool. 



720 VESICUL.E SEMINALES. 

Caustic, pulsations in the perineum; after a few drops have passed, 
pain in the urethra, bladder, and spasms in the rectum and renewed desire. 

Lycop., pressing in the perineum, near the anus, during and after mic- 
turition ; stitches in the neck of the bladder and anus at the same time. 

Iodium, hardness of the gland. (Kafka.) 

Copaiva bals., urine is emitted by drops. 

Apis, frequent desire and pressing down in the region of the sphincter. 

Discharge of prostatic fluid during a stool: Agnus cast., Alum., Anac, 
Calc. carb., Carb. veg., Conium, Corall., Hepar, Ignat., Natr. carb., Sepia, 
Silic, Staphis., Sulphur, Zincum. 

Fulness in the perineum: Alum., Berber., Bryon., Cyclam., Nux vom. 

Sensation of heaviness in the perineum : Copaiva, Graphit. 

Pulsation in the perineum: Caustic. 

Continual desire to urinate: Amm. carb. and mur., Anac, Apis, Asar., 
Aurum, Bellad., Canthar., Colchic, Copaiva, Digit., Guaiac, Ignat., Iodium, 
Mercur., Millef., Mur. ac, Phosphor., Pulsat., Scilla, Sepia, Sulphur, Sulph. 
ac, Thuja. 

Impossibility to urinate: Digit.,, Sepia. 

The desire to urinate continues after micturition: Bar. carb., Bovista, 
Bryon., Calc. carb., Carb. an., Caustic, Crot. tigl., Digit., Guaiac, Laches., 
Mercur., JSTatr. carb., Ruta, Sabina, Staphis., Thuja, Viol, trie, Zincum. 

While urinating, burning in the region of the neck of the bladder: Cha- 
mom., Nux vom., Petrol., Sulphur. 

The stream of urine is small: Graphit., Oleand., Nitr. ac, Sarsap., 
Spongia, Staphis., Sulphur, Tax. bacc, Zincum. 

Difficulty in voiding the urine — must press a long time before the urine 
flows: Alum., Apis, Hepar, Naphthal., Secale, Tax. bacc. 

Escape of urine involuntarily, drop by drop: Arnica, Bellad., Digit., 
Mur. ac, Petrol., Pulsat., Sepia. 

DISEASES OF THE VESICULJE SEMINALES. 

The vesiculse are two little, oblong bladders, sometimes divided into two 
or three branches, which lie on the posterior and inferior surface of the blad- 
der, and consist of an external contractile and an internal or mucous mem- 
brane. They are receptacles of semen, whence the latter is ejaculated during 
sexual excitement. In consequence of their location near the bladder and 
their functional relation to the sexual organs, it frequently happens, that 
affections of the bladder, urethra, prostata and testes are communicated to 
these vesicles. They are, like all mucous membranes, prone to inflammation 
and consequent derangements. Their morbid secretions mix with the semen, 
which loses its healthy appearance and nature. A clear diagnosis of such 



SPERMATORRHEA. 721 

affections is seldom possible during life; although bloody, yellow, involuntary 
emissions, attended with acute, cutting and burning pains, may lead us to 
suspect the existence of inflammation in these vesicles. 

Pollutiones Nocturnae et Diurnae; Spermatorrhoea. 

Inasmuch as the seminal secretion of a healthy man may naturally be 
supposed to be a continuous one, it appears as a physiological necessity, that 
there should occur from time to time an overflow of semen involuntarily, 
when not irritated voluntarily by coition or masturbation. As long as such 
discharges happen at night during sleep, with erotic dreams, accompanied 
by erections and voluptuous sensations, and followed by a sense of relief and 
buoyancy, these nocturnal pollutions are certainly within the boundaries of 
health. They do not occur regularly even in the same individual, but vary 
greatly in frequency from temporary causes, or certain constitutional pecu- 
liarities. However, if they occur too often, say several' times a week or 
oftener, and are followed next day by a general dulness and weakness, 
diminution of mental activity, etc., instead of buoyancy, they can scarcely 
be looked upon as healthy occurrences. This is still more so if they occur 
without erection and sensation in the night during sleep. But if they occur 
even in the daytime — "diurnal pollutions" — while the individual is awake, 
without the usual mechanical causes (coition or masturbation), from any 
trifling external cause ; for instance, from dallying with a female, riding on 
horseback, during evacuation of the bowels or bladder, or from lascivious 
imaginations, then there surely exists an irritation and weakness in the sex- 
ual organs which is pathological ; for a healthy man never loses semen in- 
voluntarily when awake. Such diurnal seminal losses have also been termed 
Spermatorrhoea, a rather hyperbolic expression, as a continuous flow of 
semen scarcely ever exists. And it should further be stated, that very often 
inexperienced young men, frightened by reading miserable and designing- 
trash upon this subject, take for spermatorrhoea what is no flow of semen at 
all, but a secretion from the mucous membrane of the urethra, and perhaps 
also from Cowper's glands, or a prostatic secretion; neither of which contains 
any trace of spermatozoa, the only sign of true semen. 

The principal Causes of abnormal seminal losses are masturbation and 
excessive indulgence in venere. In both ways the frequent irritation not only 
produces an excessive irritability of the sexual organs and an undue stimula- 
tion for the secretion of semen, but also an intensive excitement of the nerv- 
ous system, which by degrees grows into permanent overexcitability, so that 
ejaculations at last are not only provoked by peripheral, but also by central 
stimuli, such as lascivious thoughts, etc. That actual degeneration of the 
spinal cord can be produced by sexual excess alone, is still to be proven. 
46 



722 vesicul^e seminales. 

Further causes of abnormal seminal lpsses are: chronic inflammation of 
the neck of the bladder and the prostatic portion of the urethra, often produced 
by suppressed gonorrhoea, in consequence of which a higher degree of irrita- 
bility of the parts ensues ; inflammatory affections of the bladder, but especially 
lithiasis; chronic inflammation of the seminal vesicles, especially when con- 
nected with gleet; great length and narrowness of the prepuce, which prevent 
thorough cleansing of the parts from smegma and promote undue irritation ; 
itching eczema on the scrotum or about the anus; habitual constipation and 
hcemorrhoidal tumors. 

The Symptoms which accompany abnormal losses of semen are not 
caused by them, but owe their origin to the same causes which produce 
them. Of these may be mentioned: a hypochondriacal mood, with despair 
of recovery, a dislike for society, and even suicidal thoughts, which are sel- 
dom executed for want of courage; or quarrelsomeness and irritableness ; 
loss of energy and courage, depressed state of mind, impairment of memory; 
vertigo, headache ; deafness and noises in the ears; indistinct vision; fatigue; 
stiffness in limbs and back; trembling in limbs; numbness along the spinal 
cord, in the lower extremities, or in the fingers; or hyperesthesia ; coldness 
in the back or some other part ; sometimes alternating with flushes of heat ; 
palpitation, and shortness of breath; indigestion, with consequent disturb- 
ances of nutrition, such as paleness, emaciation, sallowness and dryness of 
skin ; or pasty and bloated appearance ; impotence. 

Now, this gloomy picture should not be taken as applying to all or even 
to single cases precisely ; for happily these symptoms are only partially con- 
stant and severe in cases of abnormal pollutions. A hypochondriacal mood 
is perhaps the most common to all of them. 

The termination of spermatorrhoea iuto insanity or epilepsy is quite 
unproved. On the contrary, a hereditary disposition to insanity or epilepsy 
may be in many cases the cause of masturbation and the consequent sperma- 
torrhoea. 

The Prognosis depends upon its causes. Of these the local irritations 
are relatively the most favorable, while the psychical causes are deeper and 
more difficult to eradicate. 

THERAPEUTIC HINTS.— First rule, stop the cause. This applies 
not only to sexual abuse, but also to those exciting causes above mentioned, 
which ought to be found out by the physician and serve as leading symptoms 
for the selection of the remedy. 

Aur. met. or mur., settled melancholy with suicidal mania; discharge 
of prostatic fluid from a relaxed penis, during stool or micturition ; great 
sexual weakness with great lasciviousness ; or strong erections which cease 
on the attempt to copulate ; affections of the testicles and spermatic cords. 



SPERMATORRHOEA. 723 

Calc. carb., after pollution, headache and backache; cold, clammy 
hands and feet; scrofulous subjects; shattered constitutions; sweating from 
any little exertion, especially on head. 

Cinchona, nocturnal emissions, frequent and debilitating; lascivious 
fancies; after masturbation. 

Digitalis or Digitalin, great irritability and weakness of the genitals; 
after an emission a sensation in the urethra as if something were running out 
of it; frequent palpitation and trembling of the limbs; in conversation with 
strangers he commences to stammer and becomes embarrassed. Prostatic 
troubles. 

Gelsem,, weak, irritable sexual organs; emissions without erections, 
also during stool ; genitals cold and relaxed ; or profuse warm sweat on scro- 
tum ; after suppressed gonorrhoea, orchitis, with dragging pains in the 
testicles. 

Graphit., nocturnal emissions, with flaccid penis and without voluptuous 
sensation ; sense of weakness in the genital organs ; herpetic eruption on 
scrotum ; after sexual abuse. 

Lycop., excessive and exhausting pollutions, also without erection; 
afterwards burning in urethra; itching of inner surface of foreskin; soreness 
between the scrotum and thigh; constipation; haemorrhoids. Inrpotence, 
with cold and shriveled penis ; after masturbation. 

Nux vom., after quack-medicine, wine or coffee; sluggish action of 
abdominal organs ; constipation ; haemorrhoids ; suppressed gonorrhoea ; mas- 
turbation. 

Phosph. ac, debilitating emissions from weakness of the parts, with 
onanism ; during stool ; hypochondriacal ; distressed on account of the culpa- 
bility of his indulgence. Youths who grow fast and tall; herpes preputialis, 
with tingling; urine turbid, with heavy sediment. 

Sarsap., nocturnal emissions, with lascivious dreams, followed by pain 
from the small of the back down along the spermatic cords, in the morning, 
with general prostration; or, great anguish of mind; inability to apjfly him- 
self to mental work ; smoky mist before the eyes, when reading in the evening ; 
prostration; soft, flabby muscles. The least excitement causes ejaculation of 
the fluid without sexual feeling. (J. B. Hunt.) Offensive odor about the 
genitals; herpes on the prepuce; gonorrhoea checked by cold, wet weather, 
or by mercury, followed by rheumatism. 

Selen., nocturnal emissions with lascivious dreams, followed by weak- 
ness and lameness in the loins. (J. F. Greenleaf.) Semen thin without 
normal odor ; prostatic fluid oozes while sitting, during sleep, when walking 
and during stool; itching of the scrotum. 

Silic, aching in sacrum; sweat of scrotum; heat in head; burning of 
feet with sweat; weakness and heaviness of arms; melancholy; all worse in 



724 VESICUL.E SEMINALES. 

forenoon and before an emission, and relieved after an emission. (W. P. 
Wesselhoeft.) 

Thuja, painful spermatic cord ; suppressed gonorrhoea ; renewed gonor- 
rhoea after coition ; prostatic affections ; impotence; heaviness and ill-humor 
after emissions. 

Zinc, ox., with hypochondriasis, full of fears of the consequences; 
nervous system shaken ; restless, sleepless and generally miserable. 

Besides compare: 

Arnica, when coition has been practiced in a standing position, lame 
weakness in lower extremities. 

Bellad., with gleet. 

Capsic, impotence, atrophy and coldness of the genitals. 

Carb. veg., heartburn, acidity and flatulence. 

Caustic, memory deficient; continual loss of prostatic fluid. 

Cuprum, great nervousness of young men, prematurely old ; cramps 
in the calves of the legs and feet on trying to have a connection with a 
woman. 

Dioscorea. 

Kali brom., want of sexual instinct. 

Kobalt., lewd dreams; only partial or no erections. 

Mercur., after emission burning pain in the back and icy-cold hands. 

Natr. mur., poor digestion and spinal irritation, 

Nuphar., lascivious thoughts without sexual capacity. 

Phosphor., nervous prostration; oppression and pain in chest; para- 
lytic or spasmodic symptoms in extremities. 

Picric acid. 

Sepia, ejaculation too soon ; semen watery; catarrhal affections; bloated 
and earthy-colored face. 

Sulphur, erection complete, but discharge of semen before he succeeeds 
in inserting the penis. 

Bloody emissions: Mercur., Cannab., Ledum., Sarsap. 

Impotence; Sterility in the Male. 

Impotence, a diminution or complete loss of the power of sexual inter- 
course, is always associated with either incomplete, or too short, or entirely 
absent erections. It may be Caused by : certain congenital or acquired mat- 
formations and defects of the genital organs, such as: absence of the penis, or 
considerable diminution in its length, tumors of the penis, indurations and 
knots in the corpora cavernosa, loss of the testicles either by castration . al- 
though cases are on record which show that the sexual act could be accom- 
plished after castration, this quasi-virile power, however, diminished more 



IMPOTENCE. 725 

or less speedily and finally disappeared entirely), or such disease as is equiva- 
lent to their loss. It may be a symptom of certain acute or chronic diseases, 
such as: tabes dorsales, spinal meningitis, diabetes; or the consequence of 
certain medicines, if takpn in too large doses and indiscriminately, among 
which are best known; Camphor, bromide of potassium, lupuline and ar- 
senicum. It may be produced by certain mental conditions, such as: bash- 
fulness, fear of failure, nervousness, or the absence of certain modes and 
ways to which they have become habituated with prostitutes and which they 
cannot indulge in with their wives. 

A very prominent cause is sexual excess and masturbation, by which a 
functional weakness of the genital organs and of the nervous apparatus con- 
nected with them is brought about, in consequence of which only short erec- 
tions, too short even for the introduction of the penis, so-called irritable weak- 
ness, or no erections at all, are possible under any circumstance, the so-called 
paralytic form of impotence. 

A man impotent is also sterile, that is unable to procreate, even if his 
semen should be of a natural quality, because he cannot locate it where alone 
it could fructify. But sterility has other causes, which are: 

1. Asperniatisill, which means not only a variety of conditions in 
which no semen is formed (as certain malformation or injuries of the genital 
organs, absence or malposition of the testes), but also those conditions in 
which the formed semen is not ejaculated, because its passage is barred by 
changes in the substance of the prostate, or in the ejaculatory ducts embed- 
ded in it, or in the urethra, from whence it is diverted into the bladder. The 
causes of this retention of semen are strictures of different places in the 
seminal passages produced by inflammatory processes mostly in consequence 
of gonorrhoea, or wounds, or they are congenital. 

'2. Azoosperillisill, in which copulation with ejaculation may be possi- 
ble, but in which either no seminal bodies are produced, on account of an ab- 
normal state of the testicles, or in which they are retained on account of 
strictures in the passages which conduct the semen, in consequence of bilat- 
eral inflammatory 'processes of the epididymis and vasa deferentia, sl condition 
similar to aspermatism, only that in the latter the stricture is lower down in 
the genital passages. 

THERAPEUTIC HINTS.— Compare the preceding chapter, espe- 
cially in regard to those transient forms: Agar., Agn. cast., Baryta, Calad., 
Lyeop., Xatr. mar., Xitr. ac, Phosphor., Selen. 

Among the new remedies: Eupat. pur., Gelsem., Hamam., Helon., Phy- 
toL, Stilling. 



726 FEMALE GENITALS. 



FEMALE GENITAL ORGANS. 



Examination of the Parts. 

By means of palpation and percussion of the abdomen we may be able 
to detect the presence, shape and consistence of abdominal tumors, and aus- 
cultation will serve to distinguish between pregnancy and other large tu- 
mors; the so-called uterine scuffle, which originates in the large arteries, is 
heard, not very seldom, in large fibroids, and also, but rarely, in ovarian 
tumors. 

The' digital examination per vaginam consists of the introduction of the 
well-oiled forefinger through the ostium into the vagina, by which we ascer- 
tain the condition of the walls of the vagina, whether they are dry, moist, 
sensitive, encumbered by protrusions of the rectum or bladder, or by mor- 
bid growths, etc. ; the state of the anterior and posterior cul-de-sac ; the po- 
sition and condition of the cervix and os uteri and of the lower part of the 
womb. In cases of vaginal occlusion or hyperesthesia, but especially in 
all kinds of retro-uterine tumors, a digital exploration per rectum is the most 
valuable aid for diagnosis. 

The bimanual examination consists in an exploration by means of the 
one hand through the abdominal walls, while the forefinger of the other 
hand within the vagina rests on the neck of the womb. In this, way the en- 
tire organ may be brought between the exploring fingers of both hands, so 
that its shape, consistence and mobility, etc., or the existence of any tumor 
within the true pelvis can easily be ascertained. This conjoined method of 
examination, as it is likewise termed, is best performed in the dorsal position 
on an unyielding couch. Care should be taken that the outside hand is only 
slowly pressed into the abdominal wall above the symphysis pubis, which is 
best done by taking advantage of each expiration; and by inserting the 
hand not too close to the symphysis, in order to avoid the pushing back- 
ward of the uterus. 

Examination by means of the uterine sound (of which those most in use 
are the steel, Simpson's and Skene's sounds) consists in the introduction of a 
curved metallic instrument into the cavity of the womb, guided by the fore- 
finger which has been inserted into the vagina. This exploration gives a 
measurement of the length of the uterine cavity, discloses the course taken 
by it and the sensitiveness of its walls, and tells whether the uterus is empty 
or not. This sort of examination should never be resorted to so long as 
there exists the slightest doubt as to the possibility of pregnancy. 



OOPHORITIS, OVARITIS. 727 

Ocular examination is assisted by vaginal specula in order to bring the 
os and cervix uteri into view. There are bivalvular, tri valvular and tubular 
specula, of which those most in use are Cosco's or Wocher's bivalve, Nel- 
son's tri valve and Furguson's or Mayer's tubular speculum, all of course of 
different sizes. For the better viewing of the posterior wall of the vagina 
we have Sim's duckbill, also his folding speculum and Dowson-Sim's im- 
proved speculum, instruments which the specialist may need for certain 
operations. 

There are undoubtedly cases where an examination by either of these 
means may be absolutely necessary. But it is certainly beyond the lines of 
even medical decency to subject every woman who shows any signs of uterine 
disturbances at once to digital or ocular examination, especially if that 
woman be a virgin. It is a curse of vanity to show one's ability to handle 
or mishandle an instrument at the expense of an innocent or inexperienced 
person, and it is the highest degree of ignorance to look or feel for something 
what by better information we would uot expect to find there, or what we 
should know to find without fingering. It is therefore not to be wondered 
at that thoughtful medical gentlemen have condemned the use of these 
physical examinations almost in toto. Almost — for the helping hand 
and the seeing eye will even here be needed in certain cases as anywhere 
else. 



OVARIES. 

Oophoritis, Ovaritis. 

This affection has its seat either in the parenchyma (the Graafian fol- 
licles), or in the connective tissue, or in the peritoneal covering, of the ovary. 

If in the glandular part (parenchyma) the mature Graafian follicles 
have a milky turbidity, and the cells of the membrana granulosa are in a 
state of cloudy swelling and subsequently break down into fine granules, the 
layer of the stroma surrounding the follicle is likewise inflamed. This form 
of inflammation occurs frequently in acute febrile diseases in which we also 
meet with parenchymatous inflammations of other abdominal glands; it may 
cause destruction of all the follicles and so result in sterility. 

If in the connective tissue there is hyperemia, swelling and infiltration 
of this tissue which may terminate in the formation of abscesses, generally, 
however, results in cicatricial shrinking with consequent sterility. It is most 
frequently found in the puerperal period, or as an extension of a peritonitis, 
and in consequence of suppression of the menses. 

If in the peritoneal covering (Perioophoritis), it leads to pseudo- 
membranous deposits upon the ovary and to adhesions with neighboring or- 



728 OVARIES. 

gans. Its Causes are: taking cold; getting wet during menstruation; sex- 
ual intercourse during the menstrual period; onanism; or, second arily, in- 
flammatory j)rocesses of neighboring organs — the peritoneum, or the uterus ; 
gonorrhoea. It is therefore most frequently found in serving girls, who are 
exposed to all kinds of rough influences (scrubbing of pavements, washing, 
etc.), in prostitutes and other lewd women. Girls who have once had an at- 
tack are liable to a repetition during their menstrual periods. After the 
cessation of menstruation, the disposition to it ceases likewise. 

Its Symptoms are not at all well marked, when the connective tissue 
alone is the seat of the disease. We meet with symptoms of partial peritoni- 
tis, however, if the serous covering becomes inflamed ; violent, sharp, colicky 
pains, vomiting, fever, etc. ; and so also may the bursting of a Graafian fol- 
licle be attended with inflammatory symptoms. As the ovaries lie deep in 
the lesser pelvis, covered completely by the small intestines, pressure down- 
wards, from above the symphysis pubis, will reach the sore spot only when 
the abdominal walls are greatly relaxed. Bimanual examination or an ^ex- 
ploration per anum may* become necessary in chronic cases. We may, how- 
ever, diagnosticate an acute attack pretty safely when the above-mentioned 
symptoms have set in during menstruation, after an exposure to cold or wet, 
followed by a sudden cessation of the menstrual flow. Where the inflamma- 
tion spreads over adjoining organs, we find it accompanied by painful urging 
to urinate and to evacuate the bowels; by utero-vaginal blennorrhceas, or a 
numbness in the lower extremity of the affected side. 

An acute attack rarely lasts longer than eight days, generally subsiding 
within twelve to twenty-four hours. In unfavorable cases it becomes chronic, 
and may terminate in the formation of serous cysts, induration of the ovary, 
or in suppuration. 

THERAPEUTIC HINTS.— Aeon., headache, backache, colic, fever, 
great restlessness and tossing about ; after exposure to cold winds or a sud- 
den fright during the monthly period, by which the flow ceases; painful 
urging to urinate and to evacuate the bowels. 

Ant. crud., when menstruation has been checked by taking a bath; 
nausea and vomiting, white tongue; great thirst at night; alternate costive- 
ness and diarrhoea. 

Apis, right side; swelling, with stinging pains from sexual intercourse 
during the monthly period; numbness in the right side of the abdomen, 
extending into the thigh, or upwards to the ribs; scanty urine, retarded 
stool ; cough, with soreness in the upper portion of the left chest. 

Arsen., drawing, stitching pain from the region of the ovary into the 
thigh, which feels numb and lame, worse from motion, bending or sitting 
bent; burning pain in the back while lying quietly upon it; the menses con- 



OOPHORITIS, OVARITIS. 729 

sist of a thin, whitish, badly-smelling discharge; pale, yellowish face; ema- 
ciation ; febrile action ; thirst, with drinking little at a time ; restlessness. 

Bellad., hard swelling of the ovary, with stitching, throbbing pains; 
constant bearing down, as if everything would issue out ; fever, with perspira- 
tion; glistening eyes; red face and delirium ; after child-birth. 

Bryon., stitching pain, worse from the slightest motion and contact; 
suppression of the menses, with bleeding of the nose ; inclined to constipation. 

Canthar., stitches, arresting the breathing; or violent pinching pains, 
with bearing down towards the genitals ; or great burning pain in the ovarian 
region ; constant urging and straining to urinate, with painful discharge of 
but a few drops of urine, which sometimes is bloody ; after suppressed gonor- 
rhoea. 

Coloc, cramp-like pain in the left ovarian region, as though the part 
were squeezed in a vise ; colicky pain all over the abdomen, which causes the 
patient to bend double; pain in the left foot; worse before menstruation, 
which is more profuse. 

Conium, chronic cases; induration; lancinating pains; pain in the 
mammae before the menses, which are feeble; smarting, excoriating leucor- 
rhoea ; giddiness when turning in bed ; intermitting flow of urine. 

Ham am., after a blow, the ovary swollen, with a diffuse agonizing 
soreness over the whole abdomen ; menses irregular, very painful, with ex- 
acerbation of all the sufferings at the catamenial epoch ; retention of urine. 

Hepar, when suppuration takes place, indicated by frequent crawls. 

Ignat., disappointed love; constant running of thoughts in that direc- 
tion; sighing, despondency; leucorrhoea, which passes off with labor-like 
pains. 

Iodium, when indurated. 

Laches., left ovary; tensive, pressing pains and stitches; inability to 
lie on the right side, on account of a sensation as if something were rolling 
over to that side; menses scanty, with labor-like pressure from the loins 
downward; swelling of the ovary; suppuration. 

Mercur., stitching, pressing pains in the lower region of the abdomen, 
left side ; upper portion of the abdomen distended ; stool with great tenes- 
mus ; constant urging to urinate, with scanty emission of a thick, brown-red 
urine, causing burning in the urethra; perspiration without relief; great 
weakness and emaciation; nightly aggravation and restlessness; menses 
suppressed. 

Nux vom., after previous use of different allopathic drugs. 

Platina, excessive sexual desire, from an incessant tickling within the 
genitals; painful pressing toward the genital organs, as if the menses would 
make their appearance; profuse or suppressed menses, with palpitation of 
the heart, headache, restlessness and weeping; haughtiness. 



730 OVARIES. 

Pulsat., after getting the feet wet; suppression of the menses, with 
nausea, coldness of the body, chilliness and trembling of the feet ; pressure 
on bladder and rectum ; thirstlessness, weeping, meek disposition. 

Rhus tox., after getting wet, straining or lifting. 

Zincum, boring pain, relieved by pressure and during the menstrual 
flow. 

Compare Aurum, China, Clemat., Hedeoma, Iodium, Phosph. ac, Phy- 
tol., Podoph., Sabina, Sepia, Staphis., Thuja. 

Hydrops Ovarii, Ovarian Dropsy; Formation of Cysts in 

the Ovaries. 

Most of these cysts originate, according to some authors, out of a de- 
generation of the Graafian follicles, which become distended, in rare cases, 
even to the size of a child's head ; containing a clear, yellowish, serous, or 
thick, limpid fluid. There may be one or several of such cysts. 

The multiloeular tumors consist of a formation of multiple-cysts, growing 
out of the parenchyma of the ovaries. They sometimes attain an enormous 
size, and contain either a serous or jelly-like fluid, which is dark if mixed 
with blood. 

The alveolar degeneration of the ovary destroys all the original structure 
of that organ; its whole substance becomes transformed into larger and 
smaller cavities, which are separated by a fine tissue. Some of these cavities 
attain the size of a fist, while others remain quite small. At first the organ 
retains its roundish shape; later, by the extension of some of these cavities, 
it becomes uneven. The contents of these cavities is mostly a yellowish, 
tough, honey-like substance, though the larger ones sometimes contain a 
thinner fluid. This degeneration is often complicated with cancer of the 
ovaries. 

There are yet cysts to be mentioned, which, instead of a fluid, contain 
hair, teeth and bones; their interior walls present a structure which is quite 
similar to that of the cutis, having an epidermis with sudorific and sebaceous 
glands, and sometimes a hairy growth. Such cysts are called dermoid cysts; 
they sometimes attain the size of a walnut, or even a fist. They are, per- 
haps, products of ovarian conception. 

There are also fibrous, cartilaginous and osseous tumors of the ovary which, 
like the purely cystic, may be the consequence of subacute inflammatory 
action in these organs. 

The Symptoms of ovarian cysts, in the first stage, may be identical with 
those of an oophoritis; but usually all such signs are wanting, and the cysts, 
as long as they remain small, give no inconvenience whatever. When at- 
taining a certain size, however, they exercise a pressure upon the bladder and 



OVARIAN DROPSY. 731 

the rectum, causing difficulties in micturition and defecation. When pressing 
upon the nerves, which run down on the posterior wall of the lesser pelvis, 
they cause pain in the small of the back, or pain and numbness in the lower 
extremities ; and when pressing upon the veins in the pelvis, they cause cede- 
matous or varicose swellings on the lower extremities. At the same time 
we observe, in some cases, a swelling of the mammae and a darkening of the 
rings around the nipples, with sympathetic vomiting and general malaise, thus 
simulating very closely the commencement of pregnancy. When the cysts 
grow further, they rise out of the pelvic cavity, and most generally the patient 
feels relieved of those symptoms which are caused by their pressure upon the 
pelvic organs ; in some cases, however, all these symptoms continue, as the 
cysts or portions of them within the pelvic cavity still continue to exercise 
the same compression upon the pelvic organs. 

Increasing still more, they gradually fill the abdominal cavity, press 
against the diaphragm and compress the abdominal organs; the natural con- 
sequences of which are: vomiting, shortness of breath, palpitation of the 
heart, bronchial catarrh, disturbed secretion of urine, deficient nutrition, 
and consequently anaemia and hydremia, which ends in general marasmus. 

Their growth is not a steady one ; they are frequently observed to increase 
and decrease in size periodically; the first taking place generally before and 
the latter after menstruation. As frequently intervening symptoms may be 
mentioned those of peritonitis, which are the more severe the more rapidly 
the cysts grow. If a cyst bursts, either by its own excessive distention or by 
external violence, its contents issue into the abdominal cavity and cause a 
general peritonitis; or it may, in consequence of previously formed adhesions 
and inflammatory processes, find its way into another of the abdominal or- 
gans, and be thence discharged. 

Physical Signs. — As long as the tumor remains in the true pelvis, it 
may be diagnosed by an examination per vaginam or rectum, where it is felt 
as a well-defined swelling, which dislocates the uterus in one or another di- 
rection, according to its position. The less the tumor takes part in the mo- 
tions of the uterus the more sure is its diagnosis. 

When the tumor rises out of the true pelvis there appears a painless, 
well-defined swelling over the horizontal ramus of the pelvic bones ; later it 
inclines more towards the" middle line of the abdomen, and yields, more or 
less, a sense of fluctuation; the distended abdomen appears arched and 
changes its form scarcely any during different positions of the body. 

Percussion gives a complete flat sound, where the tumor touches the 
parietal walls, being dullest where the swelling is most prominent; thus it 
differs from ascites, which gives a full sound, where the distended abdominal 
walls appear highest; for underneath that place lie, in ascites, inflated in- 
testines; and furthermore, the fluctuation of a cystic tumor never extends 



732 OVARIES. 

further than that portion of the abdomen which yields a flat percussion 
sound, because the fluid is confined in a sac, while in ascites the fluctuation 
is felt also where there is no flat percussion sound, because the fluid is driven 
further on within the peritoneal cavity by the concussion of the palpating 
hand. 

THERAPEUTIC HINTS.— Compare Oophoritis and Peritonitis. 

Apis, sudden stitches, like bee-stings, in the tumor, or sharp, cutting 
pains, with scanty urine and coustipation ; bearing down, and pain in the 
small of the back, as if the menses would come on ; numbness of the cor- 
responding lower extremity; thirstlessness ; pale skin; oedema; right side. 

Arsen., burning pain; restlessness; anxiety; oppression; sinking of 
strength ; great thirst, but little drinking at a time ; dropsical swelling all 
over; pain in the corresponding leg; cannot keep the foot still. 

Calc. carb., distention and hardness of the abdomen; pressure in the 
rectum, and bearing down in the womb; profuse and too early menses. 

Canthar., burning pain; great sensitiveness of the abdominal walls; 
constant, painful urging to urinate and defecate; tenesmus in the bladder 
and rectum; wretched, sickly appearance. 

China, after great loss of fluids; general anasarca; meteorism. 

Coloc, a firm, elastic tumor occupies the space between the uterus and 
the vagina anteriorly and the rectum posteriorly, completely occluding the 
vagina and rendering defecation very difficult. Paroxysms of acute pain 
across the hypogastrium, in the sacral region and around the hip-joint when 
attempting to walk ; the pain extends down the groin and along the femo- 
ral nerve ; it is relieved by flexing the thigh upon the pelvis, and always 
induced or aggravated by extending the thigh ; but there are frequent and 
severe paroxysms without any provocation. (C. Dunham.) 

Graphit. 

Iodium, pressing, bearing down towards the genitals; constipation; 
acrid leucorrhoea, corroding the linen ; dwindling and falling away of the 
mammae; strumous constitution. 

Lil. tigr., bearing down in the uterine region, worse walking, better 
holding up the abdomen with the hands ; tenderness of the swollen left ovary ; 
stinging, burning pains from ovary up into the abdomen and down the thigh ; 
shooting pains from left ovary across the pubes ; urine causes a smarting sen- 
sation ; prolapsed and sensitive uterus. (E. A. Farrington.) 

Lycop., painful boring stitches in the left ovarian region ; pressure on 
the rectum and bladder; pain in the sacral region, especially when rising 
from a seat; red, sandy sediment in the urine; ascites; varicose veins on 
the legs. 



CATARRH OF THE UTERUS, LEUCORRHCEA. 733 

Plumbum, the patient wants to stretch the upper and lower limbs 
during ovarian pains. (Dr. Young.) 

Podoph., tumor on right side; pain and numbness extending down the 
corresponding thigh. (Hawley.) Pains extend upward to the shoulder. 
(Seward.) 

Stramon., tumor attended with some lancinating pains and hysterical 
convulsions. During the convulsions the patient shrinks back with fear on 
seeing any one. (Miller.) 

In cases where proper homoeopathic treatment fails to show any influence 
in staying the growth of such tumors, or in improving the general health of 
the patient, operative surgery (tapping with subsequent iodine injections, 
electrolysis, ovariotomy) is indicated. 

UTERUS. 

Endometritis, Catarrh of the Uterus, Leucorrhcea. 

Always at the time of the catamenial period the mucous membrane of 
the uterus is found in a hypenemic state, its overfilled blood-vessels burst 
and occasion what is called the menstrual flow; this normal hyperemia 
might be called the physiological catarrh of the uterus. It becomes patho- 
logical when it occurs at a time when no ripe ovula are cast off. A predis- 
position to uterine catarrh lies, therefore, between the time when menstrua- 
tion begins until it ceases. 

Exciting Causes are, all such disorders as cause a stagnation in the 
proper circulation of the blood, as heart and lung diseases; chronic constipa- 
tion, etc. ; direct irritations, such as sexual excesses, masturbation, pessaries, 
etc.; or a general weakness of the system and general morbid conditions, such 
as typhus, cholera, small-pox and other infectious diseases; chlorosis; scrofu- 
losis ; tuberculosis, etc. 

Its Pathological features are like those of any other catarrh ; hyper- 
emia, swelling, dryness at first, and afterwards increased secretion of mucus. 
\Yhen becoming chronic, the mucous membrane thickens and hypertrophies, 
and is sometimes studded with polypous excrescences; its color turns brown- 
ish or slate-colored; the secretion attains a more or less purulent character; 
the follicles of the portio vaginalis swell on account of the closure of their 
excretory ducts, while their secretion inside is still going on; they form little 
round bodies of the size of a hemp-seed or larger, and are known under the 
name of ovula Nabothi. Furthermore, we find, if the process lasts long 
enough, diffuse catarrhal erosions, mostly on the posterior lip of the mouth of 
the womb; or follicular ulcers, which originate in the bursting and suppura- 



734 UTERUS. 

tion of the above-named ovula Nabothi ; and also granulating ulcers, which 
differ from the rest by their exuberant granulations, which bleed easily. 

Symptoms. — An acute attack is characterized by drawing pain in the 
small of the back and in the inguinal region, a feeling of fulness and heavi- 
ness in the pelvis, dysuria and tenesmus. External pressure upon the lower 
part of the abdomen is painful. There is more or less fever. After three or 
four days the patient observes a discharge from the genitals, which at first is 
transparent and sticky, staining the linen grayish ; by and by it becomes 
opaque and more or less purulent. In the further course of eight or ten 
days the fever gradually subsides, and after that the discharge diminishes 
until it finally ceases. 

In chronic cases, the commencement is not easily ascertained. The pa- 
tients have had, long before they attach much importance to it, a discharge 
from the womb, which varies considerably in different cases. Still it is of 
the same nature as that above-mentioned, staining the linen grayish, and 
making it stiff; sometimes, even, clots of a gelatinous mass issue forth. That 
is characteristic of a uterine catarrh. A purulent discharge is just as liable 
to have its source in the vagina; and if the discharge be corrosive, the pre- 
sumption is that it originates there. In some cases, the os uteri closes, owing 
to the sticky discharge and the swollen state of the neck of the uterus; and, 
in consequence, a collection of large masses of mucus within the uterus takes 
place, which are finally expelled by labor-like contractions of the uterus — 
uterine colic. The longer the catarrh exists, the more it changes the mucous 
lining of this organ, and the greater of course, must be its effect upon the 
monthly period. In some cases, the flow is very profuse, and in others, very 
scanty ; almost always it is attended with more or less pain. Conception is 
not necessarily prevented, if the catarrh does not extend to the tubes or 
causes them to be closed; but it has been observed that women suffering with 
chronic uterine catarrh are very prone to miscarry. A chronic uterine ca- 
tarrh may be endured for a long time ; but it finally betrays itself by pale- 
ness and an earthy color of the face, weakness and relaxation of the muscles, 
anaemia and hydremia. The most frequent expressions of chronic uterine 
catarrh are hyperesthesia, neuralgic and spasmodic complaints ; all of which 
we find united under the popular expression of hysteria. The progress of 
the disease is always slow; and among its complications we find a chronic 
parenchymatous metritis, inflections of the uterus, and closure of the cervical 
canal of this organ, which results in hydrometra. 

In regard to the diagnosis of the various leucorrhoeal discharges, the 
following may be said: 

Watery discharges appear during the greater part of pregnancy, without 
being injurious to the foetus ; also in connection with hydatid moles, where, 
after a certain time, moderate discharges repeat themselves off and on, ac- 



CATARRH OF THE UTERUS, LEUCORRHCEA. 735 

companied by bearing-down pains; in connection with cauliflower excrescences, 
where the serous discharges are often quite copious and of a brown color ; in 
connection with uterine polypi, where the watery discharges alternate with 
bloody ones, and profuse menstruation; in connection with adhesion of an 
ovarian cyst to the Fallopian tube, where the fluid of the cyst enters the tube 
and discharges slowly through the vagina. 

Mucous or purulent discharges are more or less opaque, gluey or gelati- 
nous, creamy or quite fluid. They all arise from the mucous membrane either 
of the neck of the womb, or of the uterine cavity, or of the vagina, or of the 
three combined. The discharge from the cervix is gluey, creamy and more 
profuse; from the womb it looks soapy or like glassy pieces of coagulated 
mucus ; from the vagina it is coagulated, has an acrid reaction and contains 
tesselated epithelium. 

Continuous purulent discharges originate in the vagiual mucous mem- 
brane, in the cervical glands of the uterus, on the surface of a cancerous or 
other ulcer, in suppurating membranes remaining after an abortion, in re- 
tained placenta or membranes. Gonorrhoeic discharges are also continuous 
and often difficult to diagnose from leucorrhcea, if the history is wanting. 

Interrupted purulent discharges take their origin in the uterine cavity, 
in suppurating polypi, in abscesses seated in the neighborhood of the vagina. 

Sanious discharges consist of a reddish, bloody fluid, arising from tumors 
inside of the uterine cavity, from organic diseases of the uterus, such as 
fungoid degeneration of the uterine mucous membrane, malignant ulceration 
of the os, from pelvic hematocele, when a communication exists between cyst 
and vagina. 

Foul-smelling discharges occur where the leucorrhcea is profuse and 
purulent, accompanied by hectic fever and general loss of strength, and 
where the secretion is retained for some time in the vagiua by a contraction 
of the ostium vaginae. In uterine cancer the discharge is always fetid. 

In giving THERAPEUTIC HINTS, I shall unite both uterine as well 
as vaginal catarrh. Both are known under the popular name, leucorrhcea or 
whites, as the most prominent and sometimes the only symptom of the two. 

^£sc. hipp., pain in the small of the back and hip, with a lame feel- 
ing; the pain extends from the abdomen to the small of the back, which 
makes it almost impossible to get up and to walk after sitting ; constipation 
and piles. 

Alet. far., in cases of debility from protracted illness, loss of fluids, 
defective nutrition, etc. ; great disposition to abortion. 

Alum., profuse, purulent, yellow, corroding discharge, worse before and 
after the menses; during the day only; vertigo; constipation. 



736 UTERUS. 

Ambra, discharge only at night; thick mucus with stitches in the 
vagina before the discharge ; pieces of bluish-white mucus. 

Amm. carb., watery, burning discharge from the uterus; profuse, 
acrid or milky leucorrhcea; menses every fortnight, black, coagulated, pro- 
fuse ; weight in stomach ; urine reddish ; flow often interrupted ; flushes. 

Amm. mur., leucorrhoea with distention of the abdomen, without ac- 
cumulation of wind; discharge like the white of an egg, after previous pinch- 
ing around the navel; brown, slimy, painless leucorrhoea, after every dis- 
charge of urine ; stools hard, crumbling. 

Aralia rac, offensive discharge, with pressing-down pains in the 
uterus. 

Arsen., discharge, dropping out while standing, and passing flatus; 
burning, corroding ; weak persons ; old women ; nervous restlessness. 

Aur. met. and mur., chronic metritis with malposition; induration; 
excoriation, with great sensitiveness of vagina ; utter despair. 

Bapt. tinct., acrid, fetid discharges; ulceration of the os uteri and 
vagina; debilitated state of the system. 

Bellad., acute catarrh; bearing down as if all the contents of the 
abdomen would issue through the genitals, which is followed by a discharge 
of white mucus ; colicky pains coming and going suddenly. 

Berber., burning and smarting after micturition, with a constant sore- 
ness along the urethra. (F. Baker.) 

Borax, midway between the menses; albuminous discharge; cannot 
bear downward motion. 

Bovista, after the catamenia; while walking, thick, slimy, tenacious 
mucus, like the white of an egg; also yellow, green, acrid, corrosive; during 
the night only. 

Calc. carb., milk-like discharge during micturition, or flowing pro- 
fusely only in spells ; or purulent discharge with soreness and swelling of the 
vulva; too early and too profuse menstruation; paleness of the face; weak 
feeling in the chest, especially when talking ; weakness in the knees ; emacia- 
tion ; constant cold, damp feet. 

Carb. veg., discharge only in the morning, when rising; soreness and 
rawness in the pudendum; cold knees in bed; flatulence. 

Cauloph., profuse secretion of mucus in the vagina; yellowish spot on 
the forehead, commonly called "moth;" bearing down with tardy or absent 
menses ; drawing pains in lower extremities. 

Caustic, weakening leucorrhcea, with too scanty or too profuse men- 
ses; discharge, particularly at night; yellow face; disinclination to coitus. 

China, leucorrhoea instead of the menses; painful pressing towards the 
groins and anus; bloody discharge, occasionally clots of black blood; or 



CATARRH OF THE UTERUS, LEUCORRHCEA. 737 

fetid, purulent matter, with itching and spasmodic contraction of the inner 
parts ; great weakness from loss of blood. 

Coccul., flesh-colored, watery discharge, instead of the menses, mixed 
with a purulent and ichorous liquid ; on bending or squatting down, the fluid 
gushes out; distention of the abdomen and pain, as of a heavy stone; on 
sitting down, bending, treading or any other motion, a pain, as of internal 
ulceration; great debility. 

Collins., leucorrhoea in connection with pruritus obstinate constipation 
and dysmenorrhea. 

Conium, white discharge, burning, smarting, excoriating; suppression 
of the menses ; itching at the vulva ; contractive, labor-like colic, from both 
sides of the abdomen ; weakness and lameness in the small of the back and 
subsequent lassitude; old maids; hysteric paroxysms, swelling and indura- 
tion of glands. 

Ferrum, in chlorotic patients, thin, watery discharge, at first smarting 
and corroding; palpitation of the heart; earthy, yellowish face; painfullness 
of the vagina during an embrace; swellings and indurations in the vagina. 

Gelsem., white discharge; feeling of fulnesss in the hypogastrium ; 
aching across the sacrum. 

Graphit., perfectly white discharge, very profuse, especially in the 
morning on rising from bed, also in gushes by day or night ; scanty menses ; 
irritable skin; weakness in the back and small of the back when walking 
or sitting. 

Hamam., especially in those profuse discharges which simulate a haem- 
orrhage and constitute a drain on the system as severe as a bleeding; sore- 
ness of the abdomen. 

Helon. has been recommended in cases of general atony, anaemia and 
torpid condition of the system. 

Hydrast., tenacious discharge; erosions and superficial ulceration of 
the cervix uteri and vagina; great sinking and prostration at the epigas- 
trium, with violent and continued palpitation of the heart. 

Ignat., violent, crampy pressing in the region of the womb, resembling 
labor-like pains, followed by a purulent, corrosive discharge; mild disposi- 
tions who bear sufferings, even outrages, without complaining. 

Iodium, old leucorrhoea, most abundant at the time of the menses, ren- 
dering the thighs sore and corroding the linen; dwindling and falling away 
of the mammas; goitre; induration of cervix and womb. 

Kreosot., leucorrhoea before and after the menses, especially when 
standing and walking, not when lying or sitting; the yellow discharge is 
acrid and corroding, offensive, causing redness and itching in the vulva; 
menses too early, too profuse and too long. 

Laches., leucorrhoea before the menses, copious, smarting, slimy, stif- 

47 



738 UTERUS. 

fening and staining the linen greenish; the menses appear at the regular 
time, but are too short and too feeble ; the abdomen is hot and tender to 
touch ; feels bad after sleeping. 

Liil. tigr., abundant, thin, excoriating discharge, staining the linen 
brown, worse p.m. ; bearing down relieved in lying down or sitting, or press- 
ing with the hand against the parts; frequent micturition with smarting or 
burning in urethra afterwards; depression of spirits; pain, distress and flut- 
tering of heart; menses flow as long as she keeps moving; sometimes come on 
too early and are scanty; depression of spirits; feels all the time in a hurry 
without accomplishing anything. 

Lycop., profuse, greenish, thick discharge, not constantly, but in 
spells, which are always preceded by a sharp cutting pain in the hypogas- 
trium; pale face, with frequent flushes of circumscribed redness of the 
cheeks ; discharge of wind from the vagina ; the least quantity of food fills 
her up to the throat; jerking of the lower extremities. 

Magn. mur., early in the morning after urinating and after stool; 
constipation. 

Mercur., inflammation of the genitals; discharge of various nature, al- 
ways worse at night ; gonorrhoea ; syphilis. 

Murex purp., watery, greenish, or thick bloody discharge; profuse 
and too early menses ; increased sexual desire. 

Natr. mur., leucorrhoeal discharge after contractive colic, pressing 
downwards, early in the morning, at night, when walking ; itching and sore- 
ness of the genitals; cutting pain in the urethra after micturition; yellow- 
ness of the face; and especially after local applications of nitrate of 
silver. 

Nitr. ac, mucus — which can be drawn out— flesh-colored, greenish, 
cherry-brown, fetid ; after mercurial treatment ; worse after menses. 

Nux vom., fetid discharge, tinging the linen yellow; after all sorts of 
allopathic nostrums. 

Pallad., pain in right ovary; urgency to urinate, with scanty emission, 
and sensation of weight and bearing down in pelvis, relieved by lying down ; 
prolapsus uteri ; forgets every pain in society, but is worse next day ; at- 
taches great w T eight to other people's opinion ; likes to be flattered. 

Phosphor., in consequence of chlorosis; watery slime, especially 
during or instead of the menses; acrid, smarting, corrosive, drawing 
blisters. 

Platina, during daytime; genitals excessively sensitive; can't bear 
to be touched; will go into spasms from an examination; will almost 
faint during intercourse; or excessive sexual desire; haughty disposition, 
or low-spirited. 



DIGEST TO LEUCORRHCEA. 



739 



Podoph., discharge of thick, transparent mucus, attended with con- 
stipation and bearing down in the genitals ; prolapsus uteri and ani. 

Pulsat., burning discharge, thin and acrid, milky, thick and white, 
without pain; when lying, or before and during the menses, which are 
scanty; inclination to looseness of the bowels; chilliness; thirstlessness ; 
peevishness ; sadness ; mild and tearful. 

Sepia, in the climacteric period; during pregnancy; during puberty, 
when there is a sense of pressure and bearing down in the pelvis, stinging 
pain in the ovarian region, frequent urging to urinate, and itching in the 
genital organs ; painful coitus, little sexual desire ; the discharge is of a varied 
nature, thick, creamy or yellowish, bland or excoriating, offensive, worse 
during the day and after coitus. 

Silic, acrid, excoriating discharge; or milky, in paroxysms, with cut- 
ting in the umbilical region; frequently, also, discharge during micturition. 

Sulphur, discharges of all sorts, mild and excoriating; in most chronic 
cases, just as in all other chronic catarrhal affections ; burning of the soles 
of the feet, and heat in the crown of the head; too much animal heat; feel- 
ing of faintness, with strong craving for nourishment, about eleven o'clock 
everv forenoon ; vulva sore, burning and smarting. 



Digest to Leucorrhcea. 



DISCHARGE. 

Abundant, copious, profuse : Alum.,Amm. 
carb., Cauloph., Graphit., Lil. tigr., Lycop., 
Laches. 

, simulating haemorrhage with drain 

on system: Hamsun. 

Thin : Ferrum, Lil. tigr., Pulsat. 

Watery: Aram, carb., Coccul., Ferrum, 
Murex, Phosphor. 

Thick: Ambra, Bovista, Lycop., Murex, 
Podoph., Pulsat., Sejmi. 

Milky: Amm. carb., Pulsat. 

, during micturation : Calc. carb. 

Creamy: Sepia. 

Slimy : Amm. mar., Bovista, Laches., Phos- 
phor. 

Mucus: Ambra, BeUad , Cauloph. 

, tenacious: Bovista, Hydrast. 

, can be drawn out : Nitr. ac. 

, transparent : Podoph. 

"White of an egg, like: Amm. mur., Borax, 
Bovista. 

Purulent: Alum., CjlIc. carb., China, Coc- 
cul., I gnat. 



Fetid, offensive: Aral, rac, Baptis., China, 
Kreos., Nitr. ac, Nux vom., Sepia. 

Bloody: China, Murex. 
Brown : Amm. mur. 

, staining linen : Lil. tigr. 

Cherry-brown : Nitr. ac. 
Bluish-white : Ambra. 
Flesh-colored: Coccul., Nitr.ae. 
Green, greenish: Bovista, Lycop., Murex } 
Nitr. ac. 

, stiffening and staining linen: Laches. 

White : BeUad., Conium, Gelsem., Graphit. 
Yellow: Alum., Bovista, Kreos., Sepia. 
, tinging linen: Nux vom. 



Acrid : Amm. carb., Baptis., Bovista, Kreos., 

Phosphor., Pulsat., Side. 
Burning: Amm. carb., Arsen., Conium, 

Pulsaf. 

Corrosive: Alum., Arsen., Bovista, Fer- 
rum, [gnat., Kreos., Phosphor. 

, causing redness : Kreos. 

, rendering thighs sore, and corroding 

linen : PAium. 



740 



UTERUS. 



Corrosive, drawing blisters: Phosphor. 
Excoriating: Conium, Lil. tigr., Sepia, 

Silic, Sulphur. 
Smarting: Conium, Ferrum., Laches., 

Phosphor. 
Bland, mild: Sepia, Sulphur. 

ACCOMPANYING SYMPTOMS: 

Forgets every pain in society, but is worse 
next day; attaches great weight to other 
people's opinions; likes to be flattered: 
Pallad, 

Feels all the time in a hurry without 
accomplishing anything: Lil. tigr. 

Nervous restlessness : Arsen. 

Sadness: Pulsat. 

Depression of spirits: Lil. tigr., Platina. 

Hysteric paroxysms: Gonium. 

Utter despair: Aurum. 

Mild and tearful : Pulsat, 

dispositions who bear sufferings, even 

outrages, without complaining : Ignat. 

Peevishness: Pulsat. 

Haughty disposition : Platina. 



Vertigo: Alum. 

Heat in crown of head : Sulphur 



Face pale: Calc.carb. 

with frequent flushes of circumscribed 

redness of the cheeks : Lycop. 

yellow : Caustic, 'Natr. mur. 

, earthy, yellowish : Ferrum. 

Yellowish spots, "moths," on forehead: 

Cauloph. 

Thirstlessness : Pulsat. 

Faint, hungry feeling in stomach about 
11 a.m : Sulphur. 

Sinking feeling at stomach with palpi- 
tation of heart : Hydrast, 

Least quantity of food fills her up to the 
throat: Lycop. 



Fulness in hypogastrium: Gelsem. 

Pain from abdomen to small of back, can- 
not get up to walk: JEsc. hipp. 

, colicky, coming and going suddenly : 

Bellad. 



Pain, labor-like colic from both sides of 
abdomen: Conium. 

, pinching around navel, before dis- 
charge: Amm. mur. 

, and distention, as of a heavy stone: 

Coccul. 

, pressing towards groins and anus : 

China. 

Distention of abdomen without accumu- 
lation of wind : Amm. mur. 

Flatulence : Carb. veg. 

Soreness of abdomen: Hamam. 

Hot and tender to touch : Laches. 

Constipation : Alum., Collins., Magn. mur. 

, and piles : JEsc. hipp. 

Stools hard, crumbling: Amm. mur. 

Looseness, inclined to: Pulsat. 



Urgency to urinate with scanty emission: 
Pallad. 

Frequent urging to urinate, with stinging 
in ovarian region : Sepia. 

micturition with smarting and burn- 
ing afterwards: Lil. tigr. 

After micturition, burning and smarting : 
Berber. , 

, cutting in urethra: Natr. mur. 

Constant soreness along urethra: Berber. 

Urine reddish: Amm. carb. 



Bearing, pressing down : Aral.rac, Bellad., 
Cauloph., Podoph., Sepia. 

, better by lying down: Lil. tigr., 

Pallad. 

, better by sitting or pressing with the 

hand against the parts : Lil. tigr. 

Like labor-pains before discharge: China, 
Ignat., Natr. mur. 

Cutting pain before discharge: Lycop. 

in umbilical region : Silic. 

Pain in right ovary: Pallad. 

Chronic metritis with malposition; in- 
duration : Aur. met. and mur. 

Disposition to abortion: Alet.far. 

Wind from vagina: Lycop. 

Prolapsus uteri : Pallad. 

and ani : Podoph. 

Soreness and rawness in pudenda: Carb. 
veg. 



DIGEST TO LEUCORRHCEA. 



741 



Ulceration of os and vagina: Baptis., 

HydrasL 
Excoriation with sensitiveness of vagina : 

Aur. met. and mur. 
Induration of cervix: Iodium, Aur. met. 

and mur. 

in vagina : Ferrum. 

Swelling and soreness of vulva : Cak. carb. 
Inflammation of genitals : Merc. sol. 
Acute catarrh of genitals: Bellad. 
Gonorrhoea; syphilis: Mercur. 
Sense of internal ulceration, on sitting 

down, reading, bending or any other 

motion: Coccul. 
Soreness in genitals: Calc. carb., Carb. 

veg., Natr. mur., Sulphur. 
Itching : China, Collins., Conium, Kreos., 

Natr. mur., Sepia. 
Stitches in vagina before discharge: 

Ambra. 
Burning and smarting: Sulphur. 
Sensitive, excessively ; cannot be touched : 

Platina. 
Painfulness during an embrace : Ferrum, 

Platina, Sepia. 
No desire to coitus: Caustic, Sepia. 
Excessive sexual desire: Platina. 
Increased sexual desire: Murex. 

Menses, suppressed: Conium. 

, tardy or absent: Cauloph. 

, too scanty: Caustic, Graphit, Laches., 

Lil. tigr. 
, too early: Amm. carb., Calc carb., 

Kreos., Lil. tigr., Murex. 
, too profuse: Amm. carb., Calc carb., 

Caustic, Kreos. 

, and too long : Kreos. 

, black, coagulated: Amm. carb. 

, flow interrupted: Amm. carb. 

, as long as she keeps moving : 

Lil. tigr. 
Dysmenorrhcea: Collins. 



"Weak feeling in chest when talking : Calc. 

carb. 
Palpitation of heart : Ferrum. 
Pain, distress and fluttering of heart: Lil. 

tigr. 



Weakness in back and small of back, 
when sitting or walking: Graphit. 

and lameness in small of back : Conium. 

Aching across sacrum : JEsc hipp., Gelsem. 

Jerking of lower extremities : Lycop. 

Drawing pain of lower extremities: 
Cauloph. 

"Weakness in knees: Calc carb. 

Coldknees in bed: Carb. veg. 

damp feet : Calc carb. 

Burning of soles of feet : Sulphur. 

Chilliness: Pulsat. 

Too much animal heat : Sulphur. 



Skin irritable: Graphit. 

Glands swollen and indurated: Conium. 

Goitre : Iodium. 

Dwindling and falling away of mammas: 

Iodium. 
Debility : Alet.far., Arsen., Baptis., Coccul. 

from loss of blood: China. 

Atony, ansemia: Helon. 
Chlorosis: Ferrum, Phosphor. 
Emaciation : Calc carb. 



Cannot bear downward motion: Borax. 
Feels bad after sleep : Laches. 

WORSE: 

Before menses: Alum., Kreos., Laches., 
Pulsat. 

During menses: Iodium, Phosphor., Pulsat. 

Instead of menses: China, Coccul., Phos- 
phor. 

After menses: Alum., Bovista, Kreos., 
Nitr. ac 

Midway between menses: Borax. 

In the morning : Magn. mur., Natr. mur. 

, when rising: Carb. veg., Graphit. 

During the day: Graphit, Platina, Sepia. 

only : Alum. 

In afternoon : Lil. tigr. 

In night : Caustic, Graphit, Mercur., Natr. 
mur. 

only : Ambra, Bovista. 

In spells : Calc carb., Lycop., Silic 

By gushes: Graphit. 

When lying: Kreos., Pulsat 

bending or squatting : Coccul. 



742 



UTERUS. 



When walking: Bovista, Kreos., Natr, 
mur. 

urinating: Silic. 

After urinating : Amm. mur., Magn. mur. 

stool : Magn. mur. 

While passing flatus : Arsen. 

Not while lying or sitting: Kreos. 



During puberty with bearing down : Sepia. 
pregnancy : Sepia. 



During climacteric period 
Old maids : Conium. 

Old women : Arsen. 



Sepia. 



Chronic cases with other catarrhal affec- 
tions: Sulphur. 
After Nitrate*of silver : Natr. mur. 

mercurial treatment : Nitr. ac. 

all kinds of nostrums: Nux vom. 



Parenchymatous Metritis. 

In its acute form it is of rare occurrence, and consists of an inflammatory 
process of the entire substance of the womb, including often both the mucous 
lining inside and the peritoneal covering outside. The uterine substance is 
tumefied, infiltrated with serum and hypersemic. 

Its most frequent causes are irritating applications, injections of too hot 
or too cold water into the vagina, or intra-uterine injections, pessaries, the 
introduction of the sound, etc. ; also, " catching cold," especially during the 
menses, etc. 

Commencing with a chill which is followed by fever-heat, it is character- 
ized by a deep-seated pain in the region of the uterus and an acute pain in 
the peritoneal covering, greatly increased by pressure, or movements, such 
as turning, walking, standing, coughing or straining at stool. Manual ex- 
aminations are scarcely endurable. If it commences during the menstrual 
period, it causes suppression of the flow, or at times flooding. It is often 
associated with ischuria, diarrhoea and tenesmus, nausea and in rare cases 
with vomiting. Uncomplicated cases may pass over in the course of several 
days; a termination in an abscess is of rare occurrence. 

The chronic form of parenchymatous metritis is also known under the 
name of infarction of the womb, and consists of a hyperplasia of the connective 
tissue of the uterus, out of its muscular tissue; it is accompanied by a vari- 
able degree of sensitiveness. The womb is always enlarged; its substance 
succulent and reddish, tumefied and hypersemic; the os is generally broad, 
and the lips are swollen and elongated, often ulcerated. 

Its Causes are of a widely different nature. Only rarely it develops 
out of the acute form, and then only when the organ, by some cause or the 
other, has been prevented from undergoing a complete restitution into its 
normal state. By far the most frequent origin lies in a defective retrograde 
evolution of the puerperal uterus in consequence of too early leaving the bed 
and assuming housework again ; or in consequence of retained secundines, or 
too early sexual intercourse, etc. This applies also to miscarriage and crimi- 
nal abortion. 



PARENCHYMATOUS METRITIS. 743 

Another variety of causes must be looked for in all those irritations 
which produce active hyperemia of the uterus, such as excesses in venere, 
fraudulent cohabitation and masturbation; also cauterization of the os by 
nitrate of siver or other means ; and in all those conditions which produce a 
venous stasis in the organ, such as retroflexion and prolapsus, adjacent tu- 
mors, retention of urine in the bladder, etc. 

Its Symptoms are not in all cases very characteristically developed ; but 
as a rule we meet with frequent repetitious of acute and subacute exacerba- 
tions of at least some of the following symptoms: pain in the sacral region, 
in the abdomen, a sense of weight and beariug down in the pelvis, leucor- 
rhoea, menorrhagia, constipation and frequent urging to urinate ; pain during 
stool, or coitus. During the menstrual period all the symptoms are aggra- 
vated. Gradually digestion and appetite begin to fail, and a whole train of 
hysterical symptoms develop, such as various kinds of pain in the lumbar 
region and lower extremities, vaginodynia, coccygodynia, paralysis of differ- 
ent organs, etc. 

It may bring on sterility, but not necessarily ; is often complicated with 
endometritis, ovaritis, perimetritis and displacements, and terminates after 
the age of fifty at times in cicatricial induration of the womb. By means 
of the conjoined examination the uterus is found to be enlarged and its sensi- 
tiveness increased, especially during the periods of aggravation. The sound 
reveals an elongation of the uterine cavity. 

The disease is very tedious, but not dangerous to life. If the uterus 
cannot be entirely restored to its normal state, the sufferings at least can be 
greatly relieved by homoeopathic treatment. 

THERAPEUTIC HINTS.— Compare Uterine Catarrh, Peritonitis 
and Displacements. 

Aeon., high fever; dry skin; intense thirst; great restlessness; fear of 
death, and predicting the hour of death. 

Arnica, when induced by external violence. 

Arsen., burning pain; indescribable anguish and restlessness; sudden 
sinking of strength; burning thirst, drinks often, but little at a time; cold 
drinks make her worse; burning in the veins; aggravation about midnight. 

Bellad., violent pains by spells; clutching pains, as if something with 
nails were clawing the intestines together; meteorism, with eructations; great 
sensitiveness and heat in the abdomen; painful bearing down in the pelvis 
towards the genitals and the rectum, with constant, ineffectual desire for 
stool; suppression of the lochial or menstrual discharge, or else vitiated, 
fetid discharge. Congestion of the head, with delirium, redness of face, and 
throbbing of the carotid arteries; drowsy dozing with startings, or drowsiness, 
with inability to go to sleep. 



744 UTERUS. 

Bryon., wants to lie perfectly still; the slightest motion causes pain; 
in the head splitting pain ; in the bowels, limbs and body stitch-like pain ; 
great dryness in the mouth, without thirst, or else great thirst, drinking 
tumbler after tumbler; perspiration in short spells, and only on single parts 
of the body ; constipation. 

Calc. carb., fat persons, and those whose menses are too profuse and 
return too soon; they sweat easily about the head, and are troubled con- 
stantly with cold and damp feet. Chronic infarction of the womb. 

Canthar., constant painful urging and tenesmus in the bladder; like- 
wise, in worst cases, when the patient lies unconscious with her arms stretched 
out along the side of her body, interrupted by sudden starting up, screaming, 
throwing about the arms and even convulsions ; all signs of erosions and ul- 
ceration of internal organs. 

Cauloph., insomnia; paraplegia; atony and relaxed condition of the 
uterus ; hysterical spasms ; irregular menstruation ; excessive uterine haemor- 
rhage. (M. M. Eaton.) 

Chamom., great agitation of the nervous system; she seems beside 
herself, with red face and heat all over; she is ill-humored, and can scarcely 
restrain herself to treat people with civility; sometimes one cheek red and 
the other pale; after fits of passion. 

Coloc, colicky pains in the bowels, with deadly color of the face and 
bending double; worse after eating or drinking; partial heat and partial 
coolness of the skin, with quick pulse, vomiting and diarrhoea; bitter taste 
in the mouth ; after indignation. 

Conium, swelling of the breasts ; stitches in the breast, mostly at night ; 
induration of the cervix, with sharp pains in the part; acrid leucorrhcea; 
prolapsus uteri. (M. M. Eaton.) 

Crocus, black stringy discharge; rolling and bounding in the abdomen, 
as from a foetus ; stitching in abdomen arresting respiration. 

Gelsem., hystery; hyperesthesia of a part of the body; tendency to 
hemiplegia; confusion of mind; sleeplessness; spasms; fever, without thirst, 
intermitting; nervous exhaustion. (M. M. Eaton.) 

Hyosc, typhoid state; either complete apathy, or else great excit- 
ability, spasms, jerkings, delirium, wild staring, throwing off bedclothes, 
making herself naked ; bright red clots after child-birth. 

Kreos., putrid state of the womb after child-birth; confounding ideas; 
loss of memory ; thinks herself well ; discharge of dark, offensive blood from 
the womb. 

Laches., constantly lifting the bedclothes from the abdomen, on ac- 
count of uneasy feeling caused by it ; the pain in the uterus is relieved by a 
flow of blood for the time being, but returns soon afterwards ; in bad cases, 
unconsciousness, livid face, repeated shaking chills ; skin alternately burning 



PARENCHYMATOUS METRITIS. 745 

hot and cold; abdomen distended; lochial discharge thin, ichorous; stool 
and urine suppressed. 

Mercur., inflammation of the genital organs and ulcers; moist, soft 
tongue, showing the imprints of the teeth, accompanied occasionally with 
great thirst; profuse sweat without relief; all worse at night. 

Nux vom., after taking cold, or using various kinds of drugs; in 
chronic cases, with bearing down into the vagina and towards the os sacrum ; 
constant urging to urinate; constipation. 

Phosphor., fair, graceful women; after frequent pregnancies; pysemic 
state and inflammation of the veins. 

Pulsat., after getting the feet wet; frequent chilliness; thirstlessness ; 
deficiency of milk; suppression of the lochial discharge; mild, tearful dis- 
position. 

Rhus tox., constant restless moving; can't lie still; dry tongue, with 
red tip ; red rash on the breast ; powerlessness of the lower limbs ; the lochial 
discharge turns bloody again ; typhoid symptoms. 

Sabina, in metritis hemorrhagica. 

Secale, putrescence of the uterus; abdomen distended, not very pain- 
ful ; discharge from the vagina, brownish, offensive ; ulcers on the external 
genitals discolored and rapidly spreading ; burning hot fever, interrupted by 
shaking chills ; small, sometimes intermittent pulse ; great anguish ; pain in 
the pit of the stomach, vomiting decomposed matter; offensive diarrhoea; 
suppressed secretion of urine ; the skin is covered with petechial and miliary 
eruptions, or shows discolored, inflamed places, with a tendency to mortifica- 
tion; the patient lies either in quiet delirium, or grows wild with great anx- 
iety and a constant desire to get out of bed. 

Sepia, painful stiffness in the uterine region; bearing down; sense 
of weight in anus; sense of goneness in abdomen; yellowish spots in the 
face. 

Sulphur, frequent weak, faint spells, especially before noon; bearing 
down, especially on standing ; leucorrhoea ; soreness of genitals. 

Ver. alb., if commencing with violent fits of vomiting and diar- 
rhoea; hot body; cold extremities and deadly pale face, covered with 
cold perspiration; delirium and great anxiety; suppressed lochial dis- 
charge; nymphomania. 

Ver. vir., congestion of pelvic organs, tenderness of uterus; fever; 
heat ; restlessness ; palpitation of heart ; local or general hypersesthesia. (M. 
M. Eaton.) 

For the chronic form, Eaton recommends: Ars. jod., Merc, jod., Phytol., 
Ferrum, Merc, corr., Kali hydr., Nux vom., Ars. alb., Secale, Ignat., Iris 
vers., Hyosc, Ver. vir. 



746 UTERUS. 

Hydrometra, Hsemometra, Partial or Total Closure of the 

Womb. 

In consequence of the just considered inflammatory processes, it happens 
now and then that exuberant granulations of the mucous lining or cicatriza- 
tion of ulcers form adhesions within the neck of the uterus and thus cause a 
partial or total closure of its mouth. The same result may be produced by 
pseudo-formations within the womb, or certain flexions of the cervix uteri. 
In such cases it is obvious that any secretion within this organ either cannot 
escape at all, or only with great difficulty, and under certain favorable cir- 
cumstances. The secretion collects and distends the uterus sometimes to a 
very considerable size. This distention causes the mucous lining to grow 
thin, and its glandular structure, which naturally secretes mucus, to dis- 
appear; it now approaches the nature of a serous membrane, and secretes a 
serous fluid instead of mucus. Thus originates Hydrometra or dropsy of 
the womb. 

Haemometra it is called, when blood, instead of serum, collects in the 
womb, in consequence of a partial or total closure of its mouth. This takes 
place in women who still menstruate; or the occlusion is a congenital imper- 
foration of the organ. In the first instance it is always attended with con- 
tractions of the womb, labor-like pains, or uterine colic at the period of men- 
struation, which may succeed in cases of a partial closure, to press the col- 
lected fluid out in gushes ; in the latter case the menstrual discharge does 
not take place at all. The existing trouble may be suspected when repeated 
menstrual periods pass without any flow, although the patient feels all the 
symptoms of it: periodical colicky contractions; bearing-down sensation; 
and all the rest of the symptoms of amenorrhoea and dysmenorrhea. The 
abdomen commences to enlarge above the os pubis. Only by a physical ex- 
amination can we discover the occult complaint. 

THERAPEUTIC HINTS.— It is clear that, if homoeopathic treat- 
ment of those inflammatory processes could not prevent adhesions and clos- 
ure, medicines will not be likely to unclose them. Such cases require 
surgical treatment. 

Displacements of the Womb. 

The womb is by no means fixed immovably within the pelvic cavity ; 
its fundus has almost entire freedom of motion antero-posteriorly ; the round 
ligaments having their insertion in soft parts, allow very considerable ex- 
cursions backwards. The cervix is more firmly connected, but only to the 
unstable bladder in front and to the rectum behind. The vagina too gives 



DISPLACEMENTS OF THE WOMB. 747 

no firm support, but follows the movements of the cervix. Only considerable 
lateral motion is prevented by the lateral ligaments. It is, therefore, not 
very strange that displacements of this organ should frequently occur. Even 
within the boundaries of physiological correctness its position is greatly in- 
fluenced by the varying contents of the bladder and rectum. A full bladder 
presses it back, an empty bladder allows it to fall forward, and so also has 
the full or empty rectum, though in less degree, a certain influence upon its 
position. 

Anteversion and Anteflexion. 

In anteversion the entire organ inclines forward, has, so to say, fallen 
upon the bladder which it compresses, while neck and mouth point straight 
backward. There is but slight bending between neck and body, or none at 
all. This form is always complicated with metritis, and when it exists in 
any considerable degree, it is accompanied by pain in the abdomen, haem- 
orrhages, leucorrhcea, urinary difficulties, neurosis of the rectum and 
hysteria. It is easily detected by digital per-vaginam and conjoined ex- 
amination. 

In anteflexion the body and cervix form an angle, the body having 
fallen down and forward upon the bladder, while the cervix retains its 
position in the vagina, or is slightly pointing backwards. This form is 
usually attended with dysmenorrhea, in consequence of the obstruction 
to the menstrual flow at the point of flexion. The pain begins before 
the appearance of the menstrual discharge, which has to be driven out 
by strong contractions of the womb, causing violent colicky pains, end- 
ing usually with a copious flow. There is also difficulty of conception, 
the semen being prevented from entering the womb at the point of flex- 
ion, and frequent desire to pass water on account of the pressure of the 
womb upon the bladder. It may be complicated with metritis, perimetritis 
and endometritis. Here too digital and conjoined examination will reveal 
the nature of the disorder. 

Retroversion and Retroflexion. 

In retroversion the uterus dips backward towards the rectum and its 
neck and mouth point forward toward the symphysis, and in its most exag- 
gerated form the uterus may be completely turned over, the os looking 
directly upward. Slight degrees of this form may be free of symptoms; in- 
veterate cases may be complicated with chronic inflammation. 

In retroflexion the body and cervix form an angle, the body having 
fallen backward toward the rectum, while the cervix retains its position in 
the vagina or is slightly pointing forward towards the symphysis. This form 



748 UTERUS. 

is more apt to be attended by haemorrhages than by dysmenorrhea, and 
occurs as a general thing most frequently in women who have borne chil- 
dren; it is further characterized by a pain in the lower part of the spine; 
by paralytic or neuralgic symptoms of the lower extremities or elsewhere, 
in consequence either of direct pressure upon the motor nerves, or in con- 
sequence of reflex action ; by great irritation of the nervous system, show- 
ing itself as emotional, moral, or intellectual disturbances; by urinary 
troubles, and disturbances in the function of the rectum. 

The Diagnosis of retroversion and retroflexion can usually be made 
out by digital examination per vaginam et rectum and by the conjoined 
method ; only rarely it will be necessary to introduce the sound, which by 
no means is so free of danger as seems to be supposed by many. 

Prolapsus and Procidentia. 

In prolapsus the uterus slips downward into the vagina, approaching 
gradually with its os the mouth of the vagina. The uterus standing in 
its normal position about four inches above the vaginal entrance, its descent 
is one of degrees before it reaches the mouth of the vagina, and as it is fas- 
tened to adjoining parts, it drags along in its course downward the bladder, 
the ovaries, the Fallopian tubes, the small intestines, the walls of the vagina, 
and in some instances the rectum and portion of the colon. 

I am entirely of the same opinion as is expressed by Dr. Guernsey in 
his work on obstetrics, that " the peritoneum is the true uterine supporter," 
and " that the uterus can sink in the pelvis only so far as it is permitted by 
the relaxation of the peritoneum, its grand suspensory ligament." Recent 
authors come nearer and nearer to this same view. So says Schroeder : " the 
predisposing cause will almost invariably be found to consist in a relaxation 
of all the pelvic viscera," and M. M. Eaton: "the uterus is sustained mainly 
by the folds of the peritoneum constituting the broad ligaments, the cellular 
tissue surrounding it and the vagina, and by atmospheric pressure coming in 
through the vagina." 

The predisposing relaxation of the peritoneum being present, usually in 
consequence of some general weakness of the system or a sudden fright, any 
pressure from above, such as tight lacing, straining or heavy lifting, long- 
continued standing, the puerperal condition, etc., or insufficient support from 
below, such as lacerations of the perineum, will no doubt facilitate the descent 
of the womb. 

Symptoms. — In those rare cases where from a violent cause a sudden 
descent takes place, we have severe abdominal pain, fainting and profound 
nervous shock. The gradual descent causes: bearing and dragging-down 
pain in the pelvis with pain in the small of the back, which is worse on 



DISPLACEMENTS OF THE WOMB. 749 

standing, walking, lifting or doing any kind of bodily work, and better on 
lying down and resting; frequent desire to urinate and often inability to do 
it on account of the bladder being dislocated also; difficulties in defecation, 
and a number of nervous symptoms known under the name of hysteria. 
Digital examination reveals the organ more or less far down in the vagina, 
resting in some cases upon the perineum. 

In procidentia, which is a complete prolapse, the uterus escapes through 
the vagina and lies either in part or wholly outside of the external genitals 
between the thighs. The vagina having become inverted, covers the pro- 
truded organ, and drags down in its cavity the bladder and rectum, in con- 
sequence of which a retention of urine in the drawn down portion of the 
bladder (diverticulum) and difficult defecation are necessarily produced. 

The Diagnosis of this trouble can hardly fail to be correct, if an ex- 
amination by inspection and palpation is properly conducted. 

Inversion of the Womb. 

By this we understand a turning of the uterus inside out. It can only 
take place when the organ is greatly enlarged, for instance, during parturi- 
tion, when the foetus is suddenly expelled, or afterwards upon undue pulling 
at the cord to deliver the placenta, or in cases of tumors, polypi, etc., at its 
fundus, which have softened the fundus and by their weight draw it down 
within the uterine cavity, dragging, by degrees, the uterine walls after, until 
at last a complete e version is established. This process is often accelerated 
by uterine contractions to expel the foreign body. In the normal, unimpreg- 
nated uterus inversion never takes place. 

The degrees of inversion are as varied as those of prolapse, from a mere 
depression of the fundus into the uterine cavity, to a complete turning inside 
out and protrusion of the entire organ outside of the vulva. 

Its Symptoms are usually grave haemorrhages, shock and urinary diffi- 
culties, but in some cases it is borne without any remarkable disturbance of 
the system. 

THERAPEUTIC HINTS— Many cases of these various kinds of 
displacements require, like hernia and other dislocations, taxis to reinstate 
the organ into its natural position; others yield easily to well-chosen reme- 
dies. If taxis is necessary, it ought to be executed with the utmost care and 
gentleness, and, if possible, by the hand alone. It is not necessary, nor even 
likely, in many cases, that we should succeed in one effort at restoration ; it 
took time for displacement; allow time also for replacement. With several 
gentle efforts, persistently followed up at reasonable periods, much more may 
be gained, than by one grand attack with ether and chloroform, and all 



750 UTERUS. 

kinds of instruments. He is the greatest artist who accomplishes most by 
the simplest means. In anteversion or anteflexion, place the patient on her 
back, and elevate the pelvis; steady with one or two fingers of the left hand, 
introduced into the vagina, the cervix, and with the right hand try to get 
uuder the fundus above the pubis through the relaxed abdominal walls, and 
force it gently upward and backward. In retroversion or retroflexion, place 
the patient on her left side or in the knee-chest position, raise the uterus 
gently by the introduced fingers of the right hand, and exercise at the same 
time upon the neck, which points towards the pubis, a steady pressure in a 
backward direction. The other hand may help either per rectum or through 
the abdominal walls in forcing the fundus forward. In prolapsus and proci- 
dentia, place the patient on her side or back, with the pelvis elevated, and 
push the organ gently upwards and in the direction of the natural curve of 
the pelvis, lest it might result in an artificial retroflexion by being forced 
against the sacrum. In inversion, the fundus of the womb must be pressed 
back again through the os, and the entire organ replaced — a work sometimes 
very difficult to accomplish, especially in chronic cases, when it properly be- 
longs in the domain of surgery. 

Some chronic cases of displacement are irreducible in consequence of 
adhesions with neighboring organs. In all cases of displacement, one of the 
first requirements for success is the removal of all pressure upon the womb 
from above, as is exercised by corsets, tight lacing, etc. ; supports from below 
by pessaries and supporters of all kinds have seldom proved themselves of 
great use, and often decidedly injurious; rest, in a suitable position, with 
hips elevated, and continued for some time after replacement, is often all 
that is needed. 

To secure the staying in place of the womb, we must so select a remedy 
that it fits the peculiarities of the individual case ; it will certainly restore 
the necessary tonicity of the peritoneum. 

As regards SPECIAL HINTS, Drs. Guernsey and Eggert have made 
valuable contributions. Compare them, if the following do not suffice. 

Aeon., after a sudden fright; also when inflammatory symptoms pre- 
vail. Agonizing pain during the menses, with tossing about. Fear of death. 

Agar, muse, prolapsus after cessation of menses; bearing-down pain, 
almost intolerable. 

Amm. mur., pain as from a sprain in the groin, obliging one to walk 
crooked ; menses appear too soon, with pain in the belly and small of the 
back; they flow more abundantly in the night; discharge of a quantity of 
blood with the stool during the catamenia. 

Arctium lappa, especially in old cases of prolapsus and procidentia. 
(S. A. Jones.) 



DISPLACEMENTS OF THE WOMB. 751 

Argent., pain in the small of the back, which extends towards the front 
and downwards ; pain in the left ovary and loins. 

Arg. nitr., prolapsus, with ulceration of os or cervix uteri; painful 
coition, with bleeding from vagina. 

Arnica, after a bruise or concussion, which leaves a bruised and sore 
feeling in the lower part of the abdomen, so that she cannot walk erect. 

Aurum, after lifting a heavy load, a sense of weight in the pelvis, with 
ischuria and constipation, worse at each menstrual period; great dejection 
of spirits ; longing for death, increasing to a desire for self-destruction ; or 
vehement, the least contradiction excites her wrath. 

Bellad., pressing early in the morning, as if all the contents of the 
abdomen would issue through the genital organs ; drawing pain in the small 
of the back downwards; flow of blood between the periods; great dryness of 
the vagina; frequent, unsuccessful desire to urinate or to evacuate the 
bowels; only a few drops of urine are discharged from the bladder, and 
some mucus from the rectum; the uterus comes down when straining at 
stool; or while urinating, and rises again on walking about; back aches as 
if it would break; dizziness; roaring in the ears; congestion to the head. 

Calc. carb., pressing on the uterus; aching of the vagina; stinging in 
the os uteri; the menses appear too soon, and are too profuse; milk-like 
leucorrhcea; inclination to perspire easily about the head; great liability to 
strain a part by lifting ; easily tired by bodily exertions ; in walking up stairs 
she feels dizzy and entirely exhausted ; even talking makes her weak ; great 
inclination to sigh ; she cannot get her breath long enough ; great suscepti- 
bility to catch cold ; the feet feel most of the time damp and cold, or else 
the soles of the feet are burning hot ; great desire for hard-boiled eggs ; big- 
belliedness; scrofulous diathesis. 

Calc. phos., every cold causes pains in the joints, and in other places 
where the bones unite and form a symphisis or suture. 

Cauloph., retroversion; menstrual colic; congestion and irritability of 
uterus; leucorrhcea profuse, mucous. 

Chamom., abortus; colicky pain and bearing down, with frequent 
desire to urinate ; frequent discharge of coagulated blood, with tearing pains 
in the veins of the legs, and violent labor-pains in the uterus; she is inclined 
to be quarrelsome and angry; can hardly stop talking about old vexatious 
things. 

China, general weakness in consequence of loss of vital fluids, either 
by haemorrhages, profuse diarrhoea, or debilitating illness; great disposition 
to sweat during motion and sleep; feels worse from exposure to the slightest 
current of air; all pains are worse from slightest touch. 

Conium, pain in the mammae before the menses; pressure from above 
downwards, and drawing in the legs during the menses; feeble or suppressed 



752 UTERUS. 

menses; sterility; smarting, excoriating leucorrhoea; the flow of urine sud- 
denly stops; cough during pregnancy; cough worse at night, and when 
lying down; vertigo, worse when lying down, or looking round, or going 
down stairs ; indurations in the mammae or other glands. 

Ferrum jod., retroversion and consequent pressure upon the rectum, 
that she can neither stand nor walk ; constant tenesmus, with frequent white 
slimy stools; scanty, deep-colored urine; nervous and hysteric spasms; scrofu- 
lous diathesis. 

Hydrast., nosebleed before menses; backache and headache before 
and during menses ; discharge like white of egg after menses for ten days 
with great sexual desire, although coition is painful; after these ten days fol- 
lows acrid, corroding leucorrhoea with great irritableness and aversion to 
coition; at times profuse discharge of hot water from the womb. Constant 
desire to pass water, with relief after passing it; constipation, dry, lumpy 
feces are followed by a matter like white of egg. After eating, regurgitation 
of food by the mouthful without nausea, with nervousness, irritability and 
headache ; epigastric region tender to touch and a feeling as of a tight band 
around the waist, worse at night than in the morning ; cannot sleep until af- 
ter midnight. Prolapsus uteri with indurated os. (C. W. Boyce.) 

Ignat., violent cranrpy pressing in the region of the uterus, resembling 
labor-pains, followed by a purulent, corrosive leucorrhoea; the menses are 
scanty, black and of a putrid odor; she seeks to be alone, is brooding to her- 
self and full of grief; all her pains are aggravated by drinking coffee or 
smelling tobacco smoke ; gone feeling in pit of stomach. 

Kali cafb., pain in the small of the back, as though it were pressed in 
from both sides, with labor-like colic and leucorrhoea; also during the 
menses; the pains in the bowels are apt to recur about three o'clock every 
morning; bloated face in the morning, especially between the eyebrows and 
upper lids ; great dryness and itchiness of the skin ; great tendency to start 
when being slightly touched. 

Laches., just as patients with a Lachesis sore throat cannot bear any- 
thing touching their neck, so do women afflicted with womb diseases con- 
stantly pull their dress from off the abdomen; violent labor-like pressing 
from the loins downwards during the menses, which are scanty; palpitation 
of the heart, with numbness in the left arm; constant feeling of something in 
the throat which she cannot swallow down; feeling of a ball rolling in the 
bladder or abdomen, or in both places ; climacteric period. 

Lil. tigr., feels as though she would drop asunder, must press with 
hand against vulva; worse in standing and sometimes when recumbent; fre- 
quent ineffectual urging to urinate and defecate. Menses scanty, flowing 
only as long as she is moving about; leucorrhoea profuse and corroding; she 
feels always in a hurry, yet cannot accomplish anything. 



DISPLACEMENTS OF THE WOMB. 753 

Lycop., chronic dryness of the vagina; pressing through the vagina 
on stooping; chronic suppression of the menses after fright; incarcerated 
flatulence; varicose veins on the lower extremities; jerking and twitching 
of single limbs or of the whole body, sleeping or waking ; always wakes up 
very cross. 

Mercur., peculiar weak feeling in the abdomen, as though she had to 
hold it up ; close above the genital organs a sensation as if something heavy 
were pulling downward, accompanied by a pulling pain in both thighs, as if 
the muscles and tendons were too short. During the menses red tongue, 
with dark spots and burning; salt taste in the mouth; sickly color of the 
gums, and the teeth are set on edge; great tendency to perspire; all the 
symptoms worse at night; inexpressible feeling of some internal, insupport- 
able illness. 

Natr. mur., pressing and pushing from the side of the abdomen to- 
wards the genital organs early in the morning ; she has to sit down to pre- 
vent a prolapsus uteri ; dryness of the vagina and painful embrace ; burning 
and cutting in the urethra after micturition; headache on waking every 
morning; faint, weak voice, and exhaustion from talking; after abuse of 
quinine, or the local application of nitrate of silver. 

Nitr. ac, violent pressing in the hypogastrium, as if everything were 
coming out at the pudendum, with pain in the small of the back, through the 
hips and down the thighs; she feels so weak that she loses breath and speech. 
Inclined to looseness of the bowels ; most violent, cutting pain after an evac- 
uation, lasting for hours; she feels, on the whole, better when riding in a 
carriage. 

Nux vom., prolapsus after straining by lifting, or after miscarriage; 
constant, painful pressing and burning in the uterine region ; pressive pain 
in the small of the back, worse when turning in bed; drawing in the thighs; 
constant, unsuccessful urging to stool and constant desire to urinate; the 
patient wakes after midnight and lies awake for hours, then falls into a 
heavy sleep again, constantly dreaming until late in the morning, when 
she feels disinclined to rise. Always the first remedy after allopathic 
drugging. 

Platina, great heaviness, pressing in the genitals, extending through 
the groins as far as the small of the back; profuse menses; great sensitive- 
ness of the parts, with pressing from above down ; internal chilliness and ex- 
ternal coldness; constipation; feeling of numbness and rigidity here and 
there; also with trembling and palpitation of the heart; haughty dis- 
position. 

Podoph., prolapse from overlifting or straining and often parturition; 
great costiveness; frequent micturition; weakness and soreness of back, 
especially after washing; prolapsus ani. 
48 



754 



UTERUS. 



Pulsat., chilliness and paleness of face; bad taste in the morning and 
dry tongue without thirst ; is easily moved to tears. 

Rhus tox., after a strain or hard labor; she feels worse after any long 
walk ; the pain in the small of the back is relieved by lying on a hard couch. 

Secale, after parturition; weakly, thin women. 

Sepia, pressing in the uterus, oppressing the breathing, from above 
downwards, as if everything would come out of the vagina, accompanied 
with colic; she had to cross her limbs to prevent it, followed by a discharge 
of jelly-like leucorrhoea; sense of weight in the rectum not relieved after 
stool, slow and difficult evacuations from the bowels, although the excrements 
are soft; pot-bell iedness; yellow saddle across the bridge of the nose; gone 
feeling in the pit of stomach, great weakness, tiredness, despondency and 
disinclination to move. 

Sulphur, w r eak feeling in the genital organs and pressure on the parts ; 
troublesome itching of the pudendum, with pimples all around and burning 
in the vagina; she was scarcely able to sit still; the menstrual blood is thick, 
black, and so acrid that it makes the thighs sore; burning and smarting 
leucorrhoea; sudden, imperative urging to urinate to prevent an involuntary 
flow; weak, fainty, between 11 and 12 a.m., must have something to eat; 
restless and sleepless nights; or heavy sleep which exhausts her; heat on 
top of head with cold feet; always feels too hot, especially her feet, which 
compels her to put them from under the cover; walks stooping; all the 
symptoms worse while standing; psoric diathesis. 

Ver. alb., after great fear or fright, with cold sweat, exhausting vomit- 
ing and diarrhoea. 

Zincum, usually feels best during menses; fidgety of feet. 

Besides compare the chapter on Leucorrhoea. 



Digest to Displacements of the Womb. 



LOCAL SYMPTOMS. 
Prolapsus uteri, when straining at stool 

or urinating; rises again when walking 

about: Bellad. 
, after cessation of menses: Agar. 

muse. 
, with ulceration of os and cervix: 

Arg. nilr. 

, with indurated os : Hydrast. 

, with stinging in os : Calc. carb. 

Retroversion: Cauloph., Ferr.jod. 
Bearing, pressing down: Agar., Calc. 

carb., Chamom., Laches., Platina, Std- 

phur. 



Pressing down, as if everything would 

come out : Bellad., Nitr. ac., Sepia. 

, has to cross her limbs: Sepia. 

, must press with hand against vulva : 

Lil. tigr. 
; feels as though she had to hold it 

up : Merc. sol. 
through the vagina on stooping: Ly- 

cop. 

from loins down : Laches. 

from small of back down towards 

front : Argent. 
from side of abdomen early in morn- 

inff : has to sit down : Natr. mur. 



DIGEST TO DISPLACEMENTS OF THE WOMB. 



755 



Pressing down, with burning in uterine 

region: JVwx vom. 

, with sensitiveness of parts : Platina. 

• and drawing in legs during menses: 

Conium. 
and tearing pains in the veins of the 

legs: Chamom. 

and pulling in both thighs: Mercur. 

• , extending through groins as far as 

the small of back: Platina. 
Sense of weight in pelvis after lifting a 

heavy load: Aurum. 
Labor-like, colicky pains : Chamom. 

pains during menses: Laches. 

and leucorrhoea: Ignat., Kali 

carb. 
Congestion and irritability of uterus: 

Cauloph. 
Inflammation: Aeon. 
Pain in left ovary and loins : Argent. 
in groin ; has to walk crooked : Amm. 

mur. 
Pressure upon rectum, that she can nei- 
ther stand nor walk : Ferr. jod. 



Vagina dry: Bellad., Lycop. 

, and painful embrace : Nair. mur. 

, aching : Calc. carb. 

, burning and itching and pimples 

around pudendum : Sulphur. 
• , bleeding from, after painful coition: 

Arg. nitr. 



down from 



Before menses, nosebleed: Hydrast. 

, pain in mamma; : Conium. 

During menses, pressing 

loins: Laches. 
, agonizing pain, with tossing about: 

Aeon. 

, colic: Cauloph. 

• , red tongue, with dark spots and 

burning: Mercur. 
Menses, scanty: Conium, Laches., Lil. 

tigr. 
> , black and of putrid odor: 

Ignat. 

, thick, black and acrid: Sulphur. 

- flow more abundantly in the night : 

Amm. mur. 



Menses flow as long as she is moving 

about : Lil. tigr. 
too soon, with pain in small of back 

and in belly: Amm. mur. 

and too profuse : Calc. carb. 

, profuse: Platina. 

, suppressed after fright : Lycop. 

, ; sterility: Conium. 

Flow of blood between the periods: 

Bellad. 
Frequent discharge of coagulated blood : 

Chamom. 
Profuse discharge of hot water from 

womb: Hydrast. 



Leucorrhoea, jelly-like: Sepia. 

, milk-like: Calc. carb. 

, mucous, profuse: Cauloph. 

, like white of egg, with great sexual 

desire, although coition is painful: 
Hydrast. 

, smarting, burning, excoriating: Co- 
nium, Hydrast., Ignat., Sulphur. 

, , , , with aversion to 

coition: Hydrast. 

, with pain in small of back: Kali 

carb. 

GENERAL SYMPTOMS. 

Desire to be alone, brooding to herself, 
full of grief: Ignat. 

to self-destruction: Aurum. 

Always in a hurry, without accomplish- 
ing anything: Lil. tigr. 

Disinclination to move: Sepia. 

Easily moved to tears: Pulsat. 

Despondency : Sepia. 

Dejected, longing for death: Aurum. 

Fear of death : Aeon. 

Irritability and nervousness: Hydrast. 

Can hardly stop talking about old vex- 
atious things: Chamom. 

Vehement, least contradiction excites 
her wrath : Aurum. 

Quarrelsome and angry: Chamom. 

Haughty: Platina. 

Inexpressible feeling of some internal 
illness: Mercur. 



756 



UTERUS. 



Headache on waking every morning: 
Natr. mur. 

and backache : Hydrast. 

Congestion: Bellad. 

Heat on top of head, with cold feet: Sul- 
phur. 

Dizziness and roaring in ears: Bellad. 

on walking up stairs : Calc. carb. 

when lying down, looking around, or 

going down stairs : Conium. 



Paleness of face: Pulsat. 

Bloated, especially between eyebrows and 

upper lids : Kali carb. 
Yellow saddle across bridge of nose: 

Sepia. 



Red tongue, with dark spots and burn- 
ing during menses : Mercur. 

Taste salty : Mercur. 

bad in morning, dryness without 

thirst: Pulsat. 

Desire for hard-boiled eggs : Calc. carb. 

After eating, regurgitation of food by 
the mouthful without nausea : Hydrast. 

Gone feeling in pit of stomach : Ignat., 
Sepia. 

between 11 and 12 a.m.: Sulphur. 

Voice weak, faint and exhausted from 
talking : Natr. mur. 

Feeling of something in throat which 
she has to swallow : Laches. 



Epigastrium tender to touch : Hydrast. 
Abdomen tender to touch; pull their 

dress or cover from off the: Laches. 
Feeling as of a tight band around waist, 

worse at night : Hydrast. 
as of a ball rolling in abdomen or in 

bladder: Laches. 
Pains recur about 3am.: Kali carb. 
Incarcerated flatulence: Lycop. 
Pot-belliedness: Calc. carb., Sepia. 
Constipation : Platina, Podoph. 
, dry, lumpy feces, followed by matter 

like white of egg : Hydrast. 
• and ischuria, worse during menses: 

Aurum. 
Looseness, inclined to : Nitr. ac. 



Urging, unsuccessful: Bellad., Lil. tigr., 

Nux vom. 
Tenesmus, constant, with frequent white 

slimy stools: Ferr.jod. 
"Weight, sense of, not relieved after stool : 

Sepia. 
Slow, difficult stool, although soft: Sepia. 
Stool with blood during menses: Amm. 

mur. 
After stool, cutting in rectum for hours: 

Nitr. ac. 
Prolapsus ani : Podoph. 



Desire, unsuccessful, to urinate: Bellad., 
Lil. tigr., Nux vom. 

Urging, sudden, imperative: Sulphur. 

, frequent: Chamom., Podoph. 

■ , constant, with relief after passing 

water: Hydrast. 

Ischuria, worse during menses : Aurum. 

The flow of urine suddenly stops: Co- 
nium. 

A few drops are only discharged and 
some mucus from rectum : Bellad. 

Scanty, deep-colored urine: Ferr.jod. 

Burning and cutting in urethra after 
micturition: Natr. mur. 



Cough at night when lying down and 

during pregnancy : Conium. 
Inclination to sigh, cannot get the 

breath deep enough : Calc. carb. 
Bearing- down pains take her breath 

away: Sepia. 
Induration in mammse and other glands : 

Conium. 
Palpitation of heart, with trembling: 

Platina. 
, with numbness of left arm : Laches. 



Back aches as if it would break : Bellad. 

sore and weak, especially after wash- 
ing: Podoph. 

Small of back, pain in, as though it were 
pressed in from both sides : Kali carb. 

, drawing downwards: Bellad. 

, pressing, worse when turning in bed : 

Nux vom. 



MORBID GROWTHS WITHIN THE WOMB. 



757 



Small of back, pain in, through hips 

down the thighs: Nitr. ac. 
, pain in, relieved by lying on a hard 

couch : Rh us tox. 



body, 



Thighs, drawing in : Nux vom. 
Limbs, jerking of, or of whole 

sleeping or waking : Lycop. 
Feet, fidgety of: Zincum. 

damp and cold : Calc. carb. 

cold or burning hot : Sulphur. 

Numbness and rigidity here and there 

Platina. 
Varicose on lower extremities : Lycop. 



Heavy sleep exhausts her : Sulphur. 

Sleepless before midnight : Hydrast. 

and restless at night : Sulphur. 

Wakes after midnight and lies awake 
for hours ; later heavy sleep with 
dreams till late in the morning : Nux 
vom 

Wakes up very cross : Lycop. 

Feels bad after sleep : Laches. 



un- 



Chilliness: Pulsat. 

and external coldness : Platina. 

Heat, especially of feet, which she 

covers : Sulphur. 
Tendency to perspire: Mercur. 

about head : Calc. carb. 

during motion and sleep : 

China. 



Cold sweat, vomiting and diarrhoea: 
Ver. alb. 



Dryness and itchiness of skin : Kali carb. 
Scrofulous diathesis : Cilc. carb., Ferr. 

jod. 
Weakness, loses breath and speech : 

Nitr. ac. 

from loss of fluids : China. 

Weak and tired : Sepia. 

Nervous and hysteric spasms : Ferr. jod. 



After fright : Aeon., Ver. alb. 

After straining, lifting, parturition: 
Arnica, Aurum, Calc. carb., Chamom., 
Nux vom., Podoph., Rhus tox., Szcnle. 

Worse from bodily exertions : Calc. carb. 

from too long walk : Rhus tox. 

from talking : Cilc. carb. 

from standing : Lil. tigr., Sulphur. 

from touch : China. 

from taking cold : Cdc. carb., Calc. 

phosph., China. 

at night : Mercur. 

Climacteric age : Laches. 

Better during menses : Zinzum. 

when riding in a carriage : Nitr. ac. 



After the use of quinine and local appli- 
cation of caustics : Natr. mur. 
allopathic drugging : Nux vom. 



Morbid Growths within the Womb. 

MllCOUS polypi are usually an outgrowth of chronic catarrh, and con- 
sist of enlarged follicles, which elevate the loosely textured mucous mem- 
brane, gradually forming club-shaped bodies, w T hich hang on a slender pedicle 
or stem from the fundus down towards the os, or if situated near the cervix, 
protrude through the external os. Their covering membrane being very 
vascular, gives them a cherry-red color, and they bleed easily and often pro- 
fusely ; their size varies from that of a pea to that of a hazel-nut, seldom 
much larger. 

Fibrous polypi consist of submucous fibroids, which project into the 
cavity of the uterus, and are covered by the mucous membrane which they 
push forward. They arise from the body of the womb, and remain more or 



758 UTERUS. 

less continuous with the same by means of a more narrow or broader pedicle. 
Their size varies greatly, and may attain to the dimensions of a child's head 
and over. Such growths should properly be called submucous fibroids, but 
are best known under the name of uterine fibrous polypi. If these morbid 
growths take during their development an outward direction towards the peri- 
toneal covering, which they naturally push before them, they are called sub- 
serous fibroids, and if they develop within the uterine wall itself, constituting 
a portion of the same, they are called interstitial, intraparietal or intramural 
fibroids. 

It is often the case that all three kinds of fibroids are associated with 
each other. These tumors do not directly endanger life, but may become 
dangerous through haemorrhage or suppuration and ichorous degeneration, 
and constitute at best a constant interference with the enjoyment of life. 

THERAPEUTIC HINTS.— As the most important remedies compare 
Calc. carb., Calc. phosph., Conium, Lycop., Nitr. ac, Phosphor., Sanguin., 
Silic, Staphis., Teucrium, Thuja. Many others may be indicated in indi- 
vidual cases. In case of haemorrhages compare the respective chapter. 
Operative means belong into the domain of surgery. 

Moles are fleshy bodies of various sizes, to which is attached a sac filled 
with fluid resembling the amniotic fluid; they are embryos not normally 
developed. The cause for this failure of normal development may lie in the 
ovum, being from some cause or the other incapable of a normal development 
ab initio, or in the semen, being not healthy enough to insure a normal 
growth, or, according to Eaton, in the too small number of spermatozoa, 
which penetrate the ovum. This latter may be the result of using a syringe 
after connection, or of withdrawing the penis before ejaculation, or of con- 
striction of the cervical canal in consequence of flexion, preventing the free 
ingress of semen into the uterus. 

Its Symptoms are usually those of pregnancy ; and when the abnormal 
mass is expelled by the efforts of nature, the indications for remedial aid 
correspond to those of abortus. 

Hydatids are numerous cysts or vesicles attached to each other like a 
bunch of grapes, filled with a transparent fluid like water. Upon micro- 
scopical examination they were found to contain the heads of echinococci, 
and as hydatid developments are not confined to the uterus, but have been 
found also in the liver, lungs, testicles and mammae, they cannot be considered 
as the result of imperfect impregnation. 



CANCER OF THE WOMB. 759 

Cancer of the Womb. 

Carcinoma is, according to Waldeyer, " developed by normal pavement 
or glandular epithelium penetrating with its ramifications into the depths of 
the tissues in all directions like plugs, destroying the other tissues in all 
directions by pressure, and forcing apart the bundles of connective tissue- 
fibres, so as to form for itself a framework of connective tissue and an alveo- 
lar structure for the whole tumor." 

"According to the preponderance of either this connective tissue frame- 
work, or the nests of cancerous epithelium, we distinguish the harder forms 
as Scirrhus and the softer as Medullary cancer." 

The degeneration begins almost always at the vaginal portion, rarely 
extends to the fundus, is, however, very apt to spread down the vagina, over 
to the bladder and rectum, causing, at the period of its decay, a most horrid 
destruction of these parts. Its most important Symptoms are pains in the 
small of the back, loins and groins, which grow more and more violent; 
haemorrhages, at first only during the menstrual periods, later at any time ; 
and leucorrhcea, which becomes more and more watery, corroding and 
offensive. 

The Cauliflower excrescence is a cancroid hypertrophy of the papilla? 
in the mouth of the womb, which sometimes attains to an enormous size in the 
shape of cauliflowers. It looks bright red, bleeds easily and is prone to can- 
cerous degeneration, in which state it undermines the general constitution by 
pain and loss of blood, like cancer of the womb, to which it is similar in all 
its symptoms. A Differential Diagnosis between the two can be gained 
only by an examination with the speculum. 

THERAPEUTIC HINTS — Arsen., great exhaustion; restlessness 
and fits of anguish, with terrible, sharp, burning pains; all worse about mid- 
night; acrid, corroding and burning discharges, watery, light or dark colored, 
often very offensive. 

Ars*. jod. (Wells.) 

Aur. mur., stinging, cutting, pressive pains in the uterine region; very 
offensive discharges; belching up of wind ; craves nothing but sour things. 

Bellad., painful bearing down in the pelvis, as though everything 
would fall out of the genitals; a similar pain in the small of the back; fre- 
quent, transient stitches in the region of the womb; haemorrhages from the 
womb, profuse, often very offensive. 

Bromium, eight cases. (Williams.) 

Calc. carb., burning soreness in the genital organs; aching in the 
vagina ; profuse menstruation ; flow of blood between the monthly periods ; 



760 UTERUS. 

cold feeling on the top of the head; great sensitiveness to cold air and 
liability to catch cold ; scrofulous diathesis. 

Carb. an., burning in the abdomen, extending into the thighs; labor- 
like pain in the pelvis and small of the back, extending into the thighs, with 
discharge of slimy, discolored blood ; irregular menses ; uterus swollen and 
hard ; cachectic appearance of the face ; earthy color of the skin ; great 
weakness. 

Carb. veg., paroxysmal spells of burning in the uterine region; vari- 
cose veins on the external genital organs ; cold knees in bed. 

Conium, stitching pain in the womb, accompanied by such symptoms 
as accompany pregnancy; nausea and vomiting; craving sour or salt things; 
pain and swelling of the mammae during the menses; dejection of spirits, etc. 

Graphit., cauliflower excrescence; burning, stitching pains, like elec- 
tric shocks, through the womb, extending into the thighs ; great heaviness in 
the abdomen when standing, with increased pains and faintness ; menses only 
every six weeks, with a discharge of black, clotted, offensive blood, and an 
increase of all the sufferings ; constipation ; earthy color of the face; frequent 
chilliness; sad, desponding. 

Iodium, cutting in the abdomen, with pains in the loins and small of 
the back; uterine haemorrhage at every stool; indurations of the uterus; 
painfulness and feeling of heaviness in both mammae; they hang down, re- 
laxed and lose their fat; dwindling and falling away of the mammae; the 
patient feels worse from external warmth ; after abuse of mercury. 

Kreos., cauliflower excrescence ; awful burning as of red-hot coal in 
the pelvis, with discharge of clots of blood having a foul smell; bearing down 
and sense of weight in the pelvis; drawing pains in the small of the back 
and uterine region, extending to the thighs, intermingled with stitching 
pains; the vagina is swollen and burning hot; long-standing leucorrhoea- 
becoming more and more watery, acrid, bloody and ichorous all the time ; 
frequent haemorrhages from the womb ; dwindling and falling away of the 
mammae, with small, hard, painful lumps in them; wretched complexion; 
great debility ; sleeplessness. 

Laches., pain in the parts as if swollen, they do not bear contact, and 
have to be relieved of all pressure; coughing or sneezing causes stitching 
pains in the affected parts ; tenacious and acrid menstrual flow with labor- 
like pains; discharge of a few drops of blood from the nose before menses, 
which are scanty and delaying; especially indicated during the climacteric 
period with frequent uterine haemorrhages. 

Lycop., drawing in the groin; burning and gnawing; chronic dryness 
of the vagina; pressing through the vagina on stooping; discharge of wind 
through the vagina ; pain in the small of the back, extending down to the 
feet; incarcerated flatulence, with rumbling in the left hypochondriac region; 



CANCER OF THE WOMB. 761 

red, sandy sediment in the urine; jerking of single limbs awake or asleep; 
feels worse in general from four to eight o'clock p.m. 

Magn. mur., scirrhous induration of the womb; uterine spasms ex- 
tending to the thighs and occasioning leucorrhoea; discharge of black clots 
of menstrual blood, more when sitting than when walking ; large, hard, diffi- 
cult stools which crumble off as they are expelled. 

Merc, sol., syphilitic taint, prolapse of the vagina; swelling of ingui- 
nal glands. 

Murex purp., a lively, affectionate disposition has turned to melan- 
choly from the effects of the disease; frequent, profuse menstruation, and 
strong sexual desire; soreness in the region of the cervix, or a feeling as 
though something was pressing on a sore spot in the pelvis, with pain in the 
right side of the uterus, going into the abdomen or thorax; watery, greenish 
leucorrhoea, irritating the parts; dragging and relaxation in the perineum; 
pains in the hips, loins, and down the thighs, worse from exertion. (B. F. 
Betts.) 

Nitr. ac, irregular menstruation in shorter or longer intervals; during 
the intervals a profuse, discolored, brownish and offensive leucorrhoea; great 
debility, nervousness, and depression of spirits; hemorrhoidal tendency; 
great pain in the rectum after stools, lasting for hours, even worse after a 
diarrhoeic evacuation; the urine is very offensive. During a ride in the 
carriage they feel much better. 

Natr. carb., induration of the neck of the womb; the os uteri is out 
of shape; pressing in the hypogastrium towards the genital organs, as if 
everything would come out; metrorrhagia; putrid leucorrhoea; headache in 
the sun and from mental labor; she gets nervous from playing on the piano, 
and feels great anxiety during a thunder-storm. 

Phosphor., frequent and profuse metrorrhagia, pouring out freely and 
then ceasing for a short time ; heat in the back ; chlorotic appearance ; in- 
stead of menses, watery, slimy or acrid discharge, causing blisters. 

Phytol., menses too frequent and too copious; niammse painful; ster- 
ility ; constipation ; syphilitic taint. 

Rhus tox., great soreness in vagina preventing an embrace; the men- 
strual flow, being profuse, protracted and of light color, causes biting pain 
in the vulva. 

Sepia, induratio colli uteri or vaginae; painful stiffness in the uterus; 
pressing from above downwards, oppressing the breathing; must cross her 
thighs, in order to get relief; pot-belliedness ; yellow saddle across the bridge 
of the nose; feels worse while riding in a carriage. Menses scanty; aversion 
to coitus; sad and indifferent. 

Silic, she feels nauseated during an embrace; diarrhoea or else great 
costiveness before the menses; increased menses, with repeated paroxysms of 



762 UTERUS. 

icy coldness over the whole body at the time of their appearance ; indurations 
of the mammae; most of the symptoms make their appearance about new 
moon. 

Tarant., cancerous ulcer of os, induration of neck and fundus, chronic 
vaginitis with granulations. (Nunez.) 

Thuja, cauliflower excrescences. 

Besides compare: Apis, Calc. carb., China, Clemat., Coccul., Hydrast., 
Sabina, Staphis., Sulphur and others. 

Hysteralgia. 

Under this term we understand a neuralgia uteri, or as it was formerly 
called, an irritable uterus, which consists of severe, oftentimes even excrucia- 
ting pains in the region of the womb, without our being able to prove the 
existence of corresponding changes in the uterus by our present methods of 
investigation. Hysteralgia, therefore, excludes all those cases where the 
existing pain can be traced to morbid alterations objectively demonstrable. 
These attacks of neuralgic pains are prone to remissions and aggravations, 
greatly influenced by the state of the atmosphere, by mental or emotional 
excitements, by indigestion, etc., and are generally found in women of a 
nervous temperament. 

THERAPEUTIC HINTS.— Here, too, as in all neuralgias, the num- 
ber of remedies which may be indicated is very large. 

In pains running upward: Laches., Lycop., Phosphor., Sepia. 

Downward: JEscul., Ipec, Nux vom. 

From os ilii forward and downward: Bryon. 

From groins outward and backward: Sepia. 

From groins to back : Sulphur. 

From back to groins: Sabina. (J. C. Morgan.) 

Dreadful bearing-down, drag ging-out feeling : Secale. (Burnett.) 

Compare the chapters on Abnormal Menstruation, especially Dysmenor- 
rhcea. 



Metrorrhagia, Haemorrhage from the Womb. 

We understand by metrorrhagia a more or less profuse flow of blood 
from the womb at any other time than that of the menstrual period. 

1. It may occur in the not pregnant state of the womb, in consequence of 
abnormal fluxion to that organ, or in consequence of morbid growths in the 
womb and disorganizatious of the organ, as shown in the previous chapters, 
or (and that is, perhaps, its most frequent occurrence) in consequence of those 



METRORRHAGIA. 763 

conditions which lead to the so-called "change of life" in the female organ- 
ism; here it is, perhaps, not always distinguishable from a mere profuse 
menstruation. 

2. It may occur during pregnancy. With some women it is almost a 
rule, that the menstrual period is repeated several times after conception, 
without apparent injury to the child. In others, however, a haemorrhage 
during the first months of pregnancy is the forerunner of abortion. Haemor- 
rhages during the second half of pregnancy are often signs of a placenta 
previa, or likewise forerunners of miscarriage. 

3. It may occur after the expulsion of the child, whether it be full-grown 
or not. Such bleedings are generally of great importance. They are almost 
always (if not occasioned by mechanical injuries) the consequence of in- 
sufficient contractions of the womb, the causes of which consist either of 
protracted or exhausting labors, or a too rapid expulsion of the child, or a 
partially-adhering placenta, or large blood coagula within the womb. 

4. When occurring later, during the lying-in time, the haemorrhages are 
usually not so profuse and happen chiefly in women who do not nurse the 
child. Sometimes, however, they may be caused by an inflammatory irrita- 
tion of the womb. 

5. It may occur during an attack of typhus, variola, cholera, etc. 
Metrorrhagia sets in frequently with chilly spells. The bleeding is either 

in gushes, or a continuous flow of bright red or dark blood. The face turns 
pale, the extremities grow cold; there is anxiety, restlessness, labor-like pains 
or colic; sometimes difficulty in breathing; vomiting and even convulsions. 
A great loss of blood brings on the signs of anaemia : coldness and deadly 
paleness of the face ; chills ; cold perspiration ; darkness before the eyes ; 
ringing in the ears ; faintness, drowsiness, weak pulse, convulsions. 

THERAPEUTIC HINTS.— Apocyn. cann., the flow is either con- 
tinuous or paroxysmal; the blood fluid or clotted; there is nausea, vomiting, 
palpitation of the heart, great prostration and fainting when raising the head 
from the pillow. 

Arsen., pale, hippocratic face; sunken, lustreless eyes, and icy-cold 
extremities, spots and blisters on skin, with oozing of blood. 

Arnica, after difficult labor or external injuries; head hot; remaining 
body cool. 

Bellad., great bearing down, as if everything would be pressed out, or 
a pain from the sacrum through the pelvis to the pubis ; the blood feels hot ; 
headache; loss of consciousness; darkness before the eyes; enlarged pupils; 
cold nose; oppression, groaning, yawning, jerkings of the arms; convulsive 
clenching of the thumbs. 



764 UTERUS. 

Calc. carb., climacteric period; chronic; mixed with leucorrhoea; 
previously always inclined to profuse and protracted menses. 

Cauloph., threatening abortion, and with spasmodic bearing-down 
pains ; great vascular excitement ; passive haemorrhage after abortus or con- 
finement; tremulous weakness of the whole system. 

China, at the commencement or actual presence of the above described 
symptoms of anaemia. 

Chamom., threatening abortus or actual abortion; labor-like pains 
from the small of the back extending to the genitals; blood dark and 
clotted. 

Crocus, dark, viscid, stringy blood, in black clots; feeling as if some- 
thing alive were in the abdomen; nervous excitement; palpitation of the 
heart; fearfulness; after being overheated, straining and lifting; after abor- 
tus and delivery ; worse from slightest motion ; yellowish, earthy color of 
the face. 

Eriger., uterine haemorrhage, with violent irritation of the rectum and 
bladder ; after abortion, with diarrhoea and dysuria. 

Ferrum, partly fluid and partly black, clotted blood ; labor-like and 
colicky pains; fiery red face; frequent short shudderings; headache and 
dizziness ; constipation and hot urine. 

Hamam., passive haemorrhage, with anaemia; soreness of the abdomen. 

Hyosc, continuous flow of bright red blood, or in bright red clots, 
with spasmodic jerkings of the body and great vascular excitement; nausea; 
vomiting ; hiccoughing. 

Ignat., after the abuse of chamomile tea; after mental excitement and 
depression; gone feeling in the pit of stomach. 

Ipec, especially after child-birth or the taking away of the placenta; 
the flow is continuous, and the patient gasps for breath and is deadly pale. 

Kreosot., black blood in large quantities and of an offensive smell; 
during the climacteric period. 

Kali carb., threatening abortus and consequences of it; great weak- 
ness in the small of the back and lower extremities ; pain in the small of the 
back as though it were broken; dry, hacking cough; obstinate sweating, 
with feverish chilliness; chronic inflammatory states of the womb, with 
nausea and vomiting. 

Laches., climacteric period. 

Lycop., partly black, clotted, partly bright red blood, and partly 
bloody serum, with labor-like pain, followed by swooning; distention of the 
abdomen in different places, changing localities; pain in the small of the 
back, extending into the thighs; worse in the afternoon from four o'clock, 
commencing with chilliness; restless sleep; dreams of falling down from a 
height; especially for women who habitually menstruate profusely. 



METRORRHAGIA. 765 

Mercur., frequent fainting; profuse, cold perspiration on the face; 
collection of slime in mouth and throat ; external swelling of the genitals. 

Nitr. ac, after miscarriage or confinement; diarrhcea, with cutting 
pain in the rectum after stool ; urine of an intolerably strong smell. 

Nux vom., during the climacteric period, and especially if such per- 
sons have been drugged previously by allopathic nostrums, or have used 
much coffee or alcoholic drinks, or too highly seasoned food ; if they lead a 
sedentary life, complain much of costiveness and headache, suffer with 
piles, etc. 

Phosphor., between the menses and during pregnancy; lame and 
bruised feeling in the small of the back; dry cough and tightness in the 
chest, worse before midnight ; great heat on the top of the head or in the 
spine; a great deal of vertigo; chronic looseness of the bowels, worse in the 
morning, or else chronic constipation with dry, narrow stools. 

Platina, during pregnancy; after confinement; after great mental 
emotions; dark, thick, not coagulated blood; pressing pain from the small 
of the back downward upon the pelvic organs, as though they would come 
out, with great sensitiveness of the external organs, and nymphomania; some- 
times a feeling as if limbs and body were growing larger. 

Plumbum, during the climacteric period; dark clots, alternating with 
fluid blood or bloody serum, with a sensation of fulness in the pelvis and 
slight bearing-down pains from the small of the back to the front; skin dry, 
pale, yellowish; here and there "liver-spots"; great debility, short breath on 
going up stairs; depressed spirits. Poisoning with lead brings on abortus. 

Pulsat., dark, coagulated blood emitted in paroxysms; worse in the 
evening, with labor-like pains; habitual looseness of the bowels; ordinarily 
rather scanty menses; yielding disposition. 

Rhus tox., bright red blood; threatening abortus, induced by strain- 
ing or lifting; trembling sensation in the middle of the chest; contractive 
pain around the hypochondria ; drawing, tearing in the back, loins and hips ; 
cramp-like contraction of the thighs; aching all over, worse during rest; 
heavy, unrefreshing sleep, full of dreams. 

Sabina, blood bright red or dark, also in clots, sometimes alternating, 
now dark, coagulated, and then, again, thin and bright red ; flows mostly in 
paroxysms, which are brought on by the slightest motion ; or it ceases when 
walking about ; drawing, cutting, pressing pains from the small of the back 
to the genitals and into the thighs ; women who menstruate early and almost 
always profusely; gouty diathesis; when the patient feels better in cool and 
worse in warm temperatures; threatening abortus; after miscarriage and 
confinement. 

Secale, atonic haemorrhages during the critical age; after confinement; 
dark, seldom coagulating blood, sometimes fetid; no pain, or only slight 



7G6 MENSTRUAL ANOMALIES. 

bearing down ; or dreadful bearing-down and dragging-out feeling ; flooding, 
worse from the slightest motion ; trembling, convulsive jerkings of the limbs ; 
cramps in the calves of the legs; general coldness. 

Sepia, climacteric age, or during pregnancy, especially during the fifth 
and seventh months; congestion of the head; fulness and pressure in the 
chest ; spasmodic contractions in the abdomen, with terrible bearing down ; 
induration of the womb ; varicose veins ; yellow, sallow complexion. Such 
patients are very irritable, and faint from any little exertion. 

Sulphur, in chronic cases, when other remedies do not prevent its re- 
turn'; psoric taint of the system; eruptions here and there, or previously 
suppressed eruptions ; looseness of the bowels early in the morning, or else 
great constipation ; fits of gnawing hunger before dinner ; the patient com- 
plains of great heat, or flushes of heat ; has sleepless nights, seemingly with- 
out cause, or on account of a tormenting itching all over the body ; itching 
about the anus and genitals ; chronic leucorrhoea, etc. 

Trillium, gushing of bright red blood at least movement, at times dark 
clots; frequent desire to urinate. Sallow face with white lips and tongue; 
tossing in bed from evening until after midnight, with a feeling as if hips 
and small of back were falling to pieces and a desire to bind them up tightly. 
(F. G. Gilchrist.) 

Ustilago, at the climacteric period ; active and constant flowing with 
frequent clots. 

Digest see under Menorrhagia. 

MENSTRUAL ANOMALIES. 
1. Menorrhagia 

Is, like metrorrhagia, a profuse flow of blood from the womb ; only with the 
difference that it occurs at the time of the menstrual 'period. This period may 
keep regular time, or it may come too soon, or it may last too long; in some 
cases the menses are too profuse, too early and lasting too long. Its causes 
are various. We may trace it to different structural changes and morbid 
growths of the uterus ; to stagnation of the blood in the uterine veins, de- 
pending upon heart and lung diseases ; to fluxions to the womb, brought on 
by sexual excesses, or sexual excitements by loose literature or onanism ; to 
hemorrhagic diathesis, as in scurvy, purpura hemorrhagica, hemorrhagic 
small-pox, measles, typhus, etc. Such cases, however, are of rare occurrence. 
The blood is either fluid or coagulated, and may differ greatly in color and 
character. Strong, plethoric women may endure menorrhagia for a long 
time; weak, feeble women soon show signs of anemia. 



MENORRHAGIA. 767 

THERAPEUTIC HINTS.— Compare the preceding chapter on 
Metrorrhagia, and likewise those which treat of its causes as stated above. 

Amm. carb., premature and very copious flow, especially at night, 
when sitting or riding, and after a ride in the cold air; with spasmodic 
pains in the belly and hard stools with tenesmus ; cholera-like symptoms at 
the commencement of the flow. 

Arg. nitr., congestion of the uterus; cutting pains in the small of the 
back and groins ; cramp in the stomach ; great debility of the lower limbs ; 
vertigo and enlarged feeling of the head. 

Bryon., menses premature and too profuse; dark red blood; tearing in 
the limbs ^splitting headache from the least motion, even on moving the eyes; 
white-coated tongue ; great thirst ; bilious vomiting ; tearing in the limbs ; 
constipation; stools as if burnt; or diarrhoea in the morning. 

Calc. carb., profuse, too early and lasting too long; anaemic symptoms 
and congestions of the head and chest; leucorrhoea afterwards; scrofulous 
diathesis. 

Calc. phosph., menses every two weeks, black and clotted; before 
their appearance, griping and rumbling in the bowels; leucorrhoea; stitching 
pains in the left side of the head ; sleepiness during the day. 

Cann. ind., violent uterine colic; great nervous agitation and sleep- 
lessness ; or cold hands and feet. (W. C. Richardson.) 

Chamom., profuse discharge of dark, almost black, coagulated blood, 
with drawing, clawing pains from the small of the back to the os pubis; 
irritable ; fainting spells ; cold extremities. 

Cimicif., profuse and too early; dark, coagulated blood; aching in the 
limbs ; severe pain in the back, down the thighs, and through the hips, with 
heavy pressing down; weeping mood; nervousness; hysteric spasms; great 
pain in the head and eyeballs, increased by the slightest movement of the 
head and eyeballs. 

Coccul., profuse and too often ; when rising upon the feet, it gushes out 
in a stream ; paralytic feeling of the lower extremities. 

Cocc. cacti, flow only in evening after lying down, not when stirring 
about ; urging to urinate but cannot pass water until a clot of blood is dis- 
charged ; nausea, vomiting. (C. B. Knerr.) 

Collins., menorrhagia in connection with constipation and piles. 

Crocus, profuse and lasting too long, but coming at the right time; 
dark, clotted, stringy blood ; wretched, pale, yellowish color of the face; pal- 
pitation of the heart on going up stairs; great debility. 

Cyclam., "the flow almost ceased as long as she was moving about at 
work, but as soon as she sat down quietly in the evening the flow re-appeared 
and continued after she went to bed." (H. Ring.) 

Digit., venous, passive congestion, with pale or livid color of the face; 



768 MENSTRUAL ANOMALIES. 

coldness of the skin; swelling and painfulness of the feet; all in consequence 
of some cardiac anomalies. 

Eriger., profuse and too frequent, with violent irritation of the rectum 
and bladder. 

Ferrum, profuse, too frequent, and lasting too long; with a fiery-red 
face, whilst at other times the face is pale and earthy looking. 

Gelsem., almost continuous flow, without any pain. 

Hyosc, profuse, with delirium; convulsive trembling of hands and 
feet; silly manners, rage. 

Ignat., profuse, too frequent and lasting too long; after great mental 
troubles, grief or fright ; empty feeling in the pit of the stomach ; great sen- 
sitiveness of mind without complaining. 

Iodium, profuse and too early; ovarian region painful, or sensitive to 
pressure; emaciation, notwithstanding a good appetite; chronic catarrh of 
the lungs. 

Ipec, very profuse, with heavy breathing; constant nausea. 

Kreos., profuse and last too long; great distention of the abdomen 
before the menses, so that she appears as though she were pregnant ; blood 
offensive; leucorrhoea between the menstrual periods; headache before 
menses; is very stubborn and irritable. "Worse in lying, better from 
walking about." (Von Villers.) 

Lycop., profuse and lasting too long; sadness and melancholy before 
the menses; yellowish color of the face; frequent jerkings of the limbs; in- 
carcerated flatulence. 

Nux vom., profuse and too early; great sensitiveness of the nervous 
system ; can't bear light or noise ; is put out of patience when spoken to ; 
gets angry and violent without any provocation; is head-strong and self- 
willed ; or gets frightened easily, and is almost beside herself from the least 
thing that may happen ; she shuns the fresh air. After coffee, liquors, high- 
seasoned food, drugs, sedentary life. 

Phosphor., profuse, too early and lasting too long; or too late, but 
very copious ; afterwards great weakness, blue rings around the eyes ; losing 
of flesh and great fearfulness; tender, sensitive women, with frequent heat in 
the back, and cold legs. 

Platina, profuse, too frequent and long lasting; dark blood; pressing- 
down pains ; excited sexual desire. 

Secale, profuse, dark, without pain, lasting too long, being aggravated 
by the slightest motion or mental emotion. Spitting of blood before the 
menses; leucorrhoea three days after menstruation; ischiatic pains better 
from bending the limb. 

Sepia, profuse, either too early or at the right time ; venous congestion 
of the head ; one-sided headache, with nausea and vomiting ; loathing of all 



DIGEST TO METRORRHAGIA AND MENORRHAGIA. 



769 



food; pot-bellieduess after confinement; constipation; yellow spots on the 
face. 

Trillium, menses every fourteen days, lasting seven and eight days; 
in the intervening time profuse leucorrhcea of a yellowish color and creamy 
consistence. The blood is at first bright red, but owing to ansemia, grows 
pale. 

Veratr., profuse and too early; commencing with vomiting and diar- 
rhoea ; sensation upon the top of the head as if ice lay there ; nose, hands 
and feet cold ; irritable, weeping mood. 



Digest to Metrorrhagia and Menorrhagia. 



Blood black: Cilc.carb., Chamom., Crocus, 
Ferrum, Kreos., Lycop., Plumbum. 

and clotted: Gale, phosph., Cha- 
mom., Crocus, Ferrum, Lycop., Plumbum. 

dark: Chamom., Crocus, Platina, Sa- 
bina, Secale. 

and clotted: Chamom., Cimic, 

Platina, Plumbum, Pulsat., Sabina, Tril- 
lium. 

dark red : Bryon. 

clotted or fluid: Apoc.ca.nn., Ferrum, 

Plumbum, Ustil. 

fetid or offensive : Kreos., Secale. 

hot : Bcllad. 

bright red : Hyosc, Lycop., Rhus tox., 

Sabina, Trillium. 

and clotted: Hyosc. 

stringy : Crocus. 

thin: Sibina. 

Bloody serum: Lycop. 

Flow continuous: Apoc. cinn., Gelsem., 
Hyosc, Ipse., Ustil. 

paroxysmal : Apocyn., Pulsat., Sabina. 

Passive : Cauloph., Hamam. 

Chronic, mixed with leucorrhoea: Cilc. 
earb. 



Menses habitually profuse: Cdc. carb., 

Lycop., Sabina. 

scanty: Laches., Pulsat. 

at the right time: Crocus, Sepia. 

too early: Amm. carb., Bryon., Calc. 

carb., Canic, Iodiurn. Nux vom. t Phosphor., 

S.i.bina, Sepia, Veratr. 
49 



Menses too often, frequent : Coccul., Eriger., 
Ferrum, Ignat., Platina. 

every two weeks: Calc. phosph., Tril- 
lium. 

too long, protracted: Cilc.carb., Cro- 
cus, Ferrum, Ignat., Kreos., Lycop., Phos- 
phor., Platina, Secale, Sepia. 

lasting seven and eight days : Trillium. 

commencing with vomiting and diar- 
rhoea: Amm. carb., Ver. alb. 

ACCOMPANYING SYMPTOMS. 

Loss of consciousness : Bellad. 
Delirium, silly manners, rage : Hyosc. 
Depressed spirits: Plumbum. 
Sadness and melancholy before menses : 

Lycop. 
Weeping mood: Cimic, Ver. alb. 
Fearfulness : Calc carb., Phosphor. 
Easily frightened: Nux vom. 



Irritable: Chamom., Kreos., Sepia, Ver. 

alb. 
Angry, violent, out of patience, without 

provocation: Nux vom. 
Stubborn: Kreos. 
Head-strong, self-willed : Nux vom. 
Yielding disposition : Pulsat. 
Tender: Phosphor. 
Sensitiveness, nervousness : Cimic, Nux 

vom., Phosphor. 

, without complaining: Ignat. 

Nervous agitation and sleeplessness: 

Out n. ind. 



770 



MENSTRUAL AMOMALIES. 



Dizziness, vertigo: Ferrum, Phosphor., 
JPulsat. 

, , and enlarged feeling of head: 

Arg. nitr. 

Headache : Bellad., Ferrum, Nux vom. ■ 

before menses : Kreos. 

, splitting, from motion, even of eyes : 

Bryon. 

- and pain in eyeballs, worse from mo- 
tion: Cimic. 

, stitching in left side: Calc. phosph. 

, one-sided, with nausea and vomiting: 

Sepia. 

Congestion: Sepia. 

of head and chest : Calc. carb. 

, venous: Sepia. 

Heat of head, remaining body cool: Ar- 
nica. 

of top of head, or in spine : Phosphor. 

Coldness, as of ice, on top of head: Ver. 
alb. 



Darkness before eyes; enlarged pupils: 

Bellad. 
Cannot bear light or noise : Nux vom. 
Blue rings around eyes: Phosphor. 
Sunken, lustreless eyes: Arsen. 
Cold nose : Ver. alb. 
Face pale or livid : Digit. 

deadly : Ipec. 

yellowish : Crocus. 

earthy, with pain fiery-red : Ferrum. 

hippocratic: Arsen. 

sallow: Sepia, Trillium. 

yellowish : Lycop. 

yellowish, earthy: Crocus. 

, yellowish spots : Sepia. 

"White lips and tongue : Trillium. 
Profuse cold perspiration : Ver. alb. 



White coated tongue and great thirst : 

Bryon. 
Collection of slime in mouth and throat : 

Mercur. 
Loathing of all food : Sepia. 
Nausea, constant: Ipec. 
and vomiting : Apoc. cann., Cocc. cact., 

Hyosc, Kali carb. 
Vomiting, bilious: Bryon. 



Vomiting and diarrhoea at the commence- 
ment of the flow : Amm. carb., Ver. alb. 

Hiccoughing: Hyosc. 

Fits of gnawing hunger : Sulphur. 

Empty, gone feeling in pit : Ignat. 

Cramp in stomach: Arg. nitr. 

Contractive pain around the hypochon- 
dria : Rhus tox. 



Spasmodic pains in belly : Amm. carb. 

, with bearing down : Sepia. 

Labor-like pain : Ferrum. 

, followed by swooning : Lycop. 

, from small of back to genitals : Cha- 

mom. 
Colicky pains : Ferrum. 

in uterus : Cann. ind. 

Griping and rumbling before menses: 

Calc. phosph. 
Soreness of abdomen: Hamam. 
Flatulence, incarcerated: Lycop. 
Distention of abdomen : Kreos. 

, changing places: Lycop. 

Something alive, as if, in abdomen: 

Crocus. 
Pot-belliedness after confinement : 

Sepia. 



Constipation : Bryon., Nux vom., Sepia. 

, stools as if burnt : Bryon. 

, chronic, with dry, narrow stools: 

Phosphor. 

, with tenesmus : Amm. carb. 

and piles: Collins. 

and hot urine: Ferrum. 

Irritation of rectum and bladder: Eriger. 
Looseness of bowels, habitual: Pulsat. 
Diarrhoea, worse in the morning: Bryon., 

Phosphor., Sulphur. 
, with cutting pain in rectum after 

stool: Nitr. ac. 

and dysuria : Eriger. 

Itching about anus and genitals: Sulphur. 
Piles : Nux vom. 

Frequent desire to urinate: Trillium. 
Urging, but cannot pass water until a clot 

of blood is discharged : Cocc. cact. 
Urine of intolerable strong smell : Nitr. ac. 



DIGEST TO METRORRHAGIA AND MENORRHAGIA. 



771 



"Womb, chronic inflammation of: Kali 
carb. 

■ , congestion of: Arg. nitr. 

, induration of: Sejoia. 

Ovarian region painful, sensitive to 
pressure : Iodiiim. 

Bearing, pressing down: Cauloph., Cimic, 
Platina, Plumbum, Secale, Sepia. 

, , as if everything would be 

pressed out : Bellad., Sepia. 

, , dragging out feeling : Secale. 

Labor-like pain : Cann. ind., Chamom., 
Ferrum, Lycop., Pulsat. 

, from small of back to genitals : Cha- 
mom. 

, to front: Plumbum. 

, upon pelvic organs : Platina. 

External organs sensitive : Platina. 

swollen: Mercur. 

Sexual desire, nymphomania : Platina. 

Leucorrhcea : Calc phosph. 

, chronic: Sulphur. 

between menses: Kreos., Trillium. 

after menses : Calc. carb., Nitr. ac. 



Lungs, chronic catarrh : Iodium. 

Chest, fulness and pressure in: Sspia. 

, tightness in : Phosphor. 

, trembling sensation in middle of: 

Rhus fox. 

Cough, dry, hacking: Kali carb. 

, , worse before midnight : Phos- 
phor. 

Oppf ession, groaning : Bellad. 

Breathing heavy, gasps for breath : Ipec. 

short on going up stairs: Plumbum. 

Yawning : Bellad, 

Palpitation of heart: Apocyn. 

on going up stairs: Crocus. 

Cardiac anomalies : Digit. 



Back, heat in, and cold legs: Phosphor. 
, drawing, tearing in, and loins and 

hips: Rhus fox. 
Small of back, pain as if broken: Kali 

carb. 

, bruised and lame : Phosphor. 

and hips, as if falling to pieces, with 

desire to bind them up tightly : Trillium. 



Small of back, drawing, cutting, press- 
ing from, to genitals: Sabina. 

, , clawing from, to os pubis: 

Chamom. 

, cutting from, and groins : Arg. nitr. 

, pain from, through hips and down 

the thighs: Cimic. 

, , to thighs: Lycop., Sabina. 

Pain from sacrum through the pelvis 
to the pubis: Bellad. 



Arms, jerking of: Bellad. 

Hands, convulsive trembling of, and feet : 

Hyosc. 
Thumbs, convulsive clenching of: Bellad. 
Lower limbs, debility of: Arg. nitr. 

, paralytic' feeling of: Coccul. 

Cramp-like contraction of thighs: 

Rhus tox. 
Cramps in calves of legs : Secale. 
Varicose veins : Sepia. 
Swelling and painfulness of feet: 
Limbs, aching in : Cimic. 
, , and all over, worse 

Rhus tox. 

, tearing in : Bryon. 

, jerkings of: Lycop., Secale. 

, trembling of: Secale. 

, cold: Arsen., Cann. ind., Chamom., 

Ver. alb. 
and body feel as though they were 

growing larger : Platina. 



Digit. 



in rest 



Itching all over body, preventing sleep : 

Sulphur. 
Eruptions here and there, or suppressed 

eruptions: Sulphur. 
Skin dry, pale, yellowish; liver-spots: 

Plumbum. 
Spots and blisters on skin, with oozing of 

blood: Arsen. 



Chilliness, with obstinate sweating 
carb. 

from 4 p.m. 

Shudderings : Ferrum. 
Coldness of skin: Digit. 

, general : Secale. 

of hands and feet: Cann. ind. 



Kali 



772 



MENSTRUAL ANOMALIES. 



Coldness of extremities : Chamom. 
Heat, or flushes of heat : Sulphur. 
Perspiration cold on face : Mercur. 
, obstinate, with chilliness : Kali can 



Sleepiness during day: dale. phosph. 
Sleep heavy, unrefreshing, full of dreams : 

Rhus tox. 
restless, with dreams falling from a 

height: Lycop. 
Sleepless and nervous agitation: Cann. 

ind. 
, tossing in bed from evening until 

after midnight: Trillium. 
on account of itching : Sulphur. 



Vascular excitement : Cauloph. 

and spasmodic jerkings of body : 

Hyosc. 

Nervous excitement : Crocus. 
Anaemia: Calc. carb., China, Hamam. 
Debility : Apoc. cann., Cauloph., Crocus, 

Plumbum. 
Fainting : China, Mercur. 

when raising head from a pillow: 

Apoc. cann. 

from little exertion : Sepia. 

Losing flesh : Phosphor. 

, notwithstanding good appetite: 

lodium. 
Hysteric spasms : Cimic. 
Scrofulous diathesis: Calc. carb. 
Psoric taint : Sulphur. 
Gouty diathesis: Sabina. 

CAUSES. 

Abortus, threatening or actual : Cauloph. , 



Chamom., Eriger., Kali carb , Plumbum, 
Rhus tox., Sabina, Trillium. 
Abortus or confinement: Bellad., Cauloph., 
Crocus., Ipec, Nitr. ac, Sabina, Platina. 

, after taking away placenta: 

Ipec. 

Difficult labor, or external injury: 
Arnica, 

Straining, lifting : Rhus tox. 

, , overheating: Crocus. 

During pregnancy : Phosphor., Platina. 

, at fifth or seventh month : Sepia. 

Climacteric age : Calc. carb., Kreos., La- 
ches., Nux vom., Plumbum, Secale, Sepia, 
Ustil. 

Between menses : Phosphor. 

After mental excitement, emotions: 

Ignat., Platina. 
After abuse of chamomile tea: Ignat, 

Pulsat. 

coffee, liquors, high-seasoned food, 

drugs ; sedentary life, etc. : Nux vom. 



Worse from slightest motion: Crocus, 

Sabina, Secale, Trillium. 

rising upon the feet, gushing : Coccul. 

walking : Sabina. 

when lying down : Amm. carb., Cocc. 

cact., Cyclam., Kreos. 
Better when moving about : Cocc. cact., 

Cyclam., Kreos. 
Worse in evening : Pulsat. 

at night: Amm. carb. 

after riding in cold air : Amm. carb. 

in warm temperature: Sabina. 

in cold : Nux vom. 

Better in the cool: Sabina, Secale. 



2. Amenorrhoea 

Consists of the absence of menstruation in women between the ages of puberty 
and climaxis, with the exception of the periods of pregnancy and nursing. 
The non-appearance of the menses at the age of puberty has its cause chiefly 
in chlorosis, scrofulosis, tuberculosis and rachitis. Rarer are those cases in 
which it depends upon a degeneration of the ovaries; more frequent those 
depending upon chronic infarctions or catarrhal processes of the womb in 



AMENORRHEA. 773 

consequence of the above-stated constitutional diseases. It has been ob- 
served, likewise, as a consequence of spinal diseases, imperforation of the 
hymen, and closure of the os uteri. 

The cessation or suppression of the menses is usually a consequence of 
inflammatory processes, the causes of which have been detailed under the 
head of Metritis. 

Vicarious menstruation is that peculiar anomaly of the menstrual func- 
tion, by which, at the regular monthly period, hemorrhage takes place, not 
through the womb, but by means of some other mucous membrane (nose, 
lungs, bowels, eyes, ears), from wounds and from telangiectasias. The reality 
of such abnormal action is established beyond any doubt. 

The Symptoms of amenorrhea consist chiefly of headache, especially on 
the top or on one side; heaviness of the feet; dyspnoea; dyspepsia; lassitude; 
sadness ; sleepiness in the daytime ; oedema ; palpitation of the heart ; epis- 
taxis; haemoptysis; haematemesis ; swelling of the veins on the lower ex- 
tremities, in combination with all the constitutional signs upon which the 
whole disturbance rests as a basis. 

THERAPEUTIC HIFTS.— Aeon., during puberty frequent bleed- 
ing of the nose ; great palpitation of the heart ; congestion of the head. After 
fright or taking cold. 

Apis, in young girls, who are constantly busily engaged in this or that, 
bat do nothing right; who let everything fall out of their hands or break it, 
and laugh over it ; also great congestion of the head, and even delirium ; 
©edematous swelling of the lower extremities. 

Apoc, in young girls, attended with bloating of the abdomen and ex- 
tremities. ^ 

Bellad., haBmatemesis instead of the monthly discharge; congestion to 
the head. 

Bryon., bleeding of the nose instead of the monthly flow. 

Calc. carb., in young girls of a plethoric habit, or a scrofulous diathe- 
sis, with different complaints, as if the menses would set in, but do not; sup- 
pression of the menses from working in water, with anasarca. 

Carb. veg., at the time the menses should appear, violent itching 01 
old tettery eruptioDs. 

Caustic, epileptic fits during the time of puberty. 

China, after suppression by chagrin; secretion of milk in the breasts. 

Cimicif., in suppression from a cold, mental emotions and febrile 
symptoms ; when rheumatic pains in the limbs, or intense headache, or uter- 
ine spasms are present. 

Coccul., instead of the monthly flow: cramps deep in the abdomen; 
pressure in the chest ; dyspnoea; groaning and moaning; great weakness, so 



774 MENSTRUAL ANOMALIES. 

that the patient is scarcely able to speak ; paralytic feeling in the lower ex- 
tremities. 

Cyclam., chlorotic state; great dizziness and headache. 

Cuprum, typical paroxysms of the most violent cramps in the abdo- 
men, extending up into the chest, with nausea, retching and vomiting; con- 
vulsive motions of the limbs, with piercing shrieks. 

Digit., age of puberty; dark red, bluish color of the face; distended 
veins on eyes, ears, lips and tongue; constant yawning; irregular action of 
the heart; suffocating feeling in bed; frequent desire to urinate; leucor- 
rhoea; painful and swollen feet and limbs, with paralytic feeling in them. 
Bloody expectoration or nosebleed. 

Graphit., after Pulsat. ; congestion of the head and chest; dark red- 
ness of the face ; constriction of the chest, when lying, with anxiety ; itching 
between the fingers, and tetters; nails grow thick and crooked; the limbs 
upon which she lies go to sleep. 

Ham am., vicarious bleeding from nose or stomach, with great con- 
stipation and varices on the legs. 

Kali carb., age of puberty; spasms of the chest; swelling of the face, 
especially over the eyes ; stiffness and pain in the small of the back ; dryness 
of the skin ; is easily frightened ; sleepless after 3 o'clock a.m., feeling worse 
in all respects at that time. Spitting of blood before the menses; corroding 
leucorrhoea ; pain in the anterior part of the thigh. 

Laches., nosebleed and cardialgia instead of menses. 

Lycop., suppression from a fright; great agitation of the blood in the 
evening, or a feeling as though circulation had ceased ; great desire for sweet 
things ; sour belching ; great fulness in the stomach and bowels ; liver spots 
on the chest. 

Mercur., cessation of the menses for several months; headache; weak- 
ness of sight; nervous trembling of the hands; earthy color of the face; pro- 
lapsus uteri ; diarrhoea with tenesmus ; ©edematous swelling all over ; tearing 
in the limbs, worse at night in bed, with constant sweating. 

Millef., haemoptysis. 

Natr. mur., age of puberty; melancholy and sadness, or hastiness and 
impatience; awakes with headache; has frequent fluttering of the heart ; the 
tongue is covered with small blisters, or shows the appearance of a so-called 
map-tongue; the bowels are costive and move with great difficulty, and there 
is cutting pain in the urethra after urination. 

Phosphor., menses too late, or not appearing; tight feeling in the 
chest, with dry, tight cough, and spitting of blood, worse before midnight; 
bloatedness below the eyes ; a great deal of vertigo ; leucorrhoea during the 
menses. 

Platina, menses suppressed after a voyage. 



AMENORRHEA. 775 

Pulsat., age of puberty, or suppression, especially from getting the feet 
wet; nervous, timid, tearful disposition; always anxious about domestic 
affairs ; pale, yellowish color of ths face ; dyspeptic feelings from eating pork 
or anything fat; inclined to looseness of the bowels; thirstlessness and chilli- 
ness; always feels worse in a warm room; haemoptysis, hsematemesis. 

Rhus tox., suppression from getting wet. 

Senecio gracilis, suppression; inability to sleep, nervous irritability; 
loss of appetite ; coated tongue ; bowels constipated ; constant feeling of lassi- 
tude; disinclined to move about; wandering pains in back and shoulders. 
Is called " the female regulator." 

Sepia, age of puberty or later; headache, with nausea; jerking with 
the head; paralytic sinkiug down of the eyelids; yellowness around the 
mouth, across the cheeks and nose ; loathing of all food, even the smell of 
cooking nauseates her; nausea when riding in a carriage; diarrhoea after 
drinking milk; cold hands and cold feet, with frequent flushes of heat to the 
head and face; pot-belliedness. Spitting of blood before the menses ; leucor- 
rhcea three days after menses. 

Sulphur, great congestion to the pelvic organs and to the head; cold 
feet, and heat on the top of the head ; the patient is very irritable, and in- 
clined to religious reveries; chronic inflammation of the eyelids, or other 
psoric eruptions; dreads to wash with cold water; feels exhausted from talk- 
ing; all worse when standing; sleepy in the daytime; sleepless at night; 
great agitation of the blood in the whole body. 

Xanthox., after getting the feet wet; nauseated by the sight of food; 
constipated, nervous, discouraged ; shortness of breath ; legs swollen. ( J. W. 
Davis.) 

Digest see under Dysmenorrhea. 

3. Dysmenorrhea, Menstruatio Difficilis. 

We understand by this, painful menstruation, without regard to the 
quantity of blood discharged, though in most cases the menstrual flow is 
scanty. 

The different complaints accompanying it set in either before or at the 
time when the menstrual discharge begins, and generally last a day or two, 
and sometimes through the whole menstrual period. 

We distinguish, according to its causes, three forms of dysmenorrhoea : 

1. Dysmenorrhoea in consequence of structural changes or flexions of the 
uterus, which has been termed by some writers mechanical dysmenorrhoea; 
compare the related chapters. 

2. Dysmenorrhoea in consequence of congestion in the uterus, or con- 
gestive dysmenorrhoea; it usually commences with all the signs of congestion 



776 MENSTRUAL ANOMALIES. 

to the pelvic organs — strong action of the heart, congestion of the head, and 
febrile motions in general. These symptoms continue one, two, or three days, 
until a more profuse discharge of blood has taken place. Not only plethoric 
individuals are prone to it, but also weakly and ansemic individuals. It is 
possible that, in some instances, this congestive state is induced by a thickened 
state of the peritoneal covering of the ovaries, and the consequent difficult 
perforation of a Graafian- follicle. Very violent congestion may cause an 
exudate between the mucous lining and the parenchyma of the uterus, in 
consequence of which portions of the loosened membrane are thrown off and 
discharged — membranous dysmenorrhea. 

3. Dysmenorrhea in consequence of a morbid sensibility of the nervous 
system in general and the uterine nerves especially, or neuralgic dysmenorrhea. 
This manifests itself as a disturbance in the healthy equilibrium of the 
mind's action and a dejection of spirits, which commences even before the 
menses ; the menses are attended at their beginning with distressing pains in 
the uterine region, in the back and lower extremities, or with neuralgic pains 
in more distant organs, or with cramps, spasms, etc. It is quite possible that 
in some cases the violent, spasmodic, labor-like pains in the womb are caused 
by a spasmodic closure of the os uteri. 

THERAPEUTIC HINTS.— Compare the foregoing chapters, and 
likewise those on Metritis and Displacements of the Womb. 

Aeon., congestive type, with violent backache; labor-like pressing in 
the womb; headache; restlessness; necessity to bend double on account of 
pain, but finds no relief in any position ; tossing about. 

Amm. carb., cramp-like pain in the womb before the flow, with pallor 
of face. (Talbot.) 

Apis, congestive type; violent, labor-like, bearing-down pains, followed 
by discharge of scanty, dark, bloody mucus; stinging pain in the ovaries; 
scanty, dark urine; wax-colored skin. 

Arsen., attended with various kinds of complaints; lancinations from 
the rectum to the anus and pudendum ; toothache ; restlessness ; fear of being 
left alone; the pains are worse about midnight, seem intolerable, drive to 
despair and frenzy ; external application of warmth relieves. 

Asclep. syr., neuralgic type; intermitting, bearing-down, labor-like 
pains, accompanied with a copious discharge of urine. 

Bellad., congestive and neuralgic type; violent bearing down, as if 
everything would issue out; violent throbbing headache, better from external 
pressure; throbbing toothache ; enlarged pupils; throbbing carotids, drowsi- 
ness and inability to go to sleep ; spasmodic twitchings ; delirium ; rage ; 
frenzy ; wants to bite ; tries to escape, etc. 

Bromium, violent contractive spasms some hours after the commence- 



DYSMENORRHEA. . 777 

ruent of the menstrual flow, with subsequent soreness in the abdomen ; loud 
emissions of flatulence from the vagina; hard swelling in the ovarian region; 
blue-eyed persons. 

Bryon., congestive type; tearing in all the limbs, aggravated by mo- 
tion ; great thirst, white tongue ; constipation, or diarrhoea in the morning ; 
great irascibility. 

Calc. carb., various complaints; toothache after the menses; nervous 
debility ; pale bloatedness of the face ; cannot bear anything tight around the 
waist ; stiflhess of the nape of the neck ; pain in the back ; cold hands and 
feet; sensitiveness to cold air; bad consequences from washing; scrofulous 
individuals. 

Calc. phosph., when during puberty the patient has not been careful, 
and dysmenorrhea has resulted from these causes. (J. T. Kent.) 

Cact. grand., menstruation with most terrible pains, causing her to 
cry out aloud and to weep ; the pains come on periodically, mostly in the 
evening ; the menses are scanty and cease flowing when lying down ; con- 
strictive pain in the region of the heart, a feeling as if the heart were grasped 
and compressed, as by a band of iron. 

Cauloph., painful contractions, congestion and irritability of the 
womb ; scanty flow ; sympathetic cramps in the bladder and rectum ; hysteri- 
cal spasms of chest and larynx. 

Chamom., neuralgic type; drawing, clawing pain from back towards 
front, with discharge of dark, clotted blood; great impatience, with crying 
and screaming; bloated, red face, or one side red and the other pale; hot, 
sticky perspiration on the forehead; after chagrin. 

Cimicif., aching in the limbs; severe paius in the back, down the 
thighs and through the hips, with heavy pressing down ; labor-like pains ; 
weeping mood; nervousness; hysteric spasms, cramps; tenderness of the 
hypogastric region ; scanty or profuse flow of coagulated blood ; between the 
menses, debility, neuralgic pains, tendency of prolapsus. 

Coccul., cramp-pain deep in the bowels, instead of the monthly, with 
pressure in the chest, and anxiety, sobbing, moaning and groaning; great 
weakness and fainting spells ; convulsive motions of the limbs whenever she 
wants to use them ; after night-watching. 

Collin., when complicated with obstinate constipation, piles and pro- 
lapsus. 

Coloc, she draws the lower limbs up to the abdomen, to relieve the 
colicky pain ; diarrhoea after indignation. 

Conium, scanty menses; pressing downwards and drawing in the 
thighs; pain in the mamma; suppressed sexual instinct; hysteric globus in 
the throat ; vertigo, especially when turning the head or lying down. 

Cuprum, typic paroxysms of terrible cramps in the stomach, extending 



778 MENSTRUAL ANOMALIES. 

to the chest, with nausea, retching and .vomiting; also, general epileptiform 
spasms, with piercing shrieks; great thirst; on swallowing any fluid there is 
an audible clucking noise in the throat, like that of emptying a bottle. 

Graphit., scanty menses, with crampy pains in the bowels and chest, 
and labor-like pressing in the small of the back ; she is full of despairing 
grief, with weeping; always wavering and hesitating; has vertigo unto 
falling, and headache unto fainting, in the morning; pimply eruptions on the 
face about the monthly period; tettery eruptions, especially between the 
fingers, with great itching. 

Hamam., severe pains through the lumbar and hypogastric regions, 
and down the legs ; fulness of the bowels and brain, with severe pain through 
the whole head, resulting in stupor and deep sleep ; varicosed veins on the 
legs ; vicarious menstruation. 

Laches., tearing in the abdomen, beating in the head, pain in the 
small of the back,, and bruised feeling in the hips; all relieved by a full 
flow; bleeding of the nose before the menses; jealous disposition; craves 
coffee, and feels better after drinking it ; ulcers on the legs, with a purplish 
circumference. 

Lauroc, pain extending from sacrum to pubis; frontal headache, with 
dizziness and dimness of vision; great melancholy; icy-coldness of tongue, 
and coldness of extremities. (Osborn.) 

Magn. carb., during the pain no flow; flow more during night than 
during day; the blood is dark, acrid and thick; violent neuralgic pain in 
the face, right side, driving out of bed ; or pain in the right shoulder or in 
the foot. 

Natr. mur., menses scanty and dark; preceded by frontal headaches; 
often subject to fever-blisters on lips, and during summer to urticarious erup- 
tions. (R. E. Bilding.) 

Nux mosch., after suppression by bathing; fainting from pain; drow- 
siness, somnolence; changeable mood; does not know where she is; appears 
to herself as if changed to her surroundings ; hands and feet icy-cold. 

Nux vom., twisting pains moving about in the abdomen, with sickness 
of the stomach ; crampy and stitching pains in the pelvic region ; soreness 
across the pubis; cramps in the bladder; constant, unsuccessful urging to 
defecate ; after all sorts of drugs and so-called pain-killers. 

Phosphor., colicky pains; great fermentation in the bowels; a great 
deal of vertigo; chronic looseness of the bowels; or chronic constipation, 
with dry, narrow feces ; slender-built women. 

Plat in a, great bearing down to the genitals, with profuse menstrua- 
tion ; great fear of death ; sadness and disposition to cry ; or haughty dis- 
position ; tetanous-like convulsions. 

Pulsat., colicky pains, with tossing about; the blood flows by fits and 



DIGEST TO AMEXORRHCEA, DYSMENORRHEA. 7 (9 

starts; chilliness; thirstlessness ; haemoptoe or hseniaternesis ; paleness of the 
face; mild, yielding, tearful disposition. 

Senecio, cutting pains in the region of the sacrum, hypogastrium and 
groins, with too early or too profuse menses ; she is pale, weak and nervous, 
and has a slight cough at night. 

Sepia, colicky pains and scanty discharge; great bearing down, which 
obliges her to cross the limbs; morning sickness and great sensitiveness 
against any smell from cooking; toothache; half-sided headache; nausea; 
constipation. 

Sulphur, scanty menses of a thick, acrid blood; crampy colic; terrible 
neuralgic pains in the face; much concerned about her salvation; congestion 
to the head and heat on the top of it; spotted redness of the face; cold feet; 
standing increases the pains; chronic eruptions here and there. 

Tarant., before menses bearing-down pain; fidgety of legs ; must move 
about; better on riding horseback ; during menses all worse with chorea-like 
restlessness, trembling and twitching of muscles. (P. Bender.) 

Viburn. op., before menses pain in back, gradually extending to hypo- 
gastric region and down the thighs ; headache with nausea and uneasiness ; 
cramps and bearing down before discharge appears, lasting till after the flow 
has ceased. (J. C. King.) 

Xanthox., neuralgic fever with pain along the course of the genito- 
crural nerve. (E. F. Blake.) Abundant discharge. 



Digest to Amenorrhea, Dysmenorrhea. 

Stupor and deep sleep : Hamam. I Sad : Natr. mur., Platina, Pulsed. 

Does not know where she is ; appears "Weeping mood : Cimic., Platina. 

to herself as if changed to her surround- Melancholy : Lauroc., Natr. mur. 

ings: Nux moseh. 
Religious reveries: Sulphur. 
Delirium : Apis, Bellad. 
Frenzy: Arsen., Btllad. 
Rage, wants to bite; tries to escape: 

Bellad. Despairing grief: Graph-it. 

Busy without accomplishing anything; Fear of being left alone : Arsen. 

let things drop out of their hands and : of death: Platina. 

laugh over it : Apis. Changeable mood : Nux mosch. 

Hasty and impatient: Natr. mur. Yielding, mild disposition: Pulsat. 

Groaning and moaning: Coccul. \ Wavering, hesitating: Graphit. 

Cry out and weep for pain : Cact. grand. Irritable : Senec, Sulphur. 

Weeping: Graphit. Impatient irascibility: Bryon., Chamom. 



Anxiety: Coccul., Graphit. 

about domestic affairs : Pulsat. 

about her salvation: Sulphur. 

Discouraged : Xanthox. 
Despair from pain : Arsen. 



Crying, screaming: Chamom. Jealous: Laches. 

Tossing about, beside herself from pain: j Haughty : Platina. 
Aeon. Nervous: Cimic., Pulsat., Secale, Senecio. 



780 



MENSTRUAL ANOMALIES. 



Easily frightened : Kali carb. 



Vertigo: Phosphor. 

unto falling : Graphit. 

when turning head or lying down : 

Conium. 

and headache : Cyclam. 

unto fainting, worse in morning : 

Graphit. 
and frontal headache, with dimness 

of vision : Lauroe. 
Fulness of brain with headache, result- 
ing in stupor and deep sleep : Hamam. 
Congestion to head: Aeon., Apis, 

Bellad. 
and heat on top, and cold feet: 

Sulphur. 

■ and chest : Graphit. 

Flushes of heat to head and face : Laches., 

Sepia. 
Headache : Aeon , Cimic., Mercur. 

, throbbing, beating: Bellad., Laches. 

, , worse from external pressure: 

Bellad. 

, frontal : Natr. mur. 

, half-sided : Sepia. 

, awakens with : Natr. mur. 

, with nausea and jerking of head: 

Sepia. 

, and uneasiness : Viburn. op. 

Hot, sticky perspiration on forehead: 

Chamom. 



Distended veins on eyes, ears, lips and 

tongue: Digit. 
Paralytic sinking down of lids: Sepia. 
Chronic inflammation of lids, and other 

psoric eruptions : Sulphur. 
Enlarged pupils : Bellad. 
"Weakness of sight: Mercur. 
Dimness of vision: Lauroe. 



Nosebleed: Digit. 

during puberty: Aeon. 

before menses : Laches. 

instead of menses : Bryon., Laches. 

, vicarious, or hsematemesis : Hamam. 

Cold nose : Bellad. 



Face flushes frequently : Sepia. 

dark red : Graphit. 

, bluish: Digit. 

red on one side and pale on other : 

Chamom. 

spotted redness : Sulphur. 

pale, pallor : Amm. carb., Calc. carb., 

Pulsat. 

earthy color : Mercur. 

yellow: Pulsat. 

■ around mouth, across cheeks 

and nose : Sepia. 

bloated and pale : Pulsat. 

and red : Chamom. 

above eyes: Kali carb. 

below eyes : Phosphor. 

, pimply eruptions about monthly 

period: Graphit. 

, fever blisters on lips : Natr. mur. 

, neuralgia, terrible : Sulphur. 

, on right side, driving out of 

bed : Magn. carb. 



Tongue coated: Senec. 

white, with thirst: Bryon. 

covered with blisters : Natr. mu 

, map-tongue: Natr. mur. 

, distended veins on : Digit. 

icy cold: Lauroe. 

Toothache : Arsen., Bellad., Sipia. 
after menses : Calc. carb. 



Thirst; on swallowing audible clucking 
noise in throat : Cuprum. 

Thirstless : Pulsat., Sspia. 

Craves coffee and feels better after drink- 
ing it : Laches. 

sweet things : Lyeop. 

Loss of appetite : Senec. 

Loathing of all food : Sepia. 

Nausea when smelling cooking : Sepia. 

when seeing food : Xanthox. 

when riding in a carriage : Sepia. 

, with twisting pains in bowels : Nux 

vom. 

Heematemesis instead of menses : Bellad., 
Hamam., Pulsat. 

Sour belching : Lycop. 






781 



Dyspeptic feeling from eating pork or 

fat: Pulsat. 
Fulness in stomach and bowels : Lycop. 
Cramps in stomach, extending to chest, 

with nausea, belching and vomiting : 

Cuprum. 
Cardialgia instead of menses: Laches. 



Cannot bear anything tight around the 

waist : Cede. carb. 
Tenderness of hypogastric region : Cimic. 
Pains through hypogastric and lumbar 

region down the legs : Hamam. 
Fulness of bowels : Hamam. 
Colicky pains : Sulphur. 

and fermentation in bowels: Phos- 
phor. 

and scanty menses : Sepia. 

, must bend double : Aeon. 

, must draw lower limbs up to ab- 
domen: Coioc. 

,with tossing about : Pulsat. 

Cramp-pain, deep in abdomen, instead of 
menses : Coccul. 

in bowels and chest, and pressing 

down in small of back : Graphit. 

and bladder and rectum : Cau- 

loph . 
, extending to chest, with nausea, 

retching and vomiting : Cuprum. 

before and during menses: Viburn. 

Contractive spasms some hours after 

commencement of flow : Bromium. 
Cutting pains in hypogastrium, sacrum 

and groins : Senec. 
Tearing in abdomen : Laches. 
Lancinations from rectum to anus and 

pudendum: Arsen. 
Bloating of abdomen and extremities in 

young girls : Apoc. 
Pot-belliedness : Sepia. 
Constipation : Hamam., Senec., 

Xanthox. 

, dry, narrow feces: Phosphor. 

, bowels move with difficulty 

mur. 

■ , with piles and prolapsus: Collins. 

, or diarrhoea in the morning : Bryon. 

Diarrhoea : Phosphor., Pulsat. 



Sepia, 



Natr, 



Diarrhoea with tenesmus : Merc, sol, 

after indignation : Coloc. 

after drinking milk : Sepia. 

Constant unsuccessful urging to 
cate : Nux vom. 



defe- 



Urine copious : Asclep. 

Frequent desire : Digit. 

Cutting in urethra after urination : Natr. 

mur. 
Urine scanty, dark : Apis. 
Soreness across pubis, and cramps in 

bladder : Nux vom. 

Bearing down : Aeon., Bellacl., Cimic. 

, must cross her limbs : Sepia. 

, intermitting : Asclep. 

in small of back : Graphit. 

, with discharge of dark, clotted 

blood: Chamom. 

and drawing in thighs : Conium. 

before menses : Tarant. 

and during menses: Viburn. 

, followed by discharge of scanty, dark, 

bloody mucus: Apis. 

, with profuse menstruation : Platina. 

Painful contractions : Cauloph. 

Cramp -like pain in womb before the 
flow: Amm. carb. 

Crampy and stitching pain in pelvic re- 
gion : Nux vom. 

Stinging pain in ovaries : Apis. 

Hard swelling in ovarian region: Bryon. 

Neuralgia along the genito-crural nerve : 
Xanthox. 

Congestion and irritability of womb : 
Cauloph. 

of womb and head : Sulphur. 

During pain no flow ; more flow during 
night than during day: Magn. carb. 

Blood flows by fits and starts : Pulsat. 

Menses too late or not appearing: Phos- 
phor. 

Instead of menses, itching of old tettery 
eruptions: Carb.veg. 

, cramp-pain deep in bowels: Coccul. 

, different complaints: Cole. carb. 

Menses scanty: Cauloph., Cimic, Co- 
nium, Graphit. 



782 



MENSTRUAL ANOMALIES. 



Magn. 



Menses scanty, dark: Natr. mur. 
, , acrid and thick: 

carb., Sulphur. 

, , bloody mucus : Apis. 

, cease flowing when lying down : 

Cact. grand. 

profuse : Platina, Xanthox. 

, coagulated blood : Clmic. 

and too early : Senec. 

suppressed : Cale. carb., Mercur., Senec. 

by chagrin : China. 

by fright : Lycop. 

by mental emotions, a cold and 

febrile symptom : Cimic. 

from getting feet wet : Pulsat. 

from working in water : Cole. 

carb. 

from bathing : Nux mosch. 

Between menses, debility, neuralgic 

pains, prolapsus: Cimic. 
Prolapsus uteri : Mercur. 
Leucorrhcea : Digit. 
Emissions of flatulence from vagina: 

Bromium. 
Suppressed sexual instinct: Conium. 



Cough, slight at night: Senec. 

dry, tight feeling in chest : Phosphor. 

, with spitting of blood : Digit, Millef., 

Pulsat. 

, , worse before midnight : Phos- 
phor. 

Congestion of chest and head : Graphit. 

Pressure on chest: Coccul. 

Constriction when lying, with anxiety: 
Graphit. 

Spasms of chest: Kali carb. 

and larynx : Cauloph. 

Dyspnoea: Coccul. 

Suffocating feeling in bed: Digit. 

Shortness of breath: Xanthox. 

Exhaustion from talking: Sulphur. 

Constant yawning : Digit. 

Heart, fluttering : Natr. mur. 

, palpitation: Aeon. 

, irregular action : Digit. 

constricted as if grasped by a band of 

iron : Cact. grand. 

Secretion of milk in the breasts : China. 



Liver-spots on chest: Lycop. 



Back-ache : Aeon., Calc. carb. 

, wandering back and shoulders: 

Senec. 

before menses, extending to hypo- 
gastric region and down the thighs : Vi- 
burn. 

down the thighs and through hips : 

Cimic. 

, towards front, with discharge of 

dark, clotted blood: Chamom. 

Pain in small of back, with stiffness : Kali 
carb. 

, with bruised feeling in hips : 

Laches. 

through lumbar and hypogastric re- 
gion down the legs: Hamam. 

from sacrum to pubis : Lauroc. 



Hands trembling: Mercur. 

, tetters and itching between fingers: 

Graphit. 
Nails thick and crooked : Graphit. 
Cold hands and feet: Calc. carb., Nux 

mosch., Szpia. 
Lower extremities, ©edematous swelling 

of: Apis. 

, paralytic feeling of: Coccul. 

Legs, varicosed veins of: Hamam. 

, swollen: Xanthox. 

, ulcers on, with a purplish circum- 
ference: Laches. 

, fidgety of: Tar ant. 

Feet cold : Sulphur. 

Limbs, aching, rheumatic pains : Cimic. 

, coldness : Lauroc. 

, tearing in, worse at night : Mercur. 

, , worse by motion : Bryon. 

swollen, with paralytic feeling : Digit. 

, bloating of abdomen and limbs: Apoc. 

, convulsive motions of, when she 

wants to use them : Coccul. 

, , with piercing shrieks : Cuprum. 

upon which she lies go to sleep: 

Graphit. 
Pain in right shoulder or foot: 

carb. 



DIGEST TO AMENORRHCEA, DYSMENORRHEA. 



783 



Sleepy in daytime: Sulphur. 
Drowsiness, somnolence: Xux rnosch. 
Stupor, deep sleep: Hamam. 
Drowsy, with inability to go to sleep: 

Belled. 
Inability to sleep : Senec. 
Sleepless at night: Sulphur. 



Chilliness and thirstlessness: Pulsat. 
Neuralgic fever : Xanthox. 
Constant sweating : Mercur. 



Chlorotic state : Cyclam. 
Plethoric habit: Calc. carb. 
Agitation of blood : Sulphur. 

in the evening : Lycop. 

Feeling as though circulation 

stopped : Lycop. 
Restlessness : Aeon,, Arsen, 

, must move about : Tarant. 

Disinclined to move about: Senec. 



had 



Lassitude : Senec. 

Weakness, debility: Calc. carb., Coccul. 

Fainting spells : Coccul. 

from pain : Xux rnosch. 



when 



Chronic eruptions : Sulphur. 
Old tettery eruptions, itch 

monthly should come on : Curb. veg. 
Urticarious eruptions during summer : 

Natr. mur. 
Dryness of skin : Kali carb. 
"Wax-colored skin : Apis. 
(Edematous swelling all over: Calc. 

carb.. Mereur. 



Spasmodic twitching: Bellacl, Tarant. 
Chorea-like restlessness during men- 
ses: Tarant. 
Hysteric spasms : Cimic. 



1 Tetanous-like convulsions : Platina. 
Epileptic fits during time of puberty: 

Caustic. 
Epileptiform spasms, 

shrieks: Cuprum. 



with piercing 



Scrofulous individuals : Cede. carb. 

Chlorotic state : Cyclam. 

Age of puberty : Apoc. cann., Digit., Kali 

carb., Natr. mur., Platina, Pulsat. 
Blue-eyed persons : Bromium. 
Slender-built persons: Phosphor. 
Chagrin: Chamom. 
Fright and cold : Aeon. 
Getting feet wet : Xanthox. 
Suppression of menses : Mercur., Senec. 

from working in water : Cede. carb. 

from getting wet : Rhus tox. 

from getting feet wet : Pulsat. 

from bathing : Xux rnosch. 

from cold, mental emotions, and fever: 

Cimic. 

from fright : Lycop. 

from chagrin : China. 

Worse from washing with cold water: 

Sulphur. 

from cold air : Calc. carb. 

from standing: Sulphur. 

about midnight : Arsen. 

from warm room : Pulsat. 

Better from riding on horseback: Tarant. 

from external warmth : Arsen. 

from a full flow : Laches. 



Congestive type: Aeon., Apis, Bellacl, 
Br yon. 
\ Neuralgic type: Asclep. syr., Bellad., 
Chamom. 



After Pulsat. follows Graphit. 
all sorts of drugs : Xux vom. 



784 VAGINA. 

VAGINA. 

Catarrh of the Vagina; Vaginitis. 

Like all other catarrhal affections of mucous membranes, it is character- 
ized by redness, swelling and increased secretion of mucus. There are here 
and there little protuberances, which consist of swollen papillae of the mucous 
membrane ; it invests either a part of the vagina, or extends all over the 
organ. The secretion is at first scanty, but by degrees becomes more profuse 
and opaque. In chronic cases we find the vagina relaxed, its mucous lining 
bluish-red, and studded with swollen papillae. This relaxation not unfre- 
quently leads to prolapsus vaginae. The secretion is in such cases milky, 
more or less yellow, and sometimes of other appearances. It constitutes what 
is commonly called leueorrhea, which is frequently the only sign of the exist- 
ing trouble. 

Its Causes are like those of the uterine catarrh, as recorded in their 
respective chapters ; it is of quite rare occurrence during childhood, in which 
case it may be induced by the little thread-worms (oxyures) creeping from 
anus across the perineum into the vagina. 

THERAPEUTIC HINTS —Compare Uterine Catarrh. 
The virulent catarrh of the vagina is spoken of in the chapter of Gonor- 
rhoea. 

Vaginismus 

Is defined by Schrceder as " an excessive sensitiveness of the orifice of the 
vagina, combined with spasmodic contraction of the constrictor cunni and 
the muscles of the floor of the pelvis." However, in some cases the introduc- 
tion of the finger for the purpose of examination has caused not only the 
most intense pain, but even hysterical convulsions, without contraction of the 
constrictor cunni. The anatomical changes are usually unimportant. In recent 
cases we find the affected parts usually swollen, with erosions, swelliugs of 
follicles and discharges from the mucous membrane; or papillary excres- 
cences in the fossa navicularis, all of whicn may at a later period disappear 
again. These changes are most probably the consequence of mechanical 
irritation, brought about by unsuccessful attempts at coition ; for the most 
usual source of vaginism is a small orifice and a want of moisture of the 
vagina, which, when associated with certain physical states, such as fear, 
apprehension, etc., and an existing oversensitiveness of the parts, may cause 
the whole series of distressing symptoms. Nettel mentions a case in which 
vaginismus seemed to be a symptom of lead poisoning, induced by the use of 
cosmetics. 



pruritus vulvae. 7 So 

THERAPErTIC HINTS— Coition ought not to be practiced until 
the hyperesthesia is in some measure overcome by hip-baths, injections of 
■warm water, oiling the parts, and the application either of one or the other 
of the following remedies, as indicated : 

Arnica, after forced attempts at coition. 

Bellad., dryness of the vagina; contraction of the sphincter muscle. 

Cactus grand., merely touching the parts causes constriction of the 
vagina, and prevents coition. 

Ferr. phosph., painful coition. 

Ignat., when the mental symptoms correspond, with great proneness to 
spasmodic troubles. 

Kreos., painful coition. 

Lycop., dryness of vagina, with pain during and after coition. 

Natr. mur., dryness of vagina, painful coition, and aversion to it. 

Platina, the slightest touch causes constriction of the vagina, and is so 
painful that spasms may ensue. 

Plumbum, has caused this complaint. 

Sepia, tenderness of parts; painful coition. 

Pruritus Vulvae 

Is frequently a mere symptom of other diseased conditions of the sexual 
organs. We find it in the beginning of pregnancy, and also before the men- 
strual flow ; but its most intense forms occur during the climaxis, especiallv 
of unmarried women. The itching is so intolerable and distressing that it 
takes away all sleep and rest, and causes a number of nervous complaints. 
Physical examination generally reveals no particular change of the parts, 
except perhaps some dryness of the vagina or slight eruptions on the labia. 
Such persons are often subject to hemorrhoidal complaints, and it is possible 
that this terrible itching is dependent upon a stagnation of blood in the 
vaginal veins. 

THERAPEUTIC HIXTS.-Ambra, during pregnancy, with soreness 
and swelling of the parts ; numb feeling of the whole surface of the bodv in 
the morning; perspiration of the abdomen and thighs in the daytime when 
moving about ; falling out of the hair, and great sensitiveness of the scalp 
to the touch. 

Caladium, according to the experience of others and my own the most 
efficient remedy; the terrible itching sometimes causes the habit of onanism. 

Calc. carb., itching and soreness; offensive discharge from the ears; 
cold in the head, with soreness inside of the nose ; scrofulous taint. 
50 



786 MAMMAE. 

Canthar., climacteric age; from rubbing and scratching, the skin 
swells into little tumors; urinary difficulties. 

Carb. veg., itching and burning of the pudendum and anus, especially 
before the menses ; itching, tettery eruptions on the body ; leucorrhoea, with 
burning and soreness; haemorrhoids. 

Collin., distressing itching, in connection with prolapsus and con- 
stipation. 

Conium, violent itching of the pudendum and vagina, especially after 
the menses, followed by a pressing downwards of the uterus. 

Lycop., itching, burning and gnawing, with chronic dryness of the 
vagina ; varicose veins. 

Natr. mur., falling out of the hair on the mons veneris; dryness, or 
coolness and paleness of the vagina; aversion to an embrace; eruption on 
the boundaries of the hair on the neck. 

Nux vom., tingling and itching in the parts, which excites sexual 
desire and induces onanism. 

Plat in a, when the sexual desire is greatly augmented, even to nympho- 
mania. 

Sepia, swelling and itching eruption on the inner labia; leucorrhoea, 
with itching in the vagina and pudendum ; ringworm-like eruptions on other 
parts of the body. 

Sulphur, itching in the vagina and pudendum, with pimples all around ; 
itching of the nose after menstruation ; itching of the nipples ; pimples here 
and there ; hemorrhoids. 

Tarant., dryness and heat of the parts. 

Zincum, excessive itching during the menses, inducing masturbation. 

MAMMiE. 

Mastitis, Inflammation of the Breasts. 

It develops itself chiefly during the period of nursing, and usually at 
the commencement; less frequently during weaning. Its cause is stagnation 
of milk within the gland or a tube of the gland, induced by sore or imperfect 
nipples; or weakness of the child, in consequence of which the breasts are 
not thoroughly emptied of their contents ; or undue pressure exercised upon 
the gland by misfitting dresses, producing obstructions in single tubes of the 
gland and final inflammatory symptoms. Here then we have an inflamma- 
tion of the milk-ducts of the mamms, which commences within and spreads 
outward. In other cases the inflammation begins in the subcutaneous cellular . 
tissue; a kind of erysipelatous inflammation, spreading inward, and caking 
a portion of the breast. This form may be caused by external injuries, 



MASTITIS. 787 

bruises, exposure to cold, and by fright; or it may be the result of the 
spreading of the above-named inflammation of the milk-ducts. 

It is a most painful affection in either case, and frequently results in the 
formation of abscesses. 

THERAPEUTIC HINTS.— Apis, burning, stinging pains in the 
breast; considerable swelling and hardness; erysipelatous inflammation. 

Arnica, soreness of the nipples; bruises of the breast. 

Bellad., during nursing and weaning, great hardness and swelling; 
bright redness in streaks along the milk-ducts ; throbbing, stitching pain ; 
headache ; fever ; worse in the afternoon ; bowels constipated, and urine 
scanty. 

Bryon., sets in mostly with a chill, followed by fever; great stitching 
pain in the breast, worse from slightest motion; tense swelling; little or no 
redness; bursting pain in the head when rising, with dizziness; great thirst; 
thick-coated tongue ; constipation ; feces as if burnt ; pain in all the limbs 
when moving. 

Graphit., inflamed, cracked nipples; tettery eruptions on the scalp, 
hands and between the fingers ; indurated Meibomian glands ; old cicatrices 
from former inflammations. 

Hamam., bleeding nipples, with great soreness. 

Hepar, pain in the upper arms and thighs, as if in the bones; great 
hastiness in drinking and speaking; also in persons who have taken a great 
deal of mercury ; when suppuration commences with frequent crawls, or 
when, after the breaking or opening of the abscesses (which latter, indeed, 
never ought to be done) the discharge is scanty, and there still remains great 
hardness of the inflamed parts. 

Laches., when the inflamed breast has a purplish appearance. 

Mercur., especially when after Bellad., noth withstanding, suppuration 
sets in; chilliness and profuse sweat, which does not relieve; great nervous 
weakness and trembling; also in cases where suppuration takes place in 
different parts of the breast. 

Nux vom., nipples painful during suckling, with little or no soreness 
or rawness. 

Phosphor., phlegmonous inflammation; breast swollen; red in spots 
or streaks; hard knots in different places, with fistulous opening, discharging 
a watery, discolored, offensive ichor; dry, hacking cough, with hectic fever 
and colliquative sweats; slender-built women, with a white and tender skin; 
weakened by disease or loss of fluids. 

Phytol., sore and fissured nipples, with intense suffering when putting 
the child to the breast ; the pain seems to start from the nipple and irradiate 
all over the body, going to the backbone, and streaking up and down, with 



788 MAMM.E. 

excessive flow of milk, causing great exhaustion ; a few days after confine- 
ment sudden chill, followed by some fever and a painful engorgement and 
swelling of the mammae; the drawing of milk is impossible. In ordinary 
caked breasts it is called specific. Badly-treated "gathered breasts," with 
large, fistulous, gaping and angry ulcers, filled with unhealthy granulations 
and discharging a watery, fetid, ichorous pus; the gland is full of hard, pain- 
ful nodosities. 

.Rhus tox., soreness and swelling of the breast from taking cold, 
especially getting wet ; pain in all the limbs ; worse when at rest ; great rest- 
lessness; the lochial discharge turns red again. 

Silic, chronic cases; when Phosphor, is not sufficient to heal the fistu- 
lous opening, with callous edges, or to disperse the hard lumps in the breast ; 
pale, earthy color in the face ; loss of smell ; hectic fever. 

Sulphur, sore and cracked nipples, with bleeding when nursing, the 
areolae are covered with yellowish scales, from underneath of which oozes an 
acrid fluid, with itching and burning in the night; hard lumps in the 
breast ; ulcerating sore, with spongy excrescences and great itching ; sleep- 
less nights. 

Scirrhus seu Carcinoma Mammae, Scirrhus, or Cancer of 

the Breast. 

The scirrhous form is the most frequent ; it appears either deep in the 
gland or nearer the surface, as a roundish tumor, which draws the region of 
the nipple inward, causing a navel-like depression by its gradually degener- 
ating the surrounding tissue, and its adhesion to . the external skin. Its 
development is slow, but terminates finally in a deep ulcer, with callous, 
exuberant edges, a foul, fungous opening. 

The medullary cancer is of rare occurrence. It appears as one or several 
tumors, which destroy in a short time the surrounding parts of the gland, by 
ulcerating and producing fungous growths. 

The development of cancerous growths rest upon a constitutional con- 
tamination, the nature of which we do not know. Its development is, in 
most cases, slow, often intermitting, making halts for a long time. Finally, 
it perforates the skin, and appears as an open cancer, making rapid strides 
to final destruction, 

It is generally found in one breast at a time; sometimes in both, and 
often combined with scirrhous degeneration in other parts of the system. It 
causes the most intense, burning, stinging, lancinating pains, which deprive 
the patient of sleep and rest. The open ulcer discharges profusely an offen- 
sive ichor, or it bleeds easily and profusely when, by erosion, blood-vessels 
become destroyed. The nutritive action of the system is completely pros- 



SCIKRHUS. 789 

trated, and we see the patient gradually lose strength and sink, with symptoms 
of marasmus, oedema of the lower extremities, colliquative diarrhoea or a 
sudden profuse haemorrhage from the ulcer. 

THERAPEUTIC HINTS.— Apis, when there is stinging, burning 
pain, whether in scirrhous tumors or in open cancers ; pain in the ovarian 
region, with bearing down; scanty, dark urine; oedema of the lower ex- 
tremities. 

Arsen., nightly, burning pain like fire, with great restlessness; loss of 
strength and emaciation ; the pains grow better from the external application 
of warmth. 

Ars. jod., with swelling of gland in axilla. 

Asterias rub., recommended by Petros for cancers of the left breast. 

Badiaga ought to be thought of, at least. 

Bellad., scirrhous tumors, with erysipelatous inflammation and stitch- 
ing pain ; frequent bearing down in the genital organs. 

Bromium, after the extirpation of a hard tumor in the left breast, 
there appears a hard, uneven tumor in the right breast, which is grown tight 
to its surroundings ; periodical lancinating pains, especially at night, worse 
from external pressure; grayish, earthy complexion of the face; suppression 
of menses ; emaciation, and great depression of spirits. 

Calc. carb., indurations of the breast; too early and too profuse men- 
struation ; soreness and swelling of breast before the menses. 

Calc. ox., has, more than any other remedy, relieved the terrible pains 
in open cancers. 

Carb. an., scirrhous tumor, hard and uneven; the skin over it is loose, 
on places of a dirty, blue-red appearance ; the pains are burning and draw- 
ing toward the axilla ; oppression of the chest ; nightly perspiration of the 
thighs only; desponding. 

Chim. umb., tumor broke and left a small, irregular ulcer, with 
worsted edges, sloughing, discharging fetid pus; axillary glands enlarged. 
(E. S. Coburn.) 

Clem at., scirrhus, left side, with stitches in the shoulder; or when the 
whole gland is very painful, worse in cold weather and during the night; 
worse during the growing moon ; while perspiring, she cannot bear to be un- 
covered. 

Conium, particularly, if the origin of the tumor can be traced to a 
bruise ; starting, lancinating pains. 

Graphit., when the tumor grows out of old cicatrices, which have been 
formed by repeated gatherings of the breast. 

Hydrast., scirrhous tumor; hard, heavy, and adherent to the skin, 



790 MAMMiE. 

which is dark, mottled and very much puckered; the nipple being retracted; 
pains like knives thrust into the part ; cachectic appearance of the face. 

Laches., tumor in left breast, with lancinating pain; in consequence 
of pressure upon the tumor the pain extends into the left shoulder and down 
the arm ; there is a constant painful feeling of weakness and lameness in the 
left shoulder and arm, which is aggravated by using the arm. In open can- 
cer, when it has a dark, bluish-red appearance, with blackish streaks of co- 
agulated and decomposed blood ; chronic leucorrhcea ; painful menstruation 
on the first day. 

Lapis alb., recommended by v. Grauvogl. 

Lycop., hard tumors, with stitching or cramping pain; circumscribed 
redness of the face; worse from 4 o'clock p.m. ; during the paroxysms of 
pain she is obliged to walk about and to weep; she feels better in the 
open air. 

Nitr. ac. (Woodward.) 

Phosphor., when the ulcer bleeds easily. 

Sepia, indurations in the breast and ovaries; yellow, spotted face; 
chronic leucorrhoea. 

Silic, with great itching of the swollen gland. (J. B. Bell.) 

Compare besides, Aur. mur., Baryta, Carb. veg., Chamom., Cistus, 
Hamam., Hepar, Natr. mur., Nitr. ac, Phytol., Kumex, Sulphur, Thuja, 
Zincum. 



SPINE. 



Anaemia 

Is a diminution in the amount of blood contained in the cord, either in con- 
sequence of an insufficient supply of arterial blood, or in consequence of gen- 
eral anaemia. The insufficient supply may be due to weakness of the heart's 
impulse, to compression, thrombosis or embolism of the abdominal aorta, or of 
certain spinal arteries. General ancemia may be the consequence of great loss 
of blood, severe acute diseases, inanition, etc. 

Embolism of the aorta is usually followed by a rapid palsy of the legs, 
sphincters, reflex function, etc. ; while in compression of the aorta the symp- 
toms of paralysis keep pace with the gradual development of the constriction. 
Anaemia caused by thrombosis and embolism of small arteries, gives rise 
probably to mere local and subordinate symptoms, of which nothing is known 
definitely. 

If general anaemia be the cause of spinal anaemia, the symptoms of the 
latter will be so covered by the general complex of symptoms, that it will be 
hard to say what belongs to the one or the other, although motor weakness and 
slight tremor after exertion, later paresis and finally paralysis, first of the 
lower limbs and extending upwards to trunk and arms, may be attributed to 
spinal anaemia. The symptoms usually are relieved in a horizontal position. 

THERAPEUTIC HINTS— We will have to consider the various 
causes. There may be indicated: Arsen., Calc. carb., China, Cimicif., Fer- 
rum, Gelsem., Ignat., Nux vom., Phosphor., Phosph. ac, Secale, etc. 

Hyperemia 

Is an increase in the amount of blood contained in the spinal cord and mem- 
branes, either in consequence of congestion (active or artificial fluxion) or 
stagnation (venous stasis). 

Congestion may be produced by overstimulation of the cord — from over- 

(791) 



792 spine. 

work, severe marching, sexual excesses, etc. ; by j^isoning with strychnia, 
nitrite of amyl, carbonic acid, alcohol, absinthe, etc. ; by collateral fluxion 
in consequence of the suppression of menses, hemorrhoidal bleedings, foot- 
sweat, etc., or taking cold in general ; by falls and bruises ; and by febrile 
diseases. 

Venous stasis finds its causes in diseases of the heart and lungs, in ob- 
structions of the portal system, and accompanies severe spasmodic affections, 
such as tetanus, eclampsia, etc. 

The symptoms of spinal hyperemia are, without exception, bilateral, and 
usually limited to the lower limbs; they change their seat and degree of se- 
verity frequently and quickly, and are often relieved in a horizontal position. 
They consist at times of pain in the loins and along the spine, or of tingling, 
formication, or tearing pain in the lower extremities ; of hyperesthesia of the 
skin, girdle sensation and transitory jerking of the muscles, and trembling of 
the limbs. At other times we find symptoms of depression, such as numb- 
ness and heaviness of the lower limbs and slight anaesthesia. 

THERAPEUTIC HINTS— Congestion may require: Aeon., Arnica, 
Arsen., Bellad., Cuprum, Hyper., Nux vom., Ehus tox., Sulphur, etc. Ve- 
nous stasis: Compare heart and lung diseases; abdominal disorders. 

Apoplexy, or Extravasation of Blood 

Within the spinal canal. This may take place between the vertebrae and 
the dura mater, or between the different spinal membranes, or within the 
spinal marrow itself. It is, compared with apoplexy of the brain, of very 
rare occurrence. This may have its reason partly in the peculiarity of the 
structure of the spine and its circulation, having numerous outlets and in- 
lets, thus giving less occasion for stagnation in the circulation; and partly in 
the greater security with which a long cord like the spinal marrow is held 
by its membranes, than a larger bulk, like the brain. 

1. Meningeal apoplexy, being an extravasation of blood between the 
spinal membranes, shows, when anatomically examined, a collection, usually 
of dark, coagulated, seldom fluid, blood, which extends over a smaller or 
larger surface within the spinal cord, sometimes filling the whole spinal 
column. 

Its Causes are manifold. The blood may, in consequence of apoplexy 
of the brain, or in consequence of the rupture of aneurismatic swellings of 
blood-vessels in the brain, percolate into the spine. Its most frequent causes, 
however, are external injuries, either from excessive bodily exertions, or a 
fall, blow or wound, or diseases of the vertebra?. Trismus and tetanus seem 
to cause it secondarily. 



APOPLEXY. 793 

Symptoms. — If it sets in suddenly, the patient falls down, as in an apo- 
plectic fit, but without loss of consciousness or sense. If it develops slowly, 
it commences usually with headache and pain in the spine in the region of 
the exudation, which radiates in various directions, usually corresponding to 
the distribution of the nerve-roots first attacked ; there is also formication, 
burning, tingling, etc., in the same regions, and characteristic jerkings of the 
muscles, occasionally increasing to convulsions, trembling of the extremities, 
tonic tension and contracture of various groups of muscles, and tetauic stiff- 
ness and painfullness of the back, making it difficult or impossible for the 
patient to move. After this, especially in large effusions, we observe numb- 
ness, pithiness, sensations of swelling and heaviness in the limbs and trunk, 
which may increase to paresis or even paralysis of the parts which are gov- 
erned from the spot affected. 

If the cervical region is affected the attack begins with pain in the occi- 
put, shoulders and arms, and stiff neck ; anaesthesia and paralysis of upper 
extremities; oculo-pupillary symptoms; difficulty of breathing and swallow- 
ing ; violent dyspnoea ; retarded and weak pulse. If in the dorsal region, we 
have pain in the back and abdomen, and pain in the form of a girdle; stiff- 
ness of the back ; paralysis of the legs and abdominal muscles. If in the 
lumbar region, there is a pain in the loins, tearing in the lower limbs, peri- 
neum, bladder and genitals; stiffness of the loins; paralysis of the lower 
limbs, of bladder and rectum. 

2. Medullary apoplexy, an effusion of blood within the spinal marrow 
itself, is found chiefly iruthe gray substance of the marrow and is of various 
extent. It may be no larger than a pea, and it may reach the size of a 
hazel-nut or an almond. Such effusions have been found most frequently in 
the cervical, less frequently in the dorsal, and least frequently in the lower 
portion of the spine. 

Its Causes are chiefly inflammation, softening, or other lesions of the 
marrow which precede it. In some cases it seems to have been produced 
by external injuries (fall, concussion, with or without fracture or luxation 
of the vertebrae, surgical operations), or by active congestion from taking 
cold, sexual excesses, overexertions of the body, etc. 

Symptoms. — As premonitory signs we find numbness in the fingers and 
in the feet; after exertion, great weakness and stiffness of the nape of the 
neck, extremities, or of the whole body. Its existence is characterized by a 
loss of voluntary motion, which may come on suddenly or in the course of a 
short time more gradually. This paralysis affects all the parts which receive 
their nerves from that portion of the spine below the lesion, and it is always 
found on both sides. The paralyzed muscles are perfectly lax. 

Like motion, so is also sensation more or less impaired. The parts below 
the lesion become on both sides insensible to touch or partially so. If para- 



794 sriNE. 

plegia lasts for some time it causes the limbs to shrink, and brings on gan- 
grenous bed-sores, sometimes quite rapidly. 

A lesion higher up affects the actions of respiration and deglutition, and 
the nearer to the medulla oblongata the more so, causing cessation of respira- 
tion and consequent death by asphyxia. 

Effusions in the dorsal and lumbar regions may exist for years, and if 
not too extensive may allow even a partial recovery. 

THEKAPEUTIC HINTS —The causes will hint to the appropriate 
remedies. Compare the foregoing chapters. 

Guaco is, according to Dr. Erb, a specific for paralysis of the tongue 
and extremities in consequence of bloody extravasation within the spine. 

Spinal Irritation. 

This complaint has by some been stricken out of the nomenclature of 
special diseases; Hammond considers it due to spinal ancemia, especially of 
the posterior columns, probably dependent upon some derangement of the 
sympathetic system ; Ollivier and others consider it due to spinal hypercemia, 
and still others look upon it as a dynamic disease, $ functional disorder of 
the spinal cord, as there does not exist a pathological anatomy of spinal irri- 
tation. Nevertheless a certain group of symptoms, frequently found in 
women, seems to demand a separate consideration of spinal irritation, even if 
it be but a dynamic disturbance of the spinal cord. 

Its most prominent Symptoms are : Pain and discomfort in the back, 
most frequently between the shoulder-blades, next in the back of the neck, 
less frequently in the loins, always increased from bodily exertions. The 
sore or sensitive spot or spots of the spine are easily detected by pressure, 
tapping, the passage of a hot sponge down the spine, and other irritations; 
at other times the pain is deep seated and is produced by pressure upon verte- 
bras which are not sensitive, also by movements of the spinal column, by stand- 
ing, etc. With these pains in the spine are frequently associated neuralgic 
pains in different parts of the body, sometimes fleeting, sometimes more sta- 
tionary. There is usually great weariness and exhaustion upon slight efforts, 
so that walking or manual occupations, such as sewing, writing, piano-play- 
ing, etc., soon become unbearable on account of the pains they excite in back 
and limbs. Spasmodic symptoms, such as twitchings, choreoid movements, 
singultus, etc., are often observed, and disturbances in the vegetative organs — 
belching, nausea, vomiting; palpitation of the heart, dyspnoea, spasmodic 
cough, frequent desire to urinate, with abundant discharge of pale, clear 
urine — are frequently met with; numbness, tingling and paretic symptoms 
are of less frequent occurrence. The patients are irritable, depressed and 



SPINAL IRRITATION. 795 

often sleepless; they complain of dizziness, noise in ears and an inability to 
read for any length of time ; their hands and feet are usually cold and they 
flush easily. 

Spinal irritation, if located in the cervical region, causes head and chest 
symptoms, if in the dorsal region, intercostal neuralgia, gastralgia, nausea, 
etc., if in the lumbar region, symptoms of the pelvic organs and lower ex- 
tremities; and if diffused, symptoms of all kinds in peripherical organs. 

Spinal irritation is of no stated duration ; it may last for years with 
many fluctuations. 

THERAPEUTIC HINTS— A great number of remedies may be in- 
dicated and the treatment must be wholly symptomatical. The following 
remedies have proved successful in actual cases: 

Act. rac, constant nausea and retching on pressure upon the spine, 
between the fourth and fifth vertebra; frequent fainting; palpitation on least 
movement ; amenorrhoea. 

Asaf., great painfullness of spine; belching; palpitation of heart in the 
night. 

Bellad., on pressure upon the dorsal vertebrae she cries out, gets pale, 
nauseated and belches wind; in the spine continual burning pain; stomach 
sore to touch, w 7 ith nausea and vomiting after eating. Or, sudden shriek on 
pressure upon the fourth dorsal vertebra, followed by a dry, violent cough, 
red face, headache in forehead, photophobia and perspiration. 

Coccul., stiffness of neck; pain in lower portion of spine; oppression 
of chest; palpitation of heart; trembliug of limbs ; numbness of right upper 
and lower limb. (Small.) Great hyperesthesia of all the senses, and an 
exalted susceptibility to impressions ; dreadful headaches, sleeplessness ;. when 
her mind is turned away from herself, her sufferings are forgotten. (C. "W. 
Boyce.) 

Hyper., tenderness of entire spine; paroxysms of pain in different 
joints, accompanied by mania; frightful illusions; attempting to hide from 
wild beasts; screaming if approached ; no recollection of the attack; appeared 
as if just aroused from sleep. (A. L. Dornberg.) 

Natr. mur., headache on waking in the morning; sleeplessness; con- 
stipation; salty taste and repugnance to food; trembling sensation in region 
of heart. Vision becomes dim and indistinct after reading a while; eyes 
sore on pressure upon them ; occasional neuralgia in forehead, with nausea 
and sensitiveness of eyes to gaslight; at times only one-half of an object is 
visible; black spots and streaks of light before eyes; easily fatigued; weak- 
ness from slight exertion ; restlessness of the limbs ; pain in back and sensi- 
tiveness of spine. (Burr.) 

Piper meth., pain in the back of the head and spine, and relief from 



796 spine. 

all sufferings temporarily by change (mental or physical); slight excitement, 
or diversion of the mind to some other topic. 

Rhus tox., violent pain in head from back to front, and down the 
spine ; lies on her back ; head and back drawn backward, the slightest touch 
or move causes excruciating pain. Pulse slow; obstinate constipation; com- 
plete sleeplessness ; pain in paroxysms. After getting wet. (Dittrich.) 

Secale, tenderness of lower cervical and upper dorsal spinous processes, 
with stiffness of neck. Pressure upon it produces pain there and all through 
the chest, with irritation to cough. 

Tarant., a slight touch along the spine provokes spasmodic pains in the 
chest and indescribable distress in the cardiac region; at times the heart 
feels as if twisted over; intense headache, as though thousands of needles 
were pricking into the brain; sensation of burning all over the body. She 
trembled so she could hardly talk. Headache relieved by rubbing the head 
against the pillow. (Farrington.) 

Neurasthenia Spinalis; Spinal Nervous Weakness. 

Like spinal irritation, so is spinal weakness a functional disease without 
a demonstrable pathological basis ; but it is predominantly an affection of the 
male sex. Its direct causes are excessive mental efforts, severe mental toil at 
night, great mental excitement from grief, affections, passions, etc., excessive 
sexual indulgence, onanism, etc., severe exhausting diseases. 

It manifests itself in a striking weakness and rapid fatigue, especially of 
the lower limbs, from any little exertion in walking or standing; in pain in 
the back, which shifts about from different kinds of motion, or is brought on 
by slight exposure to cold ; in pains of the extremities, which are associated 
with the fatigue occasioned by any little exertion ; in sexual irritable weak- 
ness, by which, during coition, the semen escapes too quickly and the act is 
followed by great prostration ; in sleeplessness for several hours in the night 
after a first sleep ; in a general sense of illness, hypochondriacal feelings, and 
often a womanish disposition; in cold hands and cold feet. With all this 
there is an absence of any kind of disturbance in the natural motility of the 
limbs and their 



THERAPEUTIC HINTS.— These must be suggested by referring to 
the causes. 

Excessive mental efforts require principally: Bellad., Calc. carb., Coccul., 
Cuprum, Ignat., Laches., Lycop., Natr. carb., Natr. mur., Nux vom., 
Psorin., Pulsat., Sabina, Sepia, Silic, Sulphur. 

Emotional excitement suggests: Anac, Aurum, Bellad., Bryon., Caustic, 
Chamom., Coccul., Coloc, Cuprum, Gelsem., Hyosc, Ignat., Laches., Lycop., 



HYDRORRHACHIS CONGENITA. 797 

Nitr. ac, Nux vom., Phosphor., Phosph. ac, Psorin., Pulsat., Staphis., 
Stramon., Veratr. 

Sexual excesses: Compare the corresponding chapters. 

Exhausting diseases hint to : Calc. carb., China, Kali phosph., Phosphor., 
Pier, ac, Phosph. ac, Sulphur, etc. 

Hydrorrhachis Congenita; Spina Bifida. 

This is an affection entirely analogous to congenital hydrocephalus. 
Being an imperfect development of the foetus, the latter is frequently ex- 
pelled before its full time. There are cases, however, in which children are 
born with this affection at full time. Its nature, like hydrocephalus congen- 
itus, is that of a dropsical effusion of serum, either between the dura mater 
and the vertebrae, or into the subarachnoideal space, or within the central 
canal of the spinal marrow. 

When such effusion takes place, before the vertebrae have perfectly 
closed, its pressure from within prevents their final closing ; thus, from de- 
ficiency of the vertebral arches, the spinal column, posteriorly, appears cleft 
in two; hence the name "spina bifida." This cleft may be of different de- 
grees. There may be only one of the vertebrae not closed. In the worst 
cases, this anomaly extends over the whole spinal column. In most cases, 
however, the split is confined to the lumbar or sacral region. Through this 
opening the fluid which collects inside presses out, and appears in the corre- 
sponding region as a smaller or larger tumor, according to the size of the 
opening and according to the quantity of fluid contained therein. In almost 
all cases this tumor grows rapidly after birth; it fluctuates; becomes denser 
and larger when the child cries, inhales, or presses at stool, or when it is held 
in an upright position; it sinks in, becomes smaller, when the child is quiet, 
lies in a horizontal position, or when it exhales. External pressure upon the 
tumor is painful to the child, often causes convulsions and, if combined with 
hydrocephalus, sopor and general paralytic symptoms. But these signs may 
all be wanting, when its communication with the spinal canal is very narrow. 
In some cases it is not fluid alone that protrudes through the opening of the 
vertebrae, but also portions of the spinal marrow itself, with its membranes 
and nerves. Such tumors are less fluctuating than those which consist of 
mere serum. 

In some cases the tumor or sac bursts during the birth of the child; in 
other cases, as already stated, the tumor grows rapidly after birth ; the in- 
teguments gradually inflame, become excoriated, and finally burst in a large 
circumference, which is followed by convulsions and death. In still others, 
only small openings form, and the fluid gradually oozes out of it; it may 
close and reopen again ; most generally such cases terminate in death. Still 



798 spine. 

there are cases on record in which individuals affected with spina bifida have 
lived to the age of puberty and longer. 

THERAPEUTIC HINTS.— As the most important remedies, com- 
pare Arsen., Calc. carb., Calc. phosph., Lycop., Silic., Sulphur. 

Leptomeningitis Spinalis. 

We understand by this an inflammation of the soft membranes, the spinal 
pia mater and arachnoid; inflammation of the dura mater is rarely met with 
as a primary disease. 

Its Pathological Character. — The pia mater appears pale reddish, 
sometimes purple, swollen, and infiltrated with a jelly-like and frequently 
bloody exudation. After a while the redness disappears and the membrane 
looks dirty, yellowish and grayish, being covered with a coagulated, dirty- 
grayish and yellowish exudation, resembling inspissated pus. The inflam- 
mation sometimes extends over the whole membrane; reaching even into the 
cavity of the skull. In cases of recovery there are adhesions and thickening 
of the membrane, hyperemia, hydrorrhachis and atrophy of the spinal mar- 
row. The arachnoid is almost regularly involved in the inflammatory 
process. 

As Causes, we find mentioned, inflammatory processes of neighboring 
organs, either of the spinal marrow or of the vertebrse; external injuries; 
exposure to cold, etc. It is quite a regular attendant upon Tubercular 
basilar meningitis. 

Remarkable is its epidemic appearance when it is usually combined 
with cerebral meningitis, as in spotted fever, which compare. 

Symptoms. — A combination with cerebral affections of course tinctures 
the whole picture at once with brain symptoms, and may even disguise the 
spinal affection altogether. (See Brain Diseases.) If the inflammation is 
confined to the spinal pia mater, we find : 

1. A pain in the back, at the place of inflammation, which even extends 
over the whole spine, and which is aggravated by the slightest motion, as 
turning in bed or rising, or pressing at stool, or voiding urine ; it is better 
during rest ; least in lying on the back ; sometimes it is combined with a 
feeling of constriction around the body, as though a bandage were fastened 
around it. 

2. Pains in the limbs, aggravated by motion and touch. 

3. Painful stiffness of the muscles, which may amount to opisthotonus, 
especially in cases where the inflammation extends over the cervical portion 
of the pia mater. Even the masseter muscles may be affected, so that the 
whole resembles tetanus. Respiration is difficult, and the higher the inflam- 



LEPTOMENINGITIS SPINALIS. 799 

mation extends the greater is the dyspnoea, which may end in suffocation. 
It is a characteristic feature that these tonic spasms are always excited by 
the least motion of the spine, but not by reflex irritation of the peripheric 
nerves. 

Acute spinal meningitis may pass oyer into the chronic form, with ex- 
udation and consequent paraplegia. Tubercularization of the exudate is fol- 
lowed by oedema of the lungs, catarrh of the bladder and decubitus. Its 
Prognosis is therefore rather a doubtful one. 

THERAPEUTIC HINTS.— Aeon., after a sudden check of perspira- 
tion or internal injury; high fever; crawling in the spine, as of beetles; 
cutting pain, extending in a circle from the spine to the abdomen; numbness 
of the small of the back, extending into the lower limbs ; the arms hang 
down powerless, as if paralyzed by blows; numbness, icy coldness and in- 
sensibility of hands and feet; all being accompanied by despairing thoughts 
and dread of death. 

Atroph. sulph., convulsions all over, if Bellad. did not prevent. 

Bellad., drawing, burning and throbbing pain in the spine; drowsiness, 
with inability to sleep; frequent starting, as if electric shocks were running 
through the limbs. 

Bryon., stitch-like pains from the slightest motion. 

Calc. carb. and phosph., when the inflammation proceeds from a 
disease of the bony structure of the spine. 

Cicuta, frequent jerks in the upper portion of the body; through the 
dorsal vertebra? and arms; occasional jerkings of the head. 

Coccul., unwieldiness of the lower extremities, the legs cannot be lifted 
in walking, but are dragged along; the hands feel pithy, lose their sensibility. 

Cuprum, clonic spasms, commencing in the fingers and toes and spread- 
ing further; before the spasms, painful jerkings in the hands and fingers 
and different parts of the body, commencing on the left side. 

Dulcam., rheumatic persons, who are always worse when the weather 
changes to cold; after taking cold; also during scarlatina and measles, when 
the eruption does not fully develop itself. 

Hyper., after a fall ; slightest motion of the arms or of the neck extorts 
cries; the ceryical vertebra? are very sensitive to touch; headache; desire 
for warm drinks; asthmatic spells, or spells of short, hacking cough. 

Kali hydr., after the abuse of mercury. 

Mercur., paralysis of the lower extremities, of the bladder, or of the 
rectum, with occasional jerks in the paralyzed parts; violent pain in the 
spine, worse from motion; great restlessness and sleeplessness; aggravation 
at night in bed ; insensibility of the skin. 

Nux vom., the seat of the pain is the lumbar region ; the pain is worse 



800 SPINE. 

when trying to move whilst lying on the back, also worse in the morning ; 
stiffness of lower limbs; great deal of belching; sensitiveness of the stomach 
and region of the liver to external pressure ; stool seldom and hard. 

Plumbum, in chronic cases, where the paralyzed parts soon fall away 
in flesh, where the limbs become painfully contracted, and where there 
are frequent spells of colic with retraction of the abdomen ; worse on right 
side. 

Rhus tox., in combination with exanthematic processes; or in conse- 
quence of getting wet ; high fever ; great restlessness ; tingling sensation in 
the limbs ; paralysis of the extremities. 

Myelitis, Inflammation of the Spinal Marrow. 

This affection is much less frequent than meningitis ; and when it does 
occur, it almost always is associated with meningitis. 

Its pathological features in the stage of hypercemia (red softening) con- 
sist of swelling, redness, and exudation; in the stage of fatly degeneration and 
of resorption (yellow and white softening) the affected substance assumes a 
creamy or milky appearance, becomes softer and softer, until at last nothing 
remains but the vascular network, and a portion of the hypertrophied septa, 
the softened nerve-substance having been gradually absorbed. This leads in 
the terminal stage to the formation of cicatrices or cysts, induration and 
sclerosis or hardening. The meninges are always more or less implicated in 
the inflammatory process. 

Its localization in the spinal cord varies greatly. When acute, it usually 
commences in the gray substance and may extend more or less in a vertical 
direction — (Myelitis centralis) ; it may pervade the entire thickness of the 
cord for a longer or shorter distance — (Myelitis transversa) ; it may in- 
volve only a small portion of the cord — both vertically or transversely — 
(Myelitis circumscripta) ; it may be spread over a large area, but only in 
circumscribed and scattered spots — (Myelitis disseminata) ; it may attack 
only the peripheral layers of the cord — (Myelitis peripherica). 

As its Causes are mentioned, chiefly external injuries, and exposure to 
cold, or extension of inflammatory processes from neighboring parts. Some- 
times it has been observed during the course of typhus, of the acute ex- 
anthemata, acute rheumatism, variola, pleuro-pneumonia, and other severe 
illnesses. 

Its Symptoms embrace deviations in sensibility and motion. 

1. Sensibility. The patient experiences at first a sensation of coldness, 
numbness, prickling and pain in single toes and fingers, which sensation ex- 
tends from the periphery gradually further up towards the body; at first, 
perhaps, only in one, but soon in both sides. If there be a complication 



MYELITIS. 801 

with meningitis, the patient cannot bear the slightest pressure or motion of 
the parts. 

There is a pain in the spine where the inflammation exists, which is ag- 
gravated more by external pressure than by motion; and a feeling of con- 
striction in those parts of the body which are supplied with those nerves, the 
roots of which originate in and near the affected part of the spinal marrow 
(girdle pain). In some cases these parts are very sensitive, whilst those be- 
low are quite dull and insensible. A complete anaesthesia or insensibility, 
however, takes place only in those cases in which the lesion is a degeneration 
of the marrow through its whole diameter. 

2. Motion. It shows itself at first as an unwieldiness of the peripheric 
muscles, which may end in complete paralysis. If the seat of the lesion be 
in the lumbar region, it causes paralytic symptoms of the lower extremities, 
which is of the most frequent occurrence; if it be in the dorsal region, it 
causes, in addition, paralysis of the sphincter ani and vesicae ; and if still 
higher up, violent agitation of the heart. A lesion in the cervical region af- 
fects the uj)per extremities, the respiratory motion, deglutition and even 
speech. Respiration is most seriously interfered with when the lesion exists 
just above the origin of nerves of the diaphragm. When below it, it is a 
characteristic symptom that the patient is able to gape, but he cannot cough 
or sneeze. 

As long as the marrow is not disorganized in its whole diameter, so long 
is it possible that the parts below the lesion may still remain intact ; so that, 
for example, in a cervical myelitis only the upper extremities are paralyzed 
and the lower not. When, however, the lesion extends through the entire 
diameter of the marrow, then all the parts below the lesion lose sensibility 
and motion; so that in such a case the patient consists of two halves: an 
upper one, which is normal and sound, and a lower one, which is dead, and 
deprived of feeling and voluntary motion. 

A peculiar and frequent symptom of myelitis is a persistent erection of 
the penis. The penis is painfully stiff, but shorter than normal, and may re- 
main so for days. It occurs chiefly in those cases in which the lesion has its 
seat in the dorsal or cervical region. 

Thus far we have seen that the symptoms of myelitis vary quite con- 
siderably according to the higher or lower location of the lesion. They vary, 
likewise, if the seat of the inflammation is confined only to the one or the 
other lateral cord. In such cases the paralytic symptoms may be only on 
one side — at least for a while — with more or less insensibility; or- insensi- 
bility may exist in one, and paralysis in the other side, as in some traumatic 
cases. 

The lower the seat of the disease, the more slowly it works. Many 
have lived more than ten years with paraplegia. Cervical inflammation 
51 



802 sriNE. 

may terminate fatally in a very short time by its paralyzing effect upon 
respiration. 

THERAPEUTIC HINTS.— As myelitis is almost always accompanied 
by meningitis, compare Leptomeningitis. 

Angustura vera, twitching and jerking along the back like electric 
shocks; tension of facial muscles; lockjaw. 

Arsen., dyspnoea and anxiety; constriction and tightness of chest, as 
if bound with a hoop; twitching, trembling, violent starting, weariness in all 
limbs; tetanic spasms. 

Gelsem., early stage; spinal weakness from exhaustion; confusion of 
head, spreading from occiput to forehead; dim sight; looks heavy, dull, 
drowsy; paresis of tongue and glottis; incontinence of urine; muscles feel 
bruised and will not obey the will ; loss of voluntary motion. 

Mercur., probably the most important, Compare Meningitis. 

Phosphor., after sexual excesses or getting wet; also when in connec- 
tion with an inflammatory process of the vertebrae; burning pain in the 
spine; some vertebrae sore to touch; dyspnoea and cough ; weakness of sight; 
transient vertigo; constipation with narrow, dry stools; numbness and in- 
sensibility of the extremities. 

Physostigma, tremors of young persons from emotional or physical 
disturbances; staggering gait, as if drunk; feeling of constriction around 
head and waist; feeling of weakness, as though paralyzed, passes downward 
from occiput through back to lower limbs, which feel as if asleep. 

Picric ac, tonic and clonic spasms; keeps legs wide apart when stand- 
ing; looks steadily at objects as if unable to make them out; limbs too weak 
to support the body. 

Secale, violent pain in the back, especially in the sacral region ; anaes- 
thesia of the limbs; paralysis of the limbs; convulsive jerks and shocks in 
the paralyzed limbs; painful contraction of the flexor muscles; paralysis of 
the bladder and rectum. 

Silic, w r hen the bony structure of the spine is affected. 

Sulphur, burning and tensive aching between the scapulae; heat on 
the top of the head; palpitation of the heart; sleeplessness; often when 
other remedies do not seem to have any effect. 

Veratr., painful paralytic weakness in the upper and lower limbs: he 
is scarcely able to drag them ; tingling in the fingers, causing anxiety ; pain- 
ful jerkings in limbs. 



MULTIPLE SCLEROSIS. 803 

Myelomalacia, Non-inflammatory Softening of the "Spinal 

Marrow, 

Is a process of which we know scarcely anything. Its symptoms are quite 
obscure, sometimes covered by the symptoms of spinal apoplexy, or myelitis, 
or typhus, sometimes even wanting. Its pathological character is a non-in- 
flammatory degeneration of the marrow, by which it becomes converted into 
a soft, macerated mass of a whitish,. yellowish or reddish color. 
Inflammatory softening is the consequence of acute myelitis. 

Multiple Sclerosis 

"Is a form of chronic myelitis and encephalitis, which is characterized, 
anatomically, by the development of numerous insulated sclerotic nodules, 
varying in size and of a chronic inflammatory nature, which are scattered 
irregularly throughout the entire cord and usually also throughout the entire 
brain, but which seem to posess, nevertheless, certain spots of predilection. 
Sometimes a less intense, but more diffuse sclerosis unites the different nodules 
with one another." (Erb.) It attacks women oftener than men, and most 
frequently makes its appearance during the second and third decades of life, 
scarcely ever after the forty-fifth year, and but few cases are known to have 
occurred in children under ten years of age. 

As direct Causes are mentioned: catching cold, excessive mental and 
bodily exertions and intense emotions, traumatic influences, pregnancy, hys- 
teria and acute diseases. 

Its Symptoms are extremely variable and manifold, as a natural result 
of the development of nodules in so many different localities. 

Disturbances of sensibility are of not constant occurrence; disturbances 
of co-ordination (ataxia) are frequently observed, but a peculiar tremor, which 
accompanies voluntary movements and progressively increases, is almost reg- 
ularly present. By this tremor, which appears at every attempt at moving a 
part of th T ody, head or limb, voluntarily, differs multiple sclerosis entirely 
from pard^sis agitans, where the trembling is predominantly observed during 
perfect rest, and may, at least in the earlier stages, be even controlled by the 
will of the patient. 

Besides these symptoms we observe: alteration of speech and voice. The 
speech is slow, hesitating, more or less indistinct and the voice becomes weak 
and monotonous; the acts of laughing and crying are accompanied by pecu- 
liar, noisy inspirations, and the movements of tongue and lips are frequently 
impaired, interfering with mastication and deglutition. There is a temporary 
or permanent diplopia, also nystagmus, amblyopia and at last blindness from 
atrophy of the optic nerve. We meet also head symptoms in the form of 



804 SPINE. 

vertigo, sleeplessness, violent headaches and in some cases repeated apoplectiform 
attacks, which are accompanied by high fever and followed by temporary 
hemiplegia. 

This complex of symptoms fits only to typical cases; variations are ex- 
ceedingly numerous, because the accidental distribution of the nodules varies 
in each individual case. 

THERAPEUTIC HINTS.— Compare Myelitis. 

Arg. nitr., vertigo aud staggering gait; trembling and tremulous sen- 
sation; general debility, with trembling of the limbs; chorea-like movements 
of limbs; transient blindness; sunken, pale countenance; sleeplessness. 

Nux vom., especially in the beginning, with gastralgic attacks, ver- 
tigo, etc. 

Phosphor., weakness of extremities and trembling at making an 
effort ; legs weak, gait tottering as if he were not sure of himself; speech 
embarrassed ; amaurosis with widely dilated pupils and deafness. 

Physostigma, the will is strong, but a difficulty lies in the way of 
carrying out its purpose ; the palsy is commonly preceded by twitching or 
trembling of the muscles. Attacks of partial blindness; nystagmus; trem- 
bling all over. 

Plumbum, tremor of right arm during voluntary motion; the arms 
are " shaky " when he attempts to use them ; tremor of arms, at times pre- 
ceded by weakness and numbness; the tongue trembles when being protruded, 
or when he tries to articulate ; speech dragging and slow. Diplopia ; dim- 
ness of sight ; neuritis of optic nerve. There are many more symptoms which 
hint to multiple sclerosis. 

Tarant. 12 , in water. Multiple scelerosis in consequence of fright and 
rheumatism. Trembling commenced in left hand, always aggravated by 
mental trouble. After a fright it affected all limbs. Intense pain during 
night prevents her rest and sleep, and an itching and crawling of left leg 
makes her rise and walk about. Bathing increases the pain, but fresh air 
ameliorates even at night. Intelligence and memory considerably dimin- 
ished ; trembling and pricking prevents from doing any fine work. Motility 
and sensibility unaltered ; neither paralysis, anaesthesia, nor hyperesthesia. 
The head trembles as much as the left hand and foot, and a slight tremor 
could, be observed on the tongue, when opening the mouth. No appetite, 
chronic constipation. Since menopause, acne in face. The ophthalmoscope 
showed a slight hyperemia of the retina. (Cramoisy.) 



TABES DORSALIS. 805 

Tabes Dorsalis; Sclerosis of the Posterior Columns; Gray 

Degeneration of the Posterior Columns; Progressive 

Locomotor Ataxy; Leukomyelitis Posterior 

Chronica. 

All these different names have been given to "a disease of the spinal 
cord, which runs a slow course, which arises principally during youth and 
middle age, and which in all probability belongs to the group of Chronic 
myelitis." (Erb.) 

"It is anatomically characterized by ribbon-like sclerosis of the white 
posterior columns, leading to gray degeneration, and probably, also, by later 
participation on the part of the adjoining portions, of the white lateral col- 
umns and the gray posterior horns." " The affection generally begins in the 
lumbar region, and may extend throughout the entire cord as far as the 
upper cervical portion, and even into the medulla oblongata." (Erb.) 

It attacks men much oftener than women, in the majority of cases be- 
tween the thirtieth and fiftieth year of life; before the twentieth and after 
the fiftieth year the disease is of rare occurrence. 

Its principal Causes are said to be: sexual excesses and onanism, catch- 
ing cold, bodily overexertions and hardships of all kinds, traumatic injuries, 
emotional fits and passions; acute diseases, such as typhus, rheumatism, 
pneumonia, abortions, less of blood, long-continued lactation, etc., diphtheria, 
etc. In many cases not any cause can be detected. 

Its Symptoms of the first stage consist of lancinating, neuralgic pains in 
the lower limbs, sometimes including the trunk, and more rarely in the arms, 
in paroxysms, frequently changing in severity and location, and often ex- 
tending over many mouths or even years; they at first appear at intervals, 
in the spring and fall, later they are induced by every change of weather, or 
any overexertion or mental disturbance. With these pains become associ- 
ated, sooner or later, various kinds of paresthesia, such as numbness, pithi- 
ness or formication in the feet, legs, thighs and on the trunk, and in the ulnar 
domain of one or the other hand — a characteristic symptom — in other cases, 
the sensation of a tight girdle at various heights on the trunk, or on the knee- 
joint or ankle-joint; further motor weakness and insecurity, which gradually 
increases to real motor disturbances, such as inability to walk and stand with 
former ease; unsteadiness when standing and walking; a swaying to and fro 
when on the feet, all of which manifestations are more pronounced in the 
dark or by closed eyes. Often, not in all cases, to these disturbances are 
added, diplopia in consequence of paresis or paralysis of various eye muscles, 
especially those supplied by the oculomotorius, and amblyopia, even amau- 
rosis, in consequence of degeneration of the optic nerve. The pupils are 
small, do not respond to light, but act during accommodation. (Argyll- 



806 SPINE. 

Robertson symptom.) In many cases we meet with disturbances of the 
bladder, such as difficulty of micturition, dribbling of urine, etc., and with 
weakness and irritability of the sexual functions, such as various grades of 
impotence, insufficient erections, premature ejaculations, nocturnal or diurnal 
pollutions, excitability on coming in contact with women, etc. Gastralgia 
and head symptoms (dizziness, psychical irritability, etc.) are of rarer oc- 
currence. 

The second stage presents, besides the symptoms just detailed, a charac- 
teristic disturbance in the coordination of motion, which usually commences in 
the lower limbs. The gait becomes ataxic, that is, insecure, swaying, stagger- 
ing ; the legs are unsteadily swung about, the toes pointing outward and up- 
ward, and the heels coming down to the ground with a stamp; the whole 
operation, in most patients, is done under close supervision of the eyes, and 
does not succeed at all with closed eyes or in the dark. With this faultily 
and imperfectly controlled movement of the limbs goes hand in hand a 
diminution of their powers of endurance, and, although in a lying position 
at first, the gross strength of the legs seems but little reduced, — the patient is 
yet able to execute single movements of the limbs with tolerable certainty 
and strength, while in a lying position — yet by and by even in this position 
the voluntary motions become more and more uncertain, and especially so, 
if the patient closes his eyes, while at last walking and standing become 
quite impossible without help. 

As the disease advances, the ataxy extends also to the arms and hands, so 
that complicated movements, such as w T riting, piano-playing, sewing, etc., be- 
come difficult, awkward, and at last impossible; the muscles do not obey any 
more the command of the will, but make all sorts of jerking and irregular 
movements when under its stimulation. . The reflex action of the tendons is 
extinguished ; a knock or blow, for instance, upon the patella-tendon above 
the knee is not followed any more by a jerk of the leg upward, etc. ; this ab- 
sence of the patella reflex is probably always an early and almost pathog- 
nomonic symptom, and is due, according to Westphal, to a lesion involving 
a definite zone in the centre of the posterior columns of the lumbar part of 
the cord; the reflex action of the skin, however, may or may not be affected. 
All other symptoms of the first stage grow more and more intense, until at 
the final stage actual paralysis (paraplegia), muscular atrophy, contractures, 
troubles of the bladder and the digestive organs, bed-sores and general ma- 
rasmus finish the scene. 

The disease is of long duration, which is to be counted by years, and is 
characterized by considerable fluctuations for better or worse — sometimes 
gradually advancing to recovery ; oftener, however, terminating in death. 

It differs from Chronic myelitis by its lancinating pains in the first 
stage and pronounced ataxy in its second stage, which myelitis has not; 



TABES DORSALIS. 807 

From Multiple Sclerosis by the same, instead of which multiple scle- 
rosis presents a characteristic tremor on voluntary movement, attacking limbs 
as well as head and neck ; 

From Progressive cerebral paralysis by the absence of disturbances 
of speech and physical changes, which are characteristic of cerebral paralysis ; 

From Paralysis agitailS by its disturbance in the co-ordination of 
motion, instead of which there is in paralysis agitans a tremor in perfect rest. 

THERAPEUTIC HINTS —Alcohol, tremor worse in morning, can- 
not write; increasing muscular debility and paralysis; tingling, arthralgia, 
anaesthesia, clonic and epileptiform convulsions; locomotor ataxy. 

Alum met., recommended by Von Bcenninghausen and verified by 
others. Soles of feet feel as if they were swollen and too soft ; numbness of 
the heels ; heaviness of limbs, can scarcely lift them ; slow, staggering gait, 
as after a long sickness; inability to walk except with eyes open and in day- 
time ; pain in the back as if bruised, or as if a hot iron were thrust through 
the lower vertebrae 

Arg. nitr., pains in the back, cannot walk with eyes closed, or in the 
dark ; paralytic heaviness or weakness of the legs ; staggering gait ; legs feel 
as if made of wood, or padded, with insensibility to touch, diminished warmth, 
jerks in the toes, tottering, irresolute gait; emaciation of legs, with paralytic 
weakness; chorea-like convulsive motion of limbs; legs drawn up; arms 
jerked outward and upward. 

Arsen., distressing pains; deadness in great toes, extending to foot 
and ankle-joint; feet feel large and heavy, and can be moved only by moving 
the whole limb; the gait is shuffling; feet are dragged along by lifting the 
legs; slight numbness in hands. Paralysis with gressus gallinaceus, with 
atrophy of the muscles, especially of lower extremities. 

Bellad., heaviness and lameness of legs and feet; he raises the feet 
slowly and puts them down with force; loss of co-ordination of muscles of 
both upper and lower limbs; trembling, twitching of limbs. Diplopia; 
amaurosis. 

Calc. carb., rheumatic pains in shoulders; loss of muscular power; 
atrophy of muscles of back, buttocks and lower limbs, with constant quiver- 
ing; dimness of vision, worse in right eve; cramps in feet and legs; exces- 
sively nervous; no appetite; constipation. (G. F. Butman.) 

Cupr. ac, numbness and lameness of left hand, especially of the fingers 
as far as they are supplied with the nervus ulnaris. Dragging of left foot in 
walking; numbness and lameness in sole of left foot gradually extending up 
to knee; walking and standing difficult; foot and leg atrophied; constant 
sense of coldness in left foot, little relieved by the application of hot bricks. 
Sometimes dull pain from hip to knee. (Heiuigke.) 



808 SPINE. 

Gelsem., acute, sudden, darting pahas; shooting, tearing along the 
tracks of the nerves, aggravated by changes of the weather; paralysis of 
motion; muscles will not obey the will, feel bruised; tingling, prickling, 
crawling. 

Nux vom., partial paralysis of lower limbs from overexertion and 
being drenched in rain ; drags limbs in walking, cannot lift them from the 
ground ; sensation of lower limbs impaired, feels the sticking with a pin only 
when it penetrates deep enough to draw blood; legs always cold, bluish; 
constipation ; burning at anus ; occipital headache ; no painful spot in the 
whole length of spine. (Bojanus.) 

Phosphor., burning heat in back; hands and feet numb, clumsy; 
limbs tremble from every exertion; when walking makes missteps, from 
weakness; swelling of hands and feet, with stinging pains; paralysis, formi- 
cation and tearing in the limbs; anaesthesia; increased heat; sexual irrita- 
tion; nocturnal emissions; great irritability and nervousness. 

Physostigma, unsteady from knees downward on walking, he must 
look to see where he puts his feet ; needs a cane to steady himself. 

Picric ac, mental and physical prostration; cannot read a line with- 
out becoming exhausted ; on attempting to walk he presses his hand upon 
his loin and slides his feet along the ground as in a paretic condition, soon 
becoming exhausted; dull headache deep in occiput; bodily exhaustion with 
mental clearness; sleeplessness at night from sheer exhaustion; when asleep 
priapism and seminal emissions, with or without sexual dreams; during coi- 
tion ejaculation too quickly; constipation. (S. Lilienthal.) 

Secale, difficult, staggering gait; complete inability to walk, not for 
want of power, but on account of a peculiar unfitness to perform light move- 
ments with the limbs and hands; contraction of the lower limbs, on account 
of which the patient staggers.; trembling of the limbs, sometimes attended 
with pains ; formication of hands and feet. Excessive sensation of heat, with 
aversion to heat or of being covered. (S. Lilienthal.) 

Stramon., totters as if giddy, cannot make a few steps without help; 
trembling of limbs; muscles will not obey the will; difficult to bring hand to 
tumbler or carry the latter to mouth ; obscuration of vision. 

Sulphur, unsteady gait; great debility and trembling; limbs go to 
sleep. After Nux vom. (Jahr.) 

Tarant., difficulty of moving the legs, they do not obey the will; 
weakness of legs, etc. 

Aside of these compare: iEscul. hipp., Coccul., Caustic, Laches., Nux 
mosch., Pinus sylv., Plumbum, Rhus tox., Silic. and many more. 



SPASMODIC SPINAL PARALYSIS. 809 



Spasmodic Spinal Paralysis. 

"This disease is clinically characterized by a gradually increasing jxiresis 
and paralysis, generally advancing slowly from below upwards, with muscu- 
lar tension, reflex contractions and contractures, with strikingly increased reflex 
actions of tendons, while at the same time there is entire, or almost entire, ab- 
sence of all disturbances of sensibility, or trophic disturbances, of all vesical or 
sexual weakness, and of all cerebral disturbances" (Erb.) 

Its anatomical basis is probably, according to Charcot and Erb, a chronic 
inflammatory process, a sclerosis of the posterior divisions of the lateral columns. 

Its Etiology is unknown ; it seems to develop most frequently between 
the ages of thirty and fifty, and also at times in earliest childhood. 

Its Symptoms begin with motor weakness in one or both lower limbs, 
increasing to paresis and ending in paralysis. These symptoms of weakness 
are early associated with motor irritations, commencing with twitchings, or 
jerkings of the legs when sitting or lying, increasing to spasmodic stiffness 
when making certain movements, or to regular tension of the muscles on active 
and still more on passiye motion, and ending in permanent and severe con- 
tractures, which fix the limbs in a position of extension. With all this there 
is a marked increase of the reflex action of the tendons, so that on merely 
placing the point of the foot on the floor, while sitting, a tremor very gener- 
ally sets in, evidently in no respect different from the clonic trembling on 
passiye dorsal flexion of the foot. 

These combined paralytic and spasmodic manifestations result in a very 
peculiar, the so-called spastic gait, when the patient tries to walk, which is 
described by Erb as follows : " The legs are somewhat dragged, the feet seem 
to cleave to the ground, the tips of the feet find an obstacle in every inequality 
of the ground ; every step is accompanied by a peculiar hopping elevation of 
the whole body, dependent on a reflex contraction of the calf; the patient 
immediately gets upon his toes, and slips forward on them, showing a ten- 
dency to fall forward. The legs are close together, held stiffly, the knees 
somewhat depressed forward, the upper part of the body slightly bent for- 
ward. There is no throwing about of the feet as in ataxy. This gait depends 
on muscular tension and reflex contractions in the various groups of muscles, 
which are set in activity during the process of walking." 

Sometimes the disease extends from one leg to the arm of the same side 
(hemiplegic form), and much later to the other leg and arm. In some cases 
the trouble begins in one or both arms and gradually descends to the legs. 

This whole group of symptoms becomes quite conspicuous by the absence 
of every disturbance of sensibility, of vesical and sexual weakness, of muscular 
atrophy and bed-sores ; of disturbances of the brain and cranial nerves, and is 



810 SPINE. 

thus easily distinguishable from other spinal and cerebral affections already 
detailed. 

Its course is slow and of long duration, and most generally terminates 
fatally by some other intercurrent disease. 

THERAPEUTIC HINTS —There is no case on record, as far as I am 
aware of, which has been diagnosed and treated as this particular form of 
disease. The special hints must be taken from special and peculiar symp- 
toms of the individual case. • 

Polyomyelitis Anterior Acuta, Acute Inflammation of the 
Gray Anterior Columns (Anterior Horns). 

This affection has also been called: Spinal infantile paralysis, acute 
spinal paralysis of adults, acute atrophic spinal paralysis, paralysie atrophique 
cle VEnfance, and is marked by the following group of characteristic symp- 
toms : " It begins suddenly, usually with fever, with severe cerebral symptoms 
(deafness, coma, delirium, general convulsions) ; there is very rapidly de- 
veloped and complete paralysis with entire relaxation of the muscles; this 
paralysis being of very variable distribution over the trunk and extremities, 
but generally in the form of paraplegia ; there is an absence of any severe 
disturbances of sensation ; no paralysis of the sphincters, nor bed-sores. 

A rapid improvement of the general condition soon follows ; the pa- 
ralysis proves not to be of a progressive character ; indeed, gradual improve- 
ment of the same begins, although the restitution of movement is not uni- 
form and remains in part lost forever. In some of the muscles there is ex- 
treme and rapidly progressing atrophy, with degeneration of tissue ; the de- 
velopment of the bones is retarded; the extremities are cold and cyanotic. 
During the further course of the affection considerable deformities of the 
limbs and trunk arise (club-foot, curvatures of the spine, paralytic con- 
tractures, etc.). The general condition of the individual is admirable, in 
spite of the permanent defects in the motor apparatus, which almost invari- 
ably remain. 

The disease may occur at all periods of life, though it is by far the most 
frequent in children between the ages of one and four years. It is susceptible 
of an unusually large number of grades of severity. 

The anatomical lesion, although not yet quite certainly determined for 
all cases, may be regarded as most probably consisting in an acute myelitis of 
the gray anterior columns (anterior horns), which may extend more or less 
over the greater part of their entire length, but is disposed to be most heavily 
localized in the cervical and lumbar enlargements." (Erb.) 

Of its Etiology nothing is known with certainty. 



POLYOMYELITIS ANTERIOR SUBACUTA. 811 

THERAPEUTIC HINTS.— The initial symptoms may require: 
Aeon., Bellad., Gelsem., etc. 

Compare Myelitis and Leptomeningitis. 

Polyomy elitis Anterior Subacuta et Chronica ; Subacute and 

Chronic Inflammation of the Gray Anterior Horns; 

Chronic Atrophic Spinal Paralysis. 

"Clinically the disease presents itself as a motor paralysis, usually de- 
veloped without fever, with but slight general disturbance and insignificant 
disturbances of sensibility. The paralysis more or less rapidly seizes the 
entire lower extremities — generally in the course of a few days, or at the 
most a few weeks — and soon extends to the upper extremities also (much 
more rarely showing the opposite order of development and beginning in the 
upper extremities); it is associated with complete flaccid ity of the muscles and 
loss of their reflex excitability, and is followed by rapidly progressive atrophy in 
the bulk of the paralyzed muscles, with the well-marked reaction of degen- 
eration. 

The disease has certainly, as a rule, an ascending course, though it is by 
no means always progressive ; its development generally comes to a stand-still 
sooner or later, this arrest introducing a gradual retrogression of the disturb- 
ances, which may lead to more or less complete recovery. 

The anatomical limits of the disease cannot, as yet, be declared with 
absolute certainty; but according to all that we know, there is every proba- 
bility of its being located in the gray anterior horns. The two post-mortem 
examinations thus far made virtually confirm this, and thus, for the present, 
we may designate the disease as a subacute or chronic inflammation or degen- 
eration of the gray anterior horns, with extensive disappearance and atrophy 
of the large multipolar ganglion-cells." (Erb.) 

Etiology unknown. Duration long. 

THERAPEUTIC HINTS.— Plumbum. The symptoms of chronic 
lead-poisoning correspond very closely with the symptoms of this complaint. 

Paralysis Ascendens Acuta, Acute Ascending Paralysis. 

"The disease is clinically characterized by a motor paralysis, which 
generally begins in the lower extremities, spreads pretty rapidly over the 
trunk to the upper extremities and usually also involves the medulla ob- 
longata, which sometimes runs its course without fever, sometimes with more 
or less active fever, which but slightly involves the general sensibility and 
the functions of the bladder and rectum, and which runs its course without 



812 SPINE. 

any notable atrophy of the muscles, and without any diminution or change 
of their electrical excitability. 

In the majority of instances the disease terminates fatally by asphyxia, 
paralysis of deglutition, and the like; but lighter cases may also end in 
recovery. 

The anatomical characteristics of the disease are at present purely neg- 
ative. No pathologico-anatomical alterations are to be found anywhere, and 
especially not in the spinal cord, which might explain the picture of the dis- 
ease. In particular there are no signs of hyperemia within the spinal cord, 
of myelitis, of acute destruction of the ganglion-cells or nerve-fibres. 

If the disease is therefore to be localized within the spinal cord at all, it 
is a question of finer, so-called impalpable, disturbances of nutrition, not ac- 
cessible to our present means of examination." (Erb.) 

Of its Etiology nothing positive is known. Most cases occur between 
the ages of twenty and forty, some later ; men are most frequently attacked. 

THERAPEUTIC HINTS.— Consider all the remedies which show 
paralytic affections. Many cases may have been cured homoeopathically 
without having been recognized as just this particular form of disease. 



Coccyodynia 

Signifies pains in the coccyx and coccygeal region (muscular and tendinous 
fibres of the parts attached to the coccyx), of great variety of character and 
especially felt on sitting down or rising up, or straining to defecate, or at- 
tempting to exercise, but even during perfect rest. It may be of a neuralgic 
or rheumatic, or inflammatory nature. It has been observed to originate from 
" catching cold," especially in damp and cold weather ; from falls and blows ; 
from riding on horseback ; after parturition and delivery by forceps ; after 
suppression of eruptions. It attacks most frequently the female sex, is often 
of but short duration, but may be a source of great annoyance for years. 

THERAPEUTIC HINTS. — In injuries with crepitation: Calc. 
phosph. 

For periodical aching: Fluor, ac. (Hering), Rhus tox., Ruta 
grav., Silic. 

After a fall on the ice; pain w T orse after sleep: Laches. 
After a fall resulting in periostitis of the coccyx: Mezer. (Oehme.) 
During the first appearance of catamenia after confinement: Cicuta. 
(Bruckner.) 

After confinement, burning and smarting and painful uneasiness in the 



COCCYODYNIA. 813 

coccyx, better when standing, worse from slightest motion or pressure. Ta- 
rant. (Gonzales.) 

W. S. Searle gives the following hints : 

Bellad., ischia feel sore, as if no flesh were on them, yet she feels better 
when sitting upon something hard ; intense crampy pain in small of back and 
coccyx ; can sit only a short time ; cannot lie down well ; wakes often at 
night, and has to shift her position; unable to lie at all upon the back, and 
is most relieved by standing or walking slowly. 

Caustic, dull, drawing pain in region of coccyx; darting and bruised 
feeling in coccyx; pain in small of back from any movement; pinching, 
crampy pain in lumbar region and buttocks. 

Carb. an., pain in coccyx, which becomes a burning pain when the 
parts are touched; pressing, bearing-down pain in coccyx, as if bruised; pain 
as from subcutaneous ulceration, worse on sitting or lymg down ; pressing, 
drawing, or stiffness in the lumbar region, as if the back were broken. 

Thuja, painful drawing in sacrum and coccyx, and in the thighs when 
sitting; after having been seated a while, the drawing hinders standing 
erect ; sudden cramp-like pain in lumbar region after long standing, and then 
attempting to walk; it seems as if he would fall. 

Cann. sat., pressure as if with a sharp point, on the coccyx. 

Canthar., lancinations and tearings in the coccyx, causing him to 
start. 

Cicuta, tearing, jerking in coccyx. 

Cist, can., burning, bruised pain in coccyx. 

Drosera, itching stitch in coccyx when sitting. 

Graphit., dull drawing in coccyx in the evening; violent itching of 
coccygeal region, the part being moist with scurfy eruption. 

Kali carb., violent gnawing, at rest and in motion. 

Kali hydr., pain in coccyx as from a fall. 

Kreos., drawing pains along the coccyx down to the rectum and 
vagina, where a spasmodic, contractive pain is felt; better when rising from 
her seat; subsequent milky leucorrhcea. 

Laches., continual pain in sacrum and coccyx; drawing pain, or as if 
sprained, in small of back, hindering motion. 

Magnes., sudden, piercing pain in coccyx; sudden, violent, concussive, 
tearing, stitching pain in this region as if the spine were bent back. 

Mercur., tearing pain in coccyx relieved by pressing the hand against 
the abdomen; pain in sacrum, as if one had been lying on too hard a couch. 

Mur. ac, drawing, burning along the back, beginning at the coccyx, 
as if under the skin; burning stitch in sacrum, causing one to start. 

Paris quad., tearing in coccyx when sitting; pulsative stitches in 
coccyx. 



814 SPINE. 

Petrol., pain in coccyx while sitting; great uneasiness and stiffness in 
small of back and coccyx in the evening. 

Phosphor., ulcerative pain, hindering motion, and followed by pain- 
ful stiffness of nape of neck. 

Phosph. ac, itching stitch in coccyx; fine stitches in coccyx and 
sternum. 

Plat in a, numb feeling in coccyx as from a blow. 

Ruta, pain from coccyx to sacrum, as if caused by a bruise. 

Zincum, pushing, aching, or at times, pinching pain in coccyx; lan- 
cination in sacrum ; pressure, tension and weakness in lumbar and sacral re- 
gion ; cracking in back when walking. 



MOTORY APPARATUS. 



Rheumatismus. 



We may, as characteristic of rheumatismus, establish the following three 
points: 1. It attacks either the fibrous tissues, joints, aponeurosis, the sheaths 
of the tendons, the neurilemma, the periosteum, or the muscles and tendons. 
2. It is a peculiar, painful affection, caused no doubt by inflammation, nutri- 
tive disturbances; and, 3. It comes on independently of other acute and 
chronic diseases, or traumatic causes, etc. 

The principal Causes of its development are exposure to cold and at- 
mospheric influences, though they may not be the only causes; and thus it is 
agreed among the profession to call rheumatic all those affections which are 
of a very painful and inflammatory nature, which have become localized in 
any of the above stated tissues, and which are not of a secondary, or a sym- 
pathetic, or traumatic nature, but appear idiopathic; be they caused by ex- 
posure to cold and atmospheric influences or not. Its peculiar inclination to 
change localities is, although of frequent occurrence, not an invariable feature 
of the disease. Rheumatismus has been divided according to its location 
into — 

1. Rheumatismus Articulorum Acutus, Acute Rheumatism 
of the Joints; Polyarthritis Rheumatica Acuta. 

In this form its seat is the synovial membranes of one or several joints. 
By a nutritive disturbance they become inflamed, and yield a scanty exuda- 
tion, which contains neither much fibrin nor a great many pus globules. 
The external visible swelling is the product of an inflammatory oedema of 
the surrounding cellular tissue. In severe cases, however, the inflammation 
may be very high, and the exudation quite rich in fibrin or pus globules. 
Accordingly, post-mortem examinations show either scarcely any inflamma- 
tory signs or a high state of hyperemia, and ecchymosed spots in the syno- 

(815) 



816 MOTORY APPARATUS. 

vial capsule, which is filled with a quantity of purulent exudate; even the 
ends of the bones may be injected and infiltrated by bloody extravasations. 
The heart and large vessels, in all recent cases, contain a large amount of 
fibrin ; and besides, we find different structural changes of the heart, such as 
pericarditis, endocarditis and myocarditis, as complications of the acute form 
of articular rheumatismus. 

Predisposition to this complaint seems to lie between the years of fifteen 
and forty. Early childhood and old age are generally exempt. Those ap- 
pear most prone to the disease who have once been attacked by it; men more 
than women, and robust persons more than weak and debilitated ones. 

The most frequent Exciting Cause is exposure to cold and atmospheric 
influences. Often we cannot trace its origin to any cause. It is found in all 
climates, though more in the middle than in the hot or polar zones; and 
oftener in winter and spring than in summer and fall. 

Symptoms. — An attack of articular rheumatismus is frequently, though 
not always, preceded by a feeling of general debility and malaise, with oc- 
casional chilly sensations. Then the fever commences, and with it the pain 
in one or several joints. Soon these joints begin to swell, and sometimes to 
redden; the swelling is not, in all cases, proportionate to the pain. The dis- 
ease either stays confined in the joint first attacked, or it spreads from joint to 
joint, attacking even the spine and the symphysis ossium pubis, rarely, how- 
ever, the joints of the toes. The pain is generally excruciating, worse from 
the slightest motion or contact, and yet the patient is sometimes tortured by 
a restlessness which compels him to move, notwithstanding the greatest pain. 

The fever, in some cases, runs very high, and the temperature of the 
body ranges at times between 104° and 104.9° F. ; this is, however, excep- 
tional, as in most cases the temperature is not more than one or two degrees 
above the natural standard, and the pulse not higher than ninety to one 
hundred beats in a minute. In some cases we hear murmurs in the heart, 
even if not complicated with pericarditis; and the respiration is often ac- 
celerated. The skin transpires profusely without amelioration and is often 
covered with a red or white miliary rash. The urine is generally scanty and 
saturated with urates and uric acid, which, on cooling, make a thick deposit. 

Its complication with endocarditis amounts, according to Bamberger, to 
about twenty, and with pericarditis to about fourteen per cent. Compli- 
cations with myocarditis are much less frequent, and those of pleuritis and 
pneumonia, meningitis cerebralis or spinalis, occur still less often. 

Its course is not at all a regular one, confined to a certain cyclus. It 
may pass off in from eight to twelve days, and may torment many weeks. It 
very seldom terminates fatally, and then only in case of severe complications 
with affections of the heart, lungs or cerebral meninges. Its worst features 



RHEUMATISMUS MUSCULARIS. 817 

are an increased liability to new attacks, and chronic derangement of the 
valves of the heart. 

2. Rheumatismus Articulorum Chronicus, Chronic Rheu- 

matism of the Joints. 

This form originates chiefly in the acute form, and consists of a sub- 
acute inflammation of one or more joints. Post-mortem examination, there- 
fore, reveals the synovial capsule and ligaments thickened, the cartilages of 
the bones spongiform, and the synovial fluid turbid. 

We may distinguish two forms. One in which single joints, often for 
months or even years, remain very painful to motion and contact, and show 
paroxysms of aggravation, chiefly in the night. On applying the hand to the 
diseased part, we often observe a sense of crackling or crepitation within on 
moving the limb. The swelling of the joint may be considerable, or it may 
be absent; or the joint may only appear swollen, because the adjacent mus- 
cles have become atrophied, not being used on account of the pain. This 
may lead to a false anchylosis of the joint, rarely to the development of a 
tumor albus or arthrocace. 

The second form consists of frequently repeated attacks of acute artic- 
ular rheumatism. Individuals subject to it are appropriately compared to 
barometers, as they feel, " in their bones," every little change in the weather 
immediately. It is often complicated with muscular rheumatism, and those 
forms of neuralgic and paralytic affections which are called rheumatic. 

3. Rheumatismus Muscularis, Muscular Rheumatism. Myo- 

pathia; Myalgia Rheumatica. 

To this form are assigned all those rheumatic affections which are seated 
in the muscles, tendons, fascise, periosteum, and other fibrous tissues, joints 
excepted. Post-mortem examination furnishes little positive information as 
to the nature of the complaint. In some cases the muscles have been found 
interspersed by hard fibrous callosities; in others, some of the peripheric 
nerves were found thickened and grown together; and in others, nothing at 
all could be detected. The pain is rather the most characteristic of all the 
symptoms; it is the so-called "rheumatic pain" — tearing, shooting, stitch-like, 
screwing, burning; sometimes aggravated, and sometimes relieved by motion, 
rest, cold or warm applications, etc. The swelling and redness is seldom 
prominent, often entirely wanting. Its seat is of course quite variable, as it 
may attack any set of muscles in the body. According to its location it has 
received different names, the principal of which are: 

Cephalalgia rheumatica, or that form which attacks the musculi fron- 
52 



818 MOTORY APPARATUS. 

tales, occipitales, temporales, the galea aponeurotica, or the periosteum of the 
skull. 

Torticollis rlieuinaticus, Myalgia cervicalis— "stiff neck" — has its 
seat in the cervical muscles, and interferes much with the free movements of 
the head ; frequently draws the neck to one side, and may, if of long stand- 
ing, cause a permanent contraction of the muscles of one side of the neck — 
"wry neck." 

Pleurodynia rlieillliatica, myalgia pectoralis et inter costalis, attacks 
principally the pectoral is major and intercostal muscles. In the first case, it 
hinders the motions of the arms ; and in the second, it interferes with respira- 
tion, and makes coughing and sneezing quite painful, simulating the pains of 
pleuritis. 

Olliodyilia rlieillliatica, myalgia scapular is, is of frequent occurrence, 
having its seat in the muscles of the shoulders and back ; it causes not only 
great pain on moving the arms, but also when moving the trunk to stoop or 
to turn. 

Lumbago rlieiimatica, myalgia lumbalis, kink in the back, attacks the 
lumbar muscles and the fascia lumbo-dorsalis. It is a peculiar feature of 
this affection that it frequently sets in instantaneously: the individual having 
been moving about freely and without any pain, may in the next minute be 
unable to rise from his chair; it comes like a shock, and may remain un- 
abated for eight or ten days. 

THERAPEUTIC HINTS.— I have preferred to annex the necessary 
hints to the end of the chapter on the different forms of rheumatism, because 
it is not the pathologic form that indicates the special remedy; any one 
remedy may be indicated in either form; but it is the peculiarity of the in- 
dividual case which points out the corresponding remedy. 

Aeon., when there is synochal fever and restlessness; great thirst, dry, 
hot skin, and scanty, fiery urine; stitching pains in the chest, hindering free 
respiration, and great agitation of the heart, with anxiety. Articular rheu- 
matism, with hot, pale or red swelling of the joints, shifting sometimes from 
one to another; after exposure to cold, dry w T ind. "Kink in the back hin- 
dering deep inspiration." (Wm. J. Martin.) 

Amm. phosph., recommended by Kurtz for arthritis nodosa; the 
joints of the fingers, hands and back are swollen and bent; there is loss of 
appetite, emaciation, sleeplessness, nervous irritability, evening-fever. 

Ant. crud., acute rheumatism, also gout, with gastric symptoms; nau- 
sea, vomiting, white tongue and great thirst at night. 

Apis, stinging, burning pain with great soreness and lameness of the 
affected parts, commences on right side and goes to left; oedematous swelling; 
profuse sweat brings relief. 



RHEUM ATISMUS. 819 

Apocyn. an dr., rheumatism and gout; pain especially in the right 
shoulder and knee; pain in the joint of the big toe; bilious vomiting, with 
or without diarrhoea; fever; nervous excitement ; sleeplessness; constipation. 

Arnica, tearing pain, great soreness, numbness and swelling of the 
affected parts ; worse on slightest motion, and especially when lying and get- 
ting warm in bed; fears even the possibility of being touched; complains 
constantly that the bed or couch whereupon he lies is too hard. Podagra; 
pleurodynia; pressing pain in region of left side below heart, day and night. 

Arsen., burning, stinging, tearing pain, with pale swelling of the joints; 
great debility unto fainting; restlessness, anxiety, especially at night; pro- 
fuse sweat, which relieves the pain but leaves the patient terribly weak ; fre- 
quent chilliness alternates with heat; the affected limb has to be moved con- 
stantly; external application of heat relieves; metastasis to the heart; aggra- 
vation every other day. 

Aur. raur., continued gnawing, boring pain deep in the joints, after 
the inflammatory swelling has subsided. 

Bellad., pressing, tearing, cutting pain deep in the bones, frequently 
running from the affected joint along the limbs like electric shocks; coming 
and going quickly; red, shining swelling of the joints; worse generally at 
night, from touch and slightest motion, even talking; attended with high 
fever, hot, dry skin, thirst; throbbing headache and pulsation of the carotid 
arteries. Lumbago, intensely painful sensation of cramp in the lumbo-sacral 
region and coccyx ; can sit only for a short time and while sitting becomes 
quite stiff and unable to rise again for pain ; crampy pains with stiffness in hip 
and ham, especially on left side. Torticollis, right sterno-cleido-mastoid con- 
tracted, no inflammation or pain. 

Benz. ac, tearing pains as if in the bones, from left to right and from 
below upwards; irritable bladder, urine of ammoniacal smell; syphilitic and 
gonorrhoeal complications. Arthritis deformans. 

Berber., lumbago, aching pain from above crests of ilia downward and 
inward to sacrum; aching pain in bladder before and after micturition; 
burning micturition. (H. V. Miller.) 

Bryon., stitching pain, tearing pain, worse from slightest motion; 
generally the patient does not want to move, but sometimes he is compelled 
to move by an overwhelming restlessness, notwithstanding the pain. The 
swelling is not principally confined to the joints and chiefly of a faintish red- 
ness, streaking out in different directions. There is almost always loss of 
appetite, white tongue, feeling of dryness in the mouth without thirst, or else 
great thirst; nausea; pain in the liver or spleen ; dry, hard stool, as if burnt; 
short breathing, with stitching pain in the sides of the chest; fever; sour 
sweats; easily irritated and angry. Pleurodynia, omodynia, lumbago, muscu- 
lar rheumatism in general ; metastasis to the pericardium or pleura. 



820 MOTORY APPARATUS. 

Cact. grand., metastasis to the heart, with a sensation of constriction 
in the region of the heart, as if the heart were grasped and compressed, as 
by a band of iron. 

Calc. carb., chronic arthritis, with swelling of the joints, worse with 
every change of the weather ; after working in water ; also omodynia in right 
shoulder, or from the left shoulder down along the arm and towards the 
heart ; lumbago, cold feeling in gluteal region and aching after Rhus tox., if 
it did not sufficiently relieve. Frequent sensation of coldness upon the top 
of the head ; profuse sweat and coldness of the feet ; great inclination to 
perspire; scrofulous diathesis. 

Calc. phosph., rheumatic pains in various parts of the body, but 
especially in places where bones are joined by symphyses or sutures; worse in 
cold weather. 

C amphora, according to Kreussler, when the morbid process seems 
to yield under the influence of the proper remedies but for a short time and 
then comes back again, attacking part after part of the body, even internal 
organs. 

Carbol. ac, pains feel as if they would be increased by motion, but 
are not; pains come and go quickly, are worst in hip and shoulder-joints. 

Cauloph., rheumatism of the wrists and finger-joints, with considerable 
swelling; also > when shifting from the extremities to the back and nape of 
the neck, with spasmodic rigidity of the muscles of the back and neck ; 
panting breathing ; oppression of the chest ; high fever ; nervous excitement ; 
delirium. 

Caustic, tearing pain with stiffness and swelling of the joints; con- 
traction of the flexors; the pain is worse on exposure to cold air, better in 
the warmth of the bed; great weakness and lameness of the lower limbs 
and trembling of the hands. Chronic arthritis ; old warts on the eyebrows 
and nose. 

Chamom., drawing pain in the muscles of the upper or lower extrem- 
ities, much aggravated during the night, with tossing about, as if beside him- 
self, and great irritability of temper; hot perspiration, especially about the 
head ; redness of one cheek and paleness of the other. 

China, pain in all the limbs, worse especially from external pressure, 
so that he is even afraid of anyone coming near him, lest he might be 
touched ; bears hard pressure better than slight touch ; intermittent charac- 
ter; great weakness; paleness of the face; bloated abdomen; after severe 
illness, loss of blood, etc. 

Cimicif., pleurodynia of the right side of the chest; pain worse from 
motion, extorting screams; articular rheumatism of the lower extremities, 
with much swelling and heat of the affected parts. 



RHEUMATISMUS. 821 

Coccul., when the upper arm or thigh cannot be moved in their joints 
on account of a lame pain. 

Colchic. , burning, tearing, or jerking pains ; shifting ; without swelling 
and redness, or with only a moderate, pale swelling; constant chilliness even 
near the hot stove, intermingled with short flushes of heat ; dry skin or pro- 
fuse sweat, suddenly breaking forth and disappearing again ; palpitation of 
the heart; gastric symptoms before and during the attack; Colchic. is said 
to be indicated especially when the acute form merges into the chronic, or 
when, during chronic rheumatism, acute attacks set in; also in metastasis to 
the heart. 

Collin., has been given in diseases of the heart following acute rheu- 
matism. 

Coloc, all sorts of pains, w r ith sense of formication and numbness; 
frequent urination ; skin cool ; chilliness with inclination to perspire. 

Digit., hurried, small pulse, easily affected by motion; strong pulsa- 
tions of the heart, with an indistinct and muffled sound of the heart ; hurried 
respiration ; hurried, abrupt speech ; almost complete suspension of the 
urinary secretion; shining, white swelling of the joints, not very sensitive to 
pressure; a number of joints are attacked at once; the w 7 hole body is pale. 
(Baehr.) 

Dulcam., chronic rheumatism, which gets worse from any little ex- 
posure to cold, or any change of temperature from warm to cold; also when 
rheumatic pains set in after acute cutaneous eruptions, or when the chronic 
form alternates with attacks of intestinal catarrh. 

Ferrum, omodynia, either side; pain, especially in the deltoid muscle, 
of a constant, drawing, tearing, laming nature, worse in bed; has to get up 
and to move slowly about ; worse, also, from being too lightly covered for 
any length of time; face pale, flushing easily; no swelling. 

Ferr. phosph., attacking one joint after the other without leaving the 
first; joints puffy but little red; high fever. Kink in the back. 

Gnaphal., gouty pains in the great toes. 

Graphit., arthritic nodosities on the fingers; swelling of the toes and 
balls of the toes ; coldness of the dorsum of the feet. 

Guaiac, arthritic lancinations and subsequent contractions of the limbs ; 
the pain is excited by the slightest motion and accompanied by heat in the 
affected parts, especially when the patient has been injured by mercury. It 
also promotes the spontaneous breaking of gouty abscesses, relieving greatly 
the sufferings of the patient. 

Hamam., is recommended by Ludlam as "a local application to all 
kinds of articular rheumatism." The main characteristic of Hamam. is the 
great soreness of the affected parts ; it may therefore, no doubt, act quite 
favorably in cases where this soreness is a prominent feature. 



822 MOTORY APPARATUS. 

Iodium, in chronic arthritic affections, when they are characterized by 
a violent, nightly pain in several joints, without swelling; previous abuse of 
mercury. 

Kali carb., stitching, tearing pains in joints; shuddering; chilliness; 
nightly diarrhoea; fulness and pressure in stomach after eating; frequent 
waking and desire to uriuate, with burning; cold feet; hearing impaired; 
noise in ears. (F. Schelling.) Lumbago, as if the small of the back were 
broken ; pains shoot down back of thighs. 

Kali hydr., large doses, in chronic arthritis with considerable spurious 
anchylosis. (Hirshel.) 

Kali sulph., shifting from one joint to another, leaving the first with- 
out pain. (Schiissler.) 

Kalmia, the pains are shifting, changing location suddenly; deltoid 
rheumatism of both sides, but more particularly the right; tendency to affect 
the heart ; slow pulse. 

Kreosot., when the rheumatic pain in the joints, especially in the hip 
and knee-joints, is associated with a feeling of numbness, loss of sensation, 
and a feeling as though the whole limb were going to sleep. 

Laches., rheumatic swelling of the index-finger and wrist-joint; rheu- 
matic pains in the knees, stinging, tearing, and sense of swelling; swelling of 
the knees, with tension in the bend of the knees, difficulty in stretching the 
limb, and pain of the thigh (posteriorly) as if swollen; bluish-red swellings. 
The pains are generally worse after sleeping; they do not improve after pro- 
fuse sweats ; the left side is generally the most affected ; or the affection com- 
mences on the left and goes over to the right side. Arthritic contractions 
of the limbs after the abuse of mercury and quinine ; irregular action of heart, 
and valvular affection. 

Lachnanth., torticollis, the neck is drawn to one side. Stiff neck. 

Ledum, rheumatic pains in the lower extremities, in the hip and knee- 
joints, especially when they commence below and go upwards; pains alter- 
nating with spitting of blood ; arthritic nodosities with violent pains, which 
grow worse in the evening, when getting warm in bed, and last till midnight. 

Lith. carb., gouty disposition; rheumatic soreness or sudden shocks in 
region of heart; pains in heart before and during micturition, also before and 
during the menses ; trembling and fluttering of the heart from mental agita- 
tion ; valvular deficiences. 

Lycop., the pain is mostly tearing, oftener on the right side, with and 
without swelling. In lumbago, if Bryon. has not sufficiently relieved, and 
the pain is worse from the slightest motion. In chronic forms, especially in 
old people, attended by forgetfulness, vanishing of thoughts, congestion of the 
head, vertigo, wretched countenance, sour belching, nausea early in the 
morning, flatulence in the stomach and bowels, causing great distress, con- 



RHEUMATISMUS. S23 

stipation of the bowels, urine dark and turbid, or with sediment of red sand, 
oppression of the chest from flatulence, palpitation of the heart, frequent 
flushes of heat with nausea, dry skin. The pain is generally worse at night ; 
cannot bear covering. 

Mangan., arthritis vaga, shifting from one joint to another, or affecting 
cross- wise, with shining redness and swelling of the joints; burning spots 
about joints; pain worse from touch and motion, and at night, causing the 
patient to moan and groan constantly. Gout; left big toe swollen, with ex- 
cruciating pain radiating upwards; must constantly change position. 

Menyanth., painful, spasmodic jerking of the lower extremities in 
gouty persons, with calcareous deposits in the joints. 

Mercur., tearing pain not relieved by sweat, which is often very pro- 
fuse and of a musty smell ; worse at night, and in the warmth of the bed ; 
worse also in cold and damp air; attacking joints and muscles, with and 
without swelling; or a mere puffiness of the affected parts, of a pale or 
slightly pinkish color; collection of saliva in the mouth of a copperish taste; 
slimy tongue ; bitter or sweetish taste ; foul breath ; violent pain in decayed 
teeth; swollen gums; swollen glands of the neck, painful when swallowing ; 
gripiug in the bowels with diarrhoea, especially towards evening, with fre- 
quent urging; constant feverishness ; internal heat, with chilliness and per- 
spiration; sleeplessness and restlessness at night; great debility. Complica- 
tion with cardiac, pulmonary, pleural and meningeal inflammation. "Lame- 
ness, weakness and swelling of the leg in the region of the ankle-joint, in fleshy 
old ladies with rheumatic or gouty tendency." (A. C. Rickey.) 

Nux vom., especially in rheumatism of the trunk, limbs not excepted ; 
gout, in its incipient stage, in habitual drinkers ; oversensitiveness to pain ; 
constipation; during hard stool, violent pain in the affected part; scanty, 
dark urine; heat mixed with chilliness, especially when moving; perspiration 
relieves. Torticollis, head drawn to left side ; after fright. 

Phosphor., drawing, tensive pains, from slightest exposure to cold 
with vertigo, oppression and sense of lameness and weakness in the lower 
limbs. 

Phytol., rheumatism of back and hip-joints. (A. E. Small.) Chronic 
form; obtuse, heavy, aching pain, generally worse in damp weather; with 
and without swelling; periosteal rheumatism with syphilitic taint; nightly 
aggravation; enlargement of the glands of the neck and axilla. 

Platina is recommended by Elb for the incipient state of endo- and 
pericarditis, in consequence of articular rheumatism, especially when there is 
intense anxiety and great palpitation of the heart. 

Pulsat., drawing, tearing pain, frequently shifting from one part of the 
body to another, or attacking only one side; usually attended by swelling 
and redness; pale face; slimy mouth; bitter taste; loss of appetite; no 



824 MOTORY APPARATUS. 

thirst; constant chilliness, with heat in the affected part; chilliness of left 
side; mild, quiet, tearful disposition; worse towards evening and at night in 
the warm room; better from changing position and moderately moving 
about in the fresh air; from drinking cold water and from uncovering the 
affected part. 

Rhodod., nightly drawing-pains in the periosteum from wet, cold and 
stormy weather; worse during rest, disappearing when moving, 

Rhus tox., drawing, tearing pains in fibrous tissues, joints, and sheaths 
of the nerves, attended with a sense of lameness and formication in the 
affected parts, with or without swelling and redness, caused by exposure to 
wet, damp weather, to rain, by bathing or straining ; worse during rest and 
when commencing to move; better from continued motion and dry, warm, 
external applications; great restlessness. Lumbago. 

Ruta, wrists and feet; puffy swelling about the insteps; sour sweat. 

Sabina, chronic arthritis and gout; the patient cannot bear a heated 
room ; he feels decidedly better in the cool air and in a cool room ; better 
from sitting erect, from moving and stretching ; feeling of deep-seated inward 
trouble; melancholy and sad. 

Salic, ac, inflammatory rheumatism of the joints, with great swelling 
and redness; high fever and excessive sensitiveness to the least jar; motion 
impossible. 

Sanguin., right arm swollen, can't be raised, but moved laterally; 
sensation of coldness in arm, which no amount of clothing can remove ; stiff 
neck, pain in shoulder ; trapezius sore to pressure and painful on movement. 

Secale, kink in back. (Schiissler.) 

Silic, in chronic gouty nodosities. 

Spigel., when complicated with endocarditis or pericarditis. 

Spongia, with heart affection, wakening after midnight with sense of 
suffocation. 

Sticta pulm., inflammatory, articular rheumatism, especially of small 
joints, with circumscribed redness; subsequent synovitis, with exudation. 
(Price.) 

Sulphur, chronic rheumatism; podagra; tearing, stitching pain; or 
when, after Bryon., the stitch-pain leaves, and a dull, aching, pressive pain 
remains ; sleeplessness ; hot head and cold feet. 

Tarant., articular rheumatism, attacking almost all the joints from 
below upwards to neck, attended with nervous symptoms, such as: spasmodic 
jerking of the head backwards or sideways; jerking, sighing breathing; 
palpitation of heart with pain in region of heart. 

Tart, emet., lumbago; slightest effort to move causes retching, cold, 
clammy perspiration and excruciating pain. 

Tilia Eur., when during a rheumatic fever a warm profuse perspiration 



DIGEST TO RHEUMATISM. 



825 



does not alleviate but aggravates the pain, and the swelling of the joints in- 
creases, with great thirst and a decided decrease of the urinary secretion. 
(A. Lippe.) 

Thuja, rheumatic and arthritic pains, especially of a sycotic or gonor- 
rhoea! nature ; sweating of the parts not covered ; those which are covered 
keep dry ; sensation as if the whole body were very thin and delicate, and 
could not resist the least attack, as if the continuity of the body would be 
destroyed. 

Ver. alb., electric jerks in the affected limbs; worse in bed; necessity 
to sit up and let the legs hang out of bed, or must walk about. 

Ver. vir., rheumatism, especially in left shoulder, hip and knee; also 
recommended in endocarditis and pericarditis. High fever; red streak 
through centre of tougue, with coating upon either side. 

Zincum, general, articular rheumatism, especially of the smaller joints, 
with tearing pain, lameness, and trembling or crampy pain; or twisting in 
the affected limbs, and frequent jerking of the whole body during sleep; 
fidgety of the feet. 



Digest to Rheumatism. 



ITS DIFFERENT FORMS AND 
LOCATIONS. 

Acute articular rheumatism : Aeon., 
Ant. crud., Apoc. andr., Bryon., Clinic., 
Ferr. phosph., Hamam., Platlna, PulsaL, 
Rhus tox., Salic, ac, Stlcta pulm., Tarant., 
Tilia Europ., Ver. vir., Zincum. 

When the acute form merges into the 
chronic: Colchic. 

Chronic form : Cede, carb., Caustic, Dul- 
cam., Iodium, Lycop., Phytol., Sablna, 
Sulphur. 

, with acute attacks: Colchic. 

Muscular, in general : Bryon. 

Torticollis, right sterno-cleido-mastoid 
contracted, no inflammation or pain: 
Bdlad. 

, muscles of back and neck rigid : 

Gauloph. 

, head drawn to left : Nux vom. 

Stiff neck: Lachnanth., Sanguin. 

Pleurodynia : Arnica, Bryon., Nux vom. 

, right side: Civile. 

Omodynia: Bryon., Sanguin. 

, right side: Ode. carb. 

, either side : Ferrum. 



Lumbago, kink in back:. Aeon., Bellad., 
Berber., Bryon., Calc. carb., China, Ferr. 
phosph., Kali carb., Lycop., Rhus tox., Secede, 
Tart. emet. 

Kink in back, hindering deep inspira- 
tion: Aeon. 

Gout: Aeon., Amm. phosph., Ant. crud., 
Apoc. andr., Arnica, Arsen., Bryon., Calc. 
carb., Caustic, Coloc, Graphit., Guajac., 
Iodium, Lithium carb., Lycop., Natr. mur., 
Sablna, Sllic, Sulphur. 

, left big toe, with radiating pain up- 
ward : Manga a. 

, habitual drinkers : Nux vom. 

Arthritis nodosa : Amm. phosph., Benz. 
ac, Calc phosph., Graphit., Kali hydr., 
Ledum, Menyanth., Sillc. 

, promotes breaking of gouty abscesses : 

Guajac 

Trapezius, shoulder: Sanguin. 

Trunk and limbs : Nux vom. 

Back and hip: Phytol. 

Shoulder and hip : Carbol. ac. 

and knee, left side: Ver. vir. 

and knee, right side : Apoc. andr. 

and knee : Kreos. 



826 



MOTORY APPARATUS. 



Right arm swollen, can't be raised, but 

moved laterally : Sanguin. 
Deltoid muscle : Ferrum. 

, more the right side: Kalmia. 

Wrist and index-finger: Laches. 

and finger-joints: Cauloph. 

and feet : Rata. 

Back of hands and fingers swollen and 

bent : Amni. phosph. 
Lower extremities : Clinic, Ledum. 
Hip and knee-joints: Ledum. 

and ham, worse left side: Bellad. 

Ankle-joints: Mercur. 

Small joints: Digit., Sticta pulm., Zin- 

cum. 
Where there are symphyses or sutures : 

Calc. phosph. 



Shifting, moving: Aeon., Colchic, Sian- 
gan., Mercur., Pulsat. 

, suddenly : Kalmia. 

from one joint to another, without 

leaving the first : Ferr. phosph. 

, leaving the first without pain: 

Kali sulph. 

from left shoulder down arm and 

towards heart: Calc. carb. 

from below upwards: JBenz. ac, Le- 
dum. 

from extremities to back and nape of 

neck: Cauloph., Tarant. 

from right to left: Apis. 

from left to right : Benz. ac, Laches. 



One side only : Pulsat. 
Right side oftener : Lycop. 
Left side mostly : Laches. 
Crosswise: Mangan. 



Aching : Berber., Phytol. 

Burning: Apis, Arsen., Colchic 

Crampy : Bellad., Zincum. 

Drawing : Chamom., Phosphor., Pulsat., 

Rhus tox. 
Formication and numbness: Arnica, 

Coloc, Kreos., Rhus tox. 
Heat: Aeon., Guajac, Pulsat. 
Jerking : Colchic 



Lameness : Apis, Ferrum, Rhus tox., Zin- 
cum. 

Lancinating : Guajac. 

Soreness : Apis, Hamam. 

Stinging : Apis, Arsen., Laches. 

Stitching : Bryon., Kali carb., Sulphur. 

Swelling, sense of: Laches. 

Tearing: Arnica, Arsen., Bellad., Benz. 
ac, Bryon., Caustic, Chamom., Colchic, 
Ferrum, Kali carb., Laches., Lycop., Mer- 
cur., Pulsat., Rhus tox., Sulphur, Zincum. 

Twisting: Zincum. 

Quickly coming and going: Bellad., 
Carbol. ac. 



Aching from above crests of ilia down 

and inward to sacrum: Berber. 

in gluteal region: Calc. carb. 

Boring, gnawing deep in the joints after 

the swelling has subsided: Aur. mur. 
Burning in spots about the joints. 
Coldness in arm, which no covering can 

remove: Sanguin. 

in gluteal region : Calc carb. 

Cramp in lumbo-sacral region and coccyx : 

Bellad. 
Cutting, pressing, tearing deep in bones, 

running from affected joint along limbs 

like electric shocks : Bellad. 
Drawing in periosteum, nightly : Rhodod. 
and tearing in muscles in upper and 

lower extremities : Chamom. 
, shifting from one part to an- 
other: Pulsat. 
in fibrous tissues, joints and 

nerve-sheaths : Rhus tox. 
Lame pain in upper arm and thigh : Coc- 

cul. 
Lameness and weakness in lower limbs: 

Caustic, Phosphor. 

of ankle-joints : Merc sol. 

Pain in all the limbs : China, 

in thigh, posteriorly, as if swollen : 

Laches. 
Shooting down back of thighs : Kali carb. 
Stitching, tearing in joints: Kali carb. 
Tension in bend of knees : Laches. 

Swelling: Apis, Arnica, Cauloph. 



DIGEST TO RHEUMATISM. 



827 



Swelling and heat: Chnic. 

of joints: Cede, carb., Tilia Europ. 

and stiffness : Caustic. 

of index-finger, wrist-joint, and knees: 

Laches. 

about ankle-joints: Mere. sol. 

■ of toes and balls of toes : Graphit. 

or no swelling : Lycop., Phytol. 

of joints or muscles: Merc. sol. 

No swelling : Ferrum. 

Swelling and redness: Aeon., Pulsat., 

Rhus tox., Salic, ac. 

circumscribed: Sticta puhn. 

bluish : Laches. 

faintish, pale: Aeon., Arsen., 

Bryon., Colchic. 

, shining : Bellad. 

, shining white: Digit. 

Puffiness about insteps: Ruta. 

, but little red: Ferr. phosph. 

, of a pale or slightly pinkish color: 

Mereur. 



Breathing, jerking, sighing: Tarant. 

, hurried, and abrupt speech : Digit. 

, panting: Cauloph. 

, short, with stitch-pain in sides of 

chest : Bryon. 

, hindered, from stitching pains in 

chest: Aeon. 

Oppression : Cauloph., Rhus tox. 

from flatulency : Lycop. 

Suffocation, sense of, after midnight: 
Spongia. 

Spitting of blood alternates with rheu- 
matic pain : Ledum. 

Inflammation, pulmonary, pleural, men- 
ingeal : Bryon., Merc. sol. 

Metastasis to heart : Arsen., Bryon., Cact. 
grand., Colchic, Kalmia lat. 

Heart affection : Collins., Mereur., Spon- 
ffia. 

Endo- and pericarditis: Platina, Spi- 
gel., Ver. vir. 

Valvular deficiencies : Laches., Lithium 
carb. 

Slow pulse : Kalmia. 

Hurried, small pulse, easily affected by 
motion: Digit. 



Palpitation: Colchic, Lycop., Platina, 
Tarant. 

Agitation with anxiety : Aeon. 

Strong pulsations, with muffled sound 
of heart : Digit. 

Trembling and fluttering of heart from 
mental agitation: Lithium carb. 

Irregular action : Laches. 

Pains in heart before and during mictu- 
rition and menses: Lithium carb. 

Region of heart, pain : Tarant. 

, constriction, as if heart were grasped 

by an iron hand : Cact. grand. 

, soreness and shocks: Lithium carb. 

, pressing below heart, day and night : 

Arnica. 

ACCOMPANYING SYMPTOMS : 

Forgetfulness, old people; vanishing of 
thoughts: Lycop. 

Delirium: Cauloph. 

Sad, melancholy: Sabina. 

Anxiety : Aeon., Arsen., Platina. 

Irritable : Amm. phosph. 

, beside himself: Chamom. 

, angry : Bryon. 

Mild, quiet, tearful: Pulsat. 

Nervous excitement : Apoc. andr., Cau- 
loph. 

Restlessness : Arsen., Rhus tox. 



Vertigo : Lycop., Phosphor. 
Congestion : Lycop. 
Throbbing headache : Bellad. 
Meningeal inflammation : Mereur. 



Hearing impaired, noises in ears: Kali 

carb. 
Face pale : China, Pulsat. 

, easily flushing : Ferrum. 

on "one cheek, the other red : 

Chamom. 
Whole body pale : Digit. 
Wretched countenance : Lycop. 
Old warts on eyebrows and nose : Caustic. 
Carotid arteries pulsate : Bellad. 
Swollen glands of neck, painful on 

swallowing : Mereur. 
and axilla: Phytol. 



828 



MOTORY APPARATUS. 



Tongue white : Ant. erud., Bryon. 
coated on both sides, with red streak 

in middle : Ver. vir. 

slimy: Mercur., Pulsat. 

Teeth decayed, painful, swollen gums; 

foul breath : Mercur. 
Taste bitter: Mercur., Pulsat. 

copperish or sweetish, collection of 

saliva: Mercur. 

Thirst: Aeon., JBellad., Bryon., Tilia 
Europ. 

at night : Ant. crud. 

, none: Pulsat. 

, , with feeling of dryness in 

mouth: Bryon. 

Loss of appetite : Amm. phosph., Bryon., 
Pulsat. 

Nausea, vomiting: Ant. crud. 

, sour belching early in the morning : 

Lycop. 

Gastric symptoms : Colchic. 

Bilious vomiting, with or without diar- 
rhoea: Apoc. andr. 

Pain in liver or spleen: Bryon. 

Fulness and pressure in stomach after 
eating : Kali carb. 

Flatulence in stomach and bowels : Lycop. 

Bloated abdomen: Chamom. 

Constipation: Apoc. andr., Bryon., Lycop., 
Nux vom. 

Diarrhoea, nightly: Kali carb. 

, with griping in bowels, worse to- 
wards evening: Mercur. 

alternates with rheumatic attacks: 

Lulcam. 



Aching in bladder before and after mic- 
turition: Berber. 

Irritable bladder : Benz. ac. 

Frequent waking and desire to urinate, 
with burning : Kali carb. 

urination: Coloc. 

Burning micturition : Berber. 

Urine scanty, dark: Nux vom. 

, fiery : Aeon. 

dark, turbid, red sediment : Lycop. 

decreasing : Tilia Eur op. 

suppressed: Digit. 

Contraction of flexors : Caustic. 



Contraction of limbs : Guajac, Laches. 
Synovitis, with exudation: Stictapulm. 
Jerking of head backwards and sideways: 

Tarant. 

lower extremities : Menyanth. 

affected limbs : Ver. alb. 

whole body during sleep : Zincum. 

Trembling: Zincum. 

of hands : Cimic. 

Fidgety of feet : Zincum. 

Sensitive to pain: Nux vom. 

, as if body were thin and delicate and 

could not resist the least attack without 

being destroyed : Thuja. 
Weakness: China. 
Debility: Mercur. 

unto fainting : Arsen. 

Bmaciation : Amm. phosph. 



Restlessness: Aeon., Arsen., Bryon., 
Mercur., Rhus tox. 

Tossing about : Chamom. 

Sleeplessness: Amm. phosph., Apoc. 
andr., Mercur., Sulphur. 

Must constantly change position: Man- 
gan. 

Affected limb has to be moved con- 
stantly: Arsen. 

Has to get up and move slowly about: 
Ferrum. 

Difficult to stretch the limb : Laches. 

Does not want to move : Bryon. 

Bed feels too hard : Arnica. 

Hard pressure feels better than slight 
touch: China. 



Coldness upon top of head : Cede. carb. 

in gluteal region : Cede. carb. 

of feet : Kali carb. 

and hot head: Sulphur. 

and profuse sweat : Cole. carb. 

of dorsum of feet : Graphit. 

Skin cool: Coloc. 

Chilliness, shuddering : Kali carb. 

of left side : Pulsat. 

alternating with heat : Arsen. 

when moving during heat : Nux vom. 

even near stove, intermingled with 

flushes of heat : Colchic. 



DIGEST TO RHEUMATISM. 



829 



Chilliness, with internal heat and per- 
spiration: Mercur. 

, with perspiration : Coloc. 

Fever: Apoc. andr., Bellad., Bryon., Cau- 

loph., Ferr. phosph., Mercur., Salic, ac, 

Ver. vir. 

and restlessness : Aeon. 

in evening: Amm. phosph. 

Heat mixed with chilliness : Arsen., Mere. 

sol., Nux vom. 
Flushes of heat, with chilliness: Col- 

ch ic 

, with nausea: Lycop. 

Hot head and cold feet: Sulphur. 

Dry skin: Aeon., Bellad., Colchic, Lycop. 

Perspiration, hot, about the head: Cha- 

mom. 

and cold feet : Cede. carb. 

, with chilliness and internal heat : 

Mercur. 

and chilliness : Coloc. 

of parts not covered : Tttuja. 

sour: Bryon,, Ruta. 

brings relief: Apis, Nux vom. 

, but leaves the patient very 

weak: Arsen. 

without relief : Laches., Mercur. 

, worse after: Tilia Europ. 

, inclined to: Cole, carb., Mercur. 

breaks out suddenly and disappears 

as am: Colchic. 



"Worse in evening : Ledum. 

and night : Pulsat. 

at night : Bellad., Chamom., Iodium, 

Ledum, Lycop., Mangan., Mercur., Phy- 

tol, PJtodod. 

every other day : Arsen. 

intermittent: China. 

in bed : Ferrum, Ver. alb. 

from being covered : Ferrum, Lycop. 

lying and getting warm in bed: 

Arnica. 

in warm room : Pulsat., Sabina. 

from sweat : Laches., Jlercur., Tilia 

Europ. 

after sleep : Laches. 

from cold air : Caustic., Dulcam., Phos- 
phor. 



"Worse from cold and damp weather: Cole. 

carb. and phosph., Mercur., Phytol. 
from change of temperature from 

warm to cold : L>ulcam. 
from slightest motion : Arnica, Bel- 
lad., Bryon., Cimic, Guajac., Mangan., 

Salic, ac, Sanguin. 

from least jar: Salic, ac. 

when commencing to move: Rhus 

tox. 
from effort to move, ca-ising retching 

and cold perspiration : Tart. emet. 
, as if the pains would be worse from 

motion, but are not : Calc. phosph. 

from talking: Bellad. 

during hard stool : Nux vom. 

from sitting, can't rise after : Bellad. 

during rest: Bhoclod., Rhus tox. 

from touch: Bellad., Mangan. 

, fears the possibility of being 

touched: Arnica, China. 
Better from warm external applications : 

Arsen., Rhus tox. 

the warmth of bed : Caustic. 

uncovering : Lycop., Pulsat. 

cool air and in a cool room: Sabina, 

Pulsat. 

drinking cold water : Pulsat. 

sitting up and letting legs hang out 

of bed: Ver. alb. 

changing position: Pidsat. 

walking about : Ferrum, Ver. alb. 

moving about : Rhodod., Pulsat. 

continued motion: Rhus tox. 

perspiration: Nux vom. 

CAUSES. 

Severe illness, loss of blood: China, 
Exposure to cold, dry wind : Aeon. 
Wet, cold, stormy weather: Rhodod. 
, , , bathing or straining: 

Rhus tox. 
Working in water : Calc. carb. 
After cutaneous eruptions : Dulcam. 
Scrofulous diathesis : Calc. carb. 
After gonorrhceal or sycotic affections: 

Bern, ac, Thuja. 
Syphilis: Phytol. 
Abuse of mercury: Guajac, Iodium, Laches. 



830 MOTORY APPARATUS. 



Camphora, when proper remedies seem 
ineffectual. 

Calc. carb., when Rhus tox. did not suffi- 
ciently relieve. 



Lycop., when Bryon. was insufficient and 
pain is worse from motion. 

Sulphur, when Bryon. leaves a dull, ach- 
ing, pressive pain. 



4. Gout, Podagra, Arthritis. 

Gout differs entirely from rheumatism in the form of its attacks (of 
which, later), by the overcharge of the blood with uric acid, by its never 
attacking children, and only grown persons after thirty years of age, and 
men oftener than women, especially such as are accustomed to a rich table 
and the habitual use of beer or wine, and who take very little bodily exercise. 
It is, therefore, a very rare occurrence to find a poor man suffering with 
podagra. According to statistics its main cause is a hereditary disposition, 
which is generally aroused into activity by overcharging the blood with ni- 
trogenized substances, and a want of exercise to consume the too-liberal 
supply. 

The repetition of diverse acute attacks of gout and its chronic form 
causes peculiar changes in the joints which it attacks. We find in and around 
them, besides the ordinary signs of inflammation, a chalky deposit, consisting 
principally of urate of soda, and less frequently of compounds of uric acid 
with lime, magnesia and ammonia. This deposit either lines the internal 
surface of the synovial capsule like a soft mush, or incrustates the cartilages 
of the bones as a hard mass, or even fills the whole joint as though it had 
been injected with plaster of Paris, growing hard and causing anchylosis. 
At the same time gouty deposits may take place on the external surfaces of 
synovial capsule, on the tendons and in the surrounding cellular tissue, and 
give rise to hard nodosities, tophi. In some persons similar deposits have 
been observed on other and different parts of the body, especially in the skin. 

The course of an acute attack of gout is as follows: The gentleman 
in question generally does not dream of what may happen to him over 
night. He feels fine; he has enjoyed a good dinner and supper as usual, the 
proof of which we can read in his face; his cheeks are full, round and of a 
florid complexion, only his nose looks a little suspicious. There we observe 
a fine network of enlarged capillary blood-vessels, tinging it rather redder 
than would be necessarily required for a good-looking nose. He is fat, and 
his stomach and belly are in quite a prosperous condition, looking very well 
cared for. It may be, though, that in the last few days he did not feel al- 
together right; his appetite may not have been quite as sharp, his sleep not 
quite as refreshing; he may have had some palpitation of the heart and his 
urine may have been saturated and turbid. All this, however, is generally 
overlooked or attributed to some imprudence in diet. Then, all at once in 
the night, generally after midnight, the gentleman is aroused by a burning, 



GOUT, PODAGRA, ARTHRITIS. 831 

screwing pain in one of his big toes, which gets worse from hour to hour. 
If the toe were screwed between a vise, the pain could not be worse, and the 
poor sufferer, unaccustomed to such severe handling, moans and groans and 
tosses about without avail. The toe soon commences to swell and redden ; there 
is great thirst, high fever, dry skin, saturated urine and great mental irrita- 
bility. Finally, towards morning, a remission of the violent pain takes place ; 
the day passes along comparatively easy, until next night the same violent 
paroxysm recurs. In this way it goes on for about a week, when, finally, 
the pain, redness and swelling gradually disappear, and, at last, the skin of 
the affected toe ideals off. This is a first attack of Podagra. Gout almost 
always commences in this way. In later attacks, however, other joints may 
become involved. If, then, it attacks the finger-joints, it is called Clliragra; 
if the knee-joint, Goiiagra; if the shoulder-joint, Omagra. These acute 
attacks are at first far apart. Years may intervene between them, but finally 
the intervals grow shorter and the acute regular attacks become chronic and 
irregular. 

Such chronic, irregular attacks often last for weeks and months, and al- 
ways cause the above-stated deposits in and around the affected joints. They 
are generally not quite so painful, nor attended with as high a fever as an 
acute, regular podagra: they are always preceded by digestive derangements 
and they attack several joints at the same time. After the attack subsides, 
the swelling does not, but remains at first soft and doughy, until at last it 
changes into a hard tophus, which grows with each subsequent attack. Such 
hardened, chalky deposits within the joints frequently give rise to the forma- 
tion of abscesses, which break and discharge masses of pus mixed with cal- 
careous substances. 

At still other times this morbid process attacks internal organs, such as 
the stomach, brain or heart; then it is called anomalous gout. 

Gout of the stomach manifests itself as a very severe cardialgia, 
with violent vomiting, frequently even of blood ; Gout of the brain, as a 
kind of apoplexy, or violent headache, vertigo, furibund delirium, and sub- 
sequent stupidity and sopor ; and Gout of the heart, as irregular palpita- 
tion of the heart, disturbed circulation, dyspnoea and syncope. 

It might be quite difficult to diagnosticate these spells as gout, if it were 
not that they are almost always preceded or succeeded by gouty manifesta- 
tions on the peripheric organs. This settles the question. Gout is a stub- 
born disease, but is not fatal unless complicated with other diseases, or 
in consequence of the organic mischief which it produces in the course 
of time, in the form of a lingering cachexia, or apoplexia, or angina pectoris. 

THERAPEUTIC HINTS.— As the principal exciting cause of its 



832 MOTORY APPARATUS. 

first development is high and lazy living, this, of course, ought to be stopped, 
as a first step. 

In acute attacks, the following are principally indicated: Aeon., Arnica, 
Arsen., Bryon., Calc. carb., Sabina, Sulphur. 

In chronic gout the main remedies are: Amm. phosph., Calc. carb., 
Caustic, Coloc, Guajac, Iodium, Lycop., Mangan., Natr. mur., Sabina, Silic, 
Sulphur. 

For special hints compare Rheumatism. 

5. Arthritis Deformans. 

"This disease, also described under the names of Arthritis sicca, 
spuria, nodosa, pauperum, rheumatoides, arthroxerosis, Malum 
senile, articulorum, Bheumatismus nodosus, Polypanarthritis, 
Rheumatic gout, Nodular gout, is applied to an inflammatory process 
of the joint, which produces chronic changes but never suppuration of the 
joints. It affects the nutrition of all the constituent parts of the joint, caus- 
ing, on the one hand, abnormal proliferation, on the other absorption; and 
so the whole shape of the joint becomes deformed." (Senator.) 

There are two varieties of arthritis deformans, one beginning in the 
smaller joints of the extremities, and the other in the larger joints of the trunk 
(vertebral column, hip), subsequently extending towards the periphery, and 
by preference called the "senile" form. 

The 'peripheric variety is much more common in women than in men, 
and is essentially a disease of the poorer classes. Developing towards the 
thirtieth year of life, it increases in frequency among women about the cli- 
macteric period, and is caused chiefly by prolonged exposure to cold and 
damp, by inadequate food, debilitating haemorrhages, unduly protracted lac- 
tation, grief and anxiety, by manual labor (sewing, knitting, laundry-work, 
in women; watch-making, in men). 

The senile variety is more common in men than in women ; it begins at 
the age when senile changes (atheromatous degeneration of the arteries, cal- 
cifications, etc.) commence to develop, and it attacks the rich no less than 
the poor. Thin people appear to be specially predisposed to it. 

The Symptoms consist of neuralgic pains in the parts affected, which 
lose by slow degrees their mobility; the articular ends of the bones become 
thickened, and gradually displaced, and w T hen moved produce a peculiar 
grating, which can be distinctly felt through the soft parts. There are also 
not seldom excrescences and nodular masses around the joints, while the 
muscles and soft parts in the neighborhood of the joint, or even of the en- 
tire limb, begin to waste. In the smaller, peripheral joints the disease 
spreads invariably symmetrical, which appears not quite so obvious in the 



RACHITIS, RICKETS. 833 

senile form. The fingers from the index to the ring-fingers, more rarely the 
little finger also, are flexed and dislocated at the metacarpal end of the first 
phalanges, usually towards the ulnar side, less frequently towards the radial 
side. The thumbs generally remain free, while the great toes are more fre- 
quently and more severely attacked than their neighbors. An attack of the 
hip and knee, shoulder or elbow-joints shortens the respective limb; an attack 
of the vertebral column {spondylitis deformans) produces stiffness and rigidity 
of the spine, with pains radiating from the back ; an attack of the cervical 
vertebrae prevents bending or rotating the head ; an attack of the dorsal and 
lumbar spine shortens and twists the body. Cases occur where even the 
lower jaw, the clavicles, in fact all the joints of the body became implicated. 
The process of the disease is very slow, but steadily progressing in parox- 
ysms, whicli are usually attended with severe pain and slight febrile disturb- 
ances. The urine shows a diminution in the amount of phosphoric acid. 

THERAPEUTIC HIXTS.— Calc. phosph, Phosph. ac. Compare the 
hints under Rheumatism. 



Rachitis, Rickets. 

Other names by which this disease is known are : RachitisilUlS, Mor- 
bus auglicus, Articuli duplicati, Zweiwucks, Doppelte Glieder. Its 

character consists essentially of an irritation of the osteoplastic tissue in con- 
sequence of which there is an overgrowth of the same, with less earthy salts 
than are required for the formation of healthy bone. Heitzmann asserts that 
this irritation of the osteo-plastic tissue be brought about by the influence of 
lactic acid (phosphorus exerts a similar influence), and that, when combined 
with a deficiency of lime in the food, it be capable of producing true rickets. 
This supposition agrees with the frequency of its development during the first 
two or three years of life, and with the fact that an excess of lactic acid has 
been detected in the urine of rickety children. After the third year the dis- 
ease develops much more rarely, and between the age of five and puberty it 
is quite an exceptional phenomenon ; sometimes it develops already in utero. 

As Causes have been mentioned: hereditary influences, chronic tuber- 
culosis in the father, constitutional syphilis in the parents; cold, damp, ill- 
ventilated dwellings. 

Its Premonitory Symptoms are: intestinal and bronchial catarrh, 
feverishness and restlessness towards evening and through the night, perspi- 
ration about the head, slow, irregular teething. After a while changes in 
the bony structure become apparent. The articular ends of the long bones 
swell. 

The prominence of the contiguous epiphyses, for instance of the upper 
53 



834 MOTORY APPARATUS. 

and lower arms, is so marked, that the joint between them forms a depression 
which gives the appearance of two elbows, hence the name Articuli dupli- 
cate or Zweiwuchs (double growth). The fontanelles and sutures of the 
skull delay closure, and the occipital bone becomes soft and flexible, and may 
often be depressed by the finger as though it were of parchment. This soft- 
ness extends over the entire bony structure, and is the cause of the deformities 
which the bones undergo in consequence of the force of the muscles attached 
to them and of the weight of the body. The legs usually exhibit an outward 
curve and become bow-shaped, while the thorax appears laterally compressed, 
causing the breast-bone to project like the keel of a boat (chicken breast). 
The junctions of the ribs with their cartilages become thickened and nodular, 
and appear like the beads of a rosary. The spine often becomes curved, the 
pelvis flattened in its antero-posterior diameter, or otherwise deformed, and 
the growth of the child in length delayed. The hairy part of the head is 
unchecked in its growth, and the head seems unduly big and often sinks clown 
between the shoulders; the abdomen is very prominent, and in advanced 
cases the child looks like a dwarf. 

In mild cases or such as come early under judicious treatment, the de- 
formities do not reach this grade; by a renewed activity of growth the mor- 
bid process may be checked without leaving any marked thickening of the 
bones behind. 

There have been observed some cases of an acute nature in which within 
a few weeks the epiphyses of all or of most of the long bones become swollen, 
where there were swellings on the cranial bones, and a simultaneous swelling 
of the gums and palate, with digestive derangements and fever, the whole 
process running its course within a period of a few weeks, terminating either 
in recovery, or in death by complicatioDS, such as pneumonia, meningitis, etc. 

THERAPEUTIC HINTS.— It ought to be ascertained, whether the 
milk which the child receives is of a proper condition. When the child 
has been fed on paps and other mere farinaceous food, its diet ought to be 
changed to nitrogenous substances, such as rare beefsteak, mutton chops, etc. 

When, notwithstanding, the most proper kind of nourishment, the dis- 
ease still develops itself, the child needs medicinal aid. 

For the preceding chronic diarrhoea compare the corresponding chapter. 

For the swelling of the bones compare — 

Aselli jecoris oleum, which is best used in the form of a trituration 
with sugar. It is not at all necessary to give the oil by the spoonful. 

Bellad., curvature of the lumbar vertebrae; squinting; enlarged pu- 
pils; pain in the throat when swallowing; thick, protruding belly. 

Calc. carb., slow, difficult teething; profuse sweating about the head; 



MALACOSTEON. 835 

fontanelles open ; abdomen enlarged; whitish, frothy diarrhoea; curvature of 
the spine and deformities of the extremities. 

Calc. phosph., not less important than carbonica; its principal in- 
dications are the fontanelles, which remain wide open, the diarrhoea and the 
emaciation of the child. Both the Calc. carb. and phosph. have been ad- 
ministered in large, crude doses with far less good results than in a fine 
homoeopathic preparation. 

Natr. mur., "particularly useful when the thighs are notably emaci- 
ated, and the disease in its early stages, with slight pliability of the bones.' , 
(Gilchrist.) 

Phosphor., has been used even by the old school with great success. 

m Previous abuse of mercury may call for Asaf., Aurum, Hepar, Iodium, 

Sulphur; and still other peculiarities of the case may point to August., 

Fluor, ac, Lact. ac, Lycop., Mercur., Mezer., Phosph. ac, Sepia, Silic, 

Staphis., Symphytum, Theridion (Baruch) and others. 

Malacosteon ; Mollities Ossium: Osteomalacia, Softening of 

the Bones. 

Rachitis consists of a deficient calcification of the growing bone; mala- 
costeon, on the contrary, of a gradual withdrawal of earthy salts from the 
already formed bony structure. It is a chronic disease peculiar to adult life, 
and especially to women who have passed through one or more pregnancies. 
It usually begins during pregnancy, with an active congestion and prolifera- 
tion of corpuscular elements, which is followed by the removal of earthy 
salts. The real cause of this decalcification of the bones is still a matter of 
conjecture. Damp dwellings, however, seem prominent among the exciting 
causes. 

Malacosteon is a very rare disease. In some cases the morbid process 
is confined to the pelvis and spine, in others it spreads over all the bones of 
the skeleton. The calcareous constituents being extracted, it is obvious that 
the whole frame loses its form. In this way originate curvatures of the spine ; 
the pelvis, from the pressure of the legs, flattens in on both sides and projects 
in front with its pubic region; the extremities become flexible, yielding to 
any pressure in any direction, and in some cases it has been observed that 
women of a stately size gradually shrunk down to a dwarf's figure. 

The disease commences with severe boring and tearing pains in the 
affected bones, worse on motion and better at rest, and usually attended with 
more or less fever; the saliva and secretions of the skin are said to contain 
appreciable quantities of phosphate of lime; the general condition may, in 
some cases, for a long time be not essentially affected, while in others the 
general system shows early signs of a deep-seated cachexia. 



836 MOTORY APPARATUS. 

THERAPEUTIC HINTS.— I do not find a single case mentioned in 
our literature. However, Arnica, Rhus tox., or Symphytum, after difficult 
confinement; and Calc. carb. and phosph., Fluor, ac, Phosphor., Silic, and 
others, as constitutional remedies, might be suggested. . 

Progressive Muscular Atrophy. 

The character of this disease consists in a gradual atrophy and fatty 
degeneration of certain muscles, which in the course of time spread further, 
involving progressively more and more of the muscular tissue. 

On post-mortem examination, we find, therefore, (1) the muscles dimin- 
ished in size; (2) the muscular fibres changed from red to a pale and 
yellowish color. On applying the microsco})e it appears that this process 
commences with a change of color of the muscular fibres, which are growing 
paler, and a disappearance of their transverse stria?. Later we observe fat- 
globules in the centre of the ultimate fibrils, and at last a disappearance of 
the fibrils themselves, so that the sarcolemma or sheath, which envelopes the 
ultimate fibrils, shrinks together, containing only single fat-globules. 

This degenerating process does not take place simultaneously in all the 
fibres of a muscle; we find on the contrary in the same muscle fibres thus 
degenerated and others perfectly healthy, until by degrees all are involved 
in the same morbid process. 

Some authors have thought, that this morbid process within the muscles 
is the consequence of a disease of the nerves at their roots, because in some 
cases there have been found on post-mortem examination quite conspicuous 
structural changes in the anterior roots of the spinal nerves. Yet in other 
cases nothing of the kind could be detected. And as the muscle retains its 
susceptibility to the electric currents as long as there are any muscular fibres 
left, whilst in the case of degeneration of the peripheric nerves this suscepti- 
bility to the electric current leaves at quite an early stage: it seems to follow, 
that those authors are right, who have considered the progressive muscular 
atrophy as & primary affection of the muscles themselves. 

It is found in all classes of people; seems, however, to attack women 
oftener than men ; appears to be in some cases hereditary and in others 
brought on by overexertion of the muscles, or by taking cold ; whilst in still 
others it could not be traced to any special cause. 

This disorder creeps on very slyly, mostly without any pain or any other 
apparent disturbance of the body. Commencing generally in the muscles of 
one hand or one shoulder, or in the muscles of the neck, rarely in the muscles 
of the face; the first apparent symptom is a weakness in the parts involved, 
a loss of muscular power, which is associated by a diminution of their volume. 
The attacked parts grow flat and shrink away. We find therefore in such 



OSTEITIS. 837 

cases the prominent muscle of the thumb gone, and the spinal processes 
sticking out, when the muscles of the neck have become atrophied. If these 
atrophied muscles are exposed to a cold draught of air (if we, for example, 
blow upon them), we observe at once a vibratory motion of the muscular 
fibres, a jerking of single fasciculi. This is quite a constant symptom of the 
disease. Its pathognostic sign, however, is the susceptibility of these muscles 
to the electric current, which causes a contraction in them, as long as there 
are any fibres left, distinguishing it thus from any paralysis which has its 
cause in a morbid condition of the nerves. 

The atrophy and fatty degeneration and consequent paralysis may stay 
confined to the parts first attacked, but in other cases it creeps on, involving 
progressively all the muscles supplied by the cerebro-spinal nerves, with the 
exception of the muscles of the heart and the intestinal canal. Thus gradu- 
ally, in these terrible cases, the patient becomes incapable of moving himself, 
of feeding himself, of expressing any mental emotion by his face; of talking, 
aud lastly, even of swallowing. It takes years before death releases him 
out of this terrible bondage, if not intercurrent disease shortens his sufferings. 

THERAPEUTIC HINTS.— The electric current, by induction or 
faradization, persistently used, has improved cases where the disease remained 
confined to single parts of the body. 

Arg. nitr., Arsen., Caustic, Cuprum, Laches., Plumbum, 
Sulphur. 

Osteitis, Caries, Necrosis, Exostosis. 

Osteitis is an inflammation either of the periosteum, or of the bone itself, 
or of its diploe or its medullary membrane, or of all these different structures 
together. It may be caused by external injuries, such as fractures, bruises, 
etc., or by chemical influences; or it may be the consequence of certain con- 
stitutional contaminations, like scrofulosis, arthritis, scurvy, syphilis, mer- 
curial poisoning, or suppressed acute or chronic skin diseases. 

Its symptoms generally consist of a deep-seated, heavy, boring pain, 
which assumes a tearing character when the periosteum is affected at the same 
time. This pain is usually worse at night (especially if of syphilitic origin) 
and worse also from pressure and motion. There is generally a feeling of 
heat in the bone, and if the inflamed bone is superficial, its integuments soon 
participate in the inflammatory process. Febrile actions are mostly wanting, 
except in acute cases. Such an inflammation may terminate in 

Caries, by which we understand an ulceration of the bony structure; 
or even in 

Necrosis, which means a dying off of a portion of the bony structure, 



80S MOTORY APPARATUS. 

which, in favorable cases, is gradually thrown off aud replaced by a new for- 
mation. 

In other cases the inflammation causes an exudate upon the bone, which 
hardens and grows fast to the bone, thus augmenting its natural size more or 
less considerably ; this is called Exostosis. 

THERAPEUTIC HINTS.— Angust., caries, especially of the long 
bones; great longiug for coffee, the use of which must be entirely prohibited; 
great sensitiveness of mind, very touchy, easily irritated from the least provo- 
cation. 

Arsen., "excruciating pain in bones of legs and arms, like the gnawing 
of rats, or boring with a gimlet into the bones; sudden and rapid prostration, 
with restlessness and emaciation." (Gilchrist.) 

Asaf., osteitis, caries in scrofulous individuals, and after the abuse of 
mercury; bluish redness and swelling of the external parts; ulcer with 
bluish hard edges, which are very painful to the slightest touch; discharge of 
thin, very offensive pus. Pulsations in the pit of the stomach, perceptible 
to the eye and hand ; ill-humor and irritated mood. 

Aselli jecor. ol., in different affections of the bones, in scrofulous sub- 
jects, especially when the extremities of the bones are affected; fistulous 
ulcers, with raised edges, easily bleeding, and discharging a nocculent pus 
and ichor of a nauseating smell. 

Aurum, caries of the nasal bones in consequence of ozsena, diffusing a 
most horrid odor ; caries of the cheek-bones and exostosis of the skull and 
other bones, with boring pain, after the abuse of mercury. 

Aur. mur., caries of the left external malleolus, after allopathic 
drugging. (Linsley.) 

Bellad., scrofulous individuals with glandular swellings, crusts on the 
corners of the mouth and sore, swollen and bent vertebrae; exostosis on the 
forehead, and caries of the palatine bones. 

Calc. carb., osteitis, with swelling; caries and necrosis of scrofulous 
individuals ; diarrhoea, hard, bloated abdomen ; chronic symptoms on the 
scalp ; emaciation. 

Calc. phosph., for similar affections, and especially after fractures, 
when the callus does not ossify. 

China, caries, especially where there is profuse suppuration. 

Fluor, ac, caries in consequence of syphilis or abuse of mercury; 
caries of the temporal bone. 

Iodium. 

Lycop. 

Mercur., osteitis, caries; pain, as if the part were broken. 



TUBERCULOSIS OF THE JOINTS. 839 

Mezer., periostitis and swelling of the bones, especially on the tibia, 
with the most violent nightly pains in the bones. 

Nitr. ac, especially in syphilitic affections and after the abuse of 
mercury. 

Phosphor., exostosis on the skull, with violent tearing and boring 
pains, worse at night; swelling of the glands of the neck; sour belching and 
vomiting; burning in the mouth, oesophagus and stomach; constipation; 
emaciation; fainting when raising the head; lame weakness of the ex- 
tremities. 

Phosph. ac, osteitis, and also when after an external injury of the 
periosteum there remains a feeling as though the bone were scraped by a 
knife. 

Ruta, periostitis and pains in consequence of external injury, with 
erysipelatous inflammation of the external parts. 

Silic, one of the most important remedies in the different affections of 
the bones, with fistulous openings and discharge of thin pus and bony frag- 
ments. 

Staphis. is recommended, especially in osteitis of the phalanges of the 
fingers. 

Sulphur, after suppressed itch and mercurial poisoning. 

Theridion. (Baruch.) 

Tuberculosis of the Joints, White Swelling. 

Tuberculosis being a constitutional disease, may localize itself in various 
parts of the body. AVhen localizing in the joints, it attacks by preference 
the hip-, knee-, ankle-, elbow-, or wrist-joints, and was called by older writers, 
on account of the peculiar glossy, shining appearance of the affected joint, 
"white swelling." "In its incipiency we find the synovial membrane injected, 
somewhat opaque, and here and there softened or thickened by fibrous exuda- 
tion. There is effusion of lymph, which assumes a pulpy consistence of a pale 
yellowish or greenish color. The articular cartilage is of a dull whitish or 
slightly grayish aspect, and somewhat thickened, softened and partially 
separated from its osseous connections. The cancellated structure of the 
bones is abnormally vascular, light, porous, humid, and at the same time 
easily broken and cut. Not unfrequently its cells are distended, with 
yellowish tubercular matter, of a semi-solid, osseous consistency; or, this sub- 
stance presents itself in the form of distinct masses, free or encysted, and, 
perhaps, not larger than a millet-seed. The ligaments appear abnormally 
red, tumefied and softened. The synovial fluid is generally increased in 
quantity, but rarely to any considerable extent. In its further progress, the 
lymph gradually increases in quantity, and is often intermixed with a little 



840 MOTORY APPARATUS. 

sero-purulent matter, or thick, greenish-looking pus. The synovial membrane 
is partially destroyed, and what remains is of an opaque, muddy and ragged 
appearance. The cartilage is ulcerated, pulpified, discolored, perforated and 
almost completely detached. The bony structure is very red, soft, carious, 
rough and easily crumbled. The ligaments exhibit well-marked signs of 
inflammation, being loose and spongy at one joint, attenuated at another, and 
perhaps thickened or hypertrophied at a third. In this way the structures 
of the joint are completely subverted, with hardly any trace of their original 
appearances. Pus is more usually seen, often, indeed, in large quantities, 
sometimes thick, pultaceous, caseous, ichorous or sero-sanguinolent. In some 
instances it is very thin and almost black, evidently from the effects of the 
necrosed condition of the bones. 

" In case of recovery, the joint will be found to be filled by a white, 
fibrous, organized substance; the extremities of the bones being anchylosed, 
or firmly attached by new matter to the surrounding structures. It is very 
rare that a new socket is formed ; and yet this is not impossible. In time, 
the artificial joint may admit of considerable motion, but, in general, this is 
extremely restricted. Occasionally an imperfect ligament is formed round 
the bony remnants, and the surface of these bony remnants may even become 
slightly tipped with cartilage. Finally, osseous growth — short, irregular and 
friable — sometimes make their appearance upon the bones, in the vicinity of 
the former disease." (Gross.) 

This is the general character of the pathological changes which tubercu- 
losis causes, when located in the joints. I shall now speak of the several 
joints which it attacks in preference, causing affections which are not unfre- 
quently met with in practice. 

Coxarthrocace, Coxalgia, Hip Disease. 

This affection is most frequently found from the third to the seventh 
year. Growing out of a constitutional diathesis, it may be excited by exter- 
nal injuries, exposure to cold, or different wasting diseases; sometimes it 
comes on stealthily without any appreciable cause. It seldom, or never, at- 
tacks both hip-joints, but is frequently complicated with psoas abscess, oph- 
thalmia, pulmonary phthisis and degeneration of the lymphatic glands. 

In its first stage, we observe that the child is easily tired, and complains 
of a pain in the knee, on the inner side, which is worse from motion, so that 
the child limps when walking; this pain is likewise worse in the night, and 
frequently attended with spasmodic jerking of the extremity, disturbing 
sleep. The knee itself shows neither swelling nor discoloration. Gradually 
the pain extends to the thigh and leg, and in some cases it is felt most keenly 
in the tendo Achillis, or over the instep; or it shifts from one place to 



COXARTHROCACE, COXALGIA, HIP DISEASE. 841 

another; or may disappear for a short time entirely. Finally, after weeks 
and even months, the pain is also felt in the hip and its neighborhood ; and 
then most intense and persistent directly over the articulation, deep-seated 
and of a dull, gnawing character. Up to this time there is no perceptible 
impairment of the general state of the system. By and by, however, during 
the second stage, when the pain in hip and knee increases still more in vio- 
lence, when the buttock flattens, the gluteo-femoral crease disappears and the 
limb apparently grows longer, with nightly spasmodic twitchings and wasting 
of its muscles : then we also find the sleep habitually disturbed by unpleasant 
dreams, and frequent starting of the patient out of sleep with crying and 
screaming; the appetite becomes impaired, the bowels often constipated, and 
there is more or less fever, especially at night, followed frequently by copious 
sweats. Xow the patient begins to show a careworn countenance; he grows 
peevish and irritable, and loses flesh and strength. 

In. the third stage matter forms within the diseased joint. "This is in- 
dicated by an increase of pain on the slightest motion; by a sense of throb- 
bing and tension, deep and persistent ; by severe swelling of the gluteal re- 
gion, generally most prominent at the centre of the articulation; by oedema 
of the subcutaneous cellular tissue; by a remarkably turgid and enlarged 
condition of the subcutaneous veins; by violent rigors, followed by high 
fever and copious sweats. As the matter increases in quantity, it gradually 
works its way towards the nearer surface ; its approach being denoted by the 
appearance of a circumscribed, erysipelatous blush. Here there is generally 
distinct fluctuation, and the parts, feeling soft and baggy, soon yield at one 
or more points, followed by the escape of the contents of the sac." (Gross.) 

These openings may in different cases form indifferent places: in the 
gluteal region, either directly above the joint, or in its immediate vicinity; 
on the upper and back part of the thigh, below the great trochanter; on the 
upper and inner surface of the thigh; on the superior and external part of 
the groin; on the sacro-sciatic notch; or on several points, either simultane- 
ously or successively. Or the matter may partially escape internally, when 
the bottom of the acetabulum is perforated, into the rectum, bladder or va- 
gina ; or it may collect in a sort of pouch, between the inner surface of the 
iliac bone and the soft parts of the pelvis. 

By this time the limb has actually grown shorter from' one inch and a 
quarter to several inches, and the foot points either directly forwards and 
outwards, but oftener inwards. The thigh is generally flexed upon the pelvis, 
and turned either towards the sound limb or is bent off from it. The great 
trochanter generally lies directly over the acetabulum, or in its immediate 
vicinity ; whilst the head and neck of the femur are usually so much wasted 
as to exist only in a rudimentary form. Dislocations of the femur are ex- 
ceedingly rare; and are possible only in such ca^es where there is an exten- 



842 MOTORY APPARATUS. 

sive destruction of the soft parts; allowing the superior extremity of the bone 
to move about, and to insert itself into a new position. 

THERAPEUTIC HINTS— Arse n., third stage; the child is emaci- 
ated, exhausted ; very restless ; has diarrhoea, worse in the middle of the night ; 
wants to drink constantly, but little at a time. It is indeed going fast if 
Arsen. should not soon change the scene for the better. 

Bellad., burning, stinging in the articulation ; nightly aggravation, with 
starting in sleep, fever, and congestion of the head ; or drowsiness, with in- 
ability to go to sleep. Cramps in glutei muscles; outer hamstring feels as if 
contracted ; inability to walk. 

Calc. carb., second stage; sweat on the head during sleep; scratching 
the head impatiently when getting awake ; frequent desire for boiled eggs ; 
abdomen hard and bloated ; inclined to diarrhoea, especially towards evening ; 
glandular swellings on the neck. 

Calc. phosph., third stage; it puts an end to the further destruction 
of the bone, stops suppuration and promotes new organization. 

Carb. veg., third stage; ichorous, offensive, blackish discharge; deeply- 
sunken state of the whole organism. 

China, profuse suppuration, sweat and diarrhoea. 

Coloc, second and third stage; difficult urination of dark urine; green 
diarrhoea; lies upon the affected side with bent-up knee; the pain is of a 
crampy nature, as though the parts were screwed in a vise. 

Hepar, suppurating stage, with fever and sweat, where the patient 
wants to be tightly covered. 

Iodium, intermittent, sharp, tearing pain between the left hip and the 
head of the femur, increased by moving the joint; glandular swellings ; abuse 
of mercury. 

Kali carb., third stage; crampy tearing in the hip-joint and knee; 
bruised pain in the hip-joint when moving and sneezing; twitchings of the 
muscles of the thigh; dull pain in the side of the knee when walking, and es- 
pecially when extending the limb; starting when asleep; twitching of the 
limbs during sleep ; all the symptoms worse towards three o'clock a.m. ; great 
tendency to start, especially when being touched. 

Laches., in any stage, if there be a regular aggravation of febrile mo- 
tion in the afternoon about three o'clock, an aggravation of general malaise 
after sleep, a notable offensiveness of the alvine discharges, even if of a nat- 
ural consistence, and previous abuse of mercurial preparations ; before or after 
Laches, is frequently indicated. 

Lycop., when there is an aggravation of fever and suffering, especially 
from four to eight o'clock p.m. ; great fear of being left alone ; violent jerking 



GOXARTHROCACE, TUMOR ALBUS GENU. 843 

of the limbs and body, awake and asleep, and great crossness on awaking out 
of sleep. 

Mercur., first and second stage, with prominent aggravation in the 
night, restlessness and inclination to sweat ; is frequently indicated before or 
after Bellad., and when suppuration seems inevitable. 

Phosphor., hectic fever; dry, hacking cough; chronic diarrhoea ; urine 
turbid on voiding, precipitating a whijte sediment on cooling; thin, watery 
pus oozing from the diseased joint. 

Rhus tox., first and second stage; on pressure upon the trochanter, 
pain in the hip-joint; pain in the knee predominant; swelling of the glands 
of the neck ; crusty eruptions on face and head ; after exposure to rain ; worse 
in damp, cold weather; when keeping quiet, and on first moving. 

Silic, in suppuration and caries of the bones anywhere, one of the most 
important remedies; pale, earthy complexion; loss of smell and taste; stop- 
page of the nose or acrid coryza; the parts upon which one lies easily go to 
sleep ; any little sores or wounds are apt to fester ; glandular swellings. 

Stramon., according to Dr. Jeanes, always indicated when the left hip 
is affected. I have given Stramon. with great success wherever abscesses 
form, if attended with violent pain, driving one mad. 

Sulphur, psoric individuals; frequent redness and inflammation of the 
eyelids; heat of the head, and cold hands and feet; frequent red spots in the 
face ; is averse to being washed ; morning diarrhoea, or constipation ; sleepy 
in the daytime and wakeful at night ; easily perspiring. 

Gonarthrocace, Tumor Albus Genu, White Swelling of 

the Knee. 

Gonarthrocace, growing upon the same constitutional contamination as 
hip-joint disease, runs through nearly the same phases as that disease, and is 
most frequently excited by an external injury, such as a fall, twist, or blow 
upon the knee. 

At first there is a severe, dull, heavy, gnawing pain at the inner condyle 
of the femur, at the lower part of the patella, or at the inside of the head of 
the tibia; seldom at the outer part of the joint; it may be intermitting, and 
it may be continuous in its character, extending up and down the limb, and 
depriving the patient of all sleep and rest. 

After a while the parts commence swelling, owing partly to interstitial 
deposits, and partly to an increase of synovial fluid. This swelling is at first 
most conspicuous in front and at the sides of the patella, effacing the normal 
depressions in that region, and replacing them by soft, fluctuating bags. "A 
similar prominence, often of great size, exists just above the joint, over the 
lower part of the femur, bounded inferiorly by the patella, and on each side 



844 MOTORY APPARATUS. 

by the lateral ligament, its anterior wall being formed by the tendon of the 
exterior muscles. Very little tumefaction ever occurs in the popliteal region, 
even in the more advanced stages of the disease. The skin is tense and glossy ; 
the subcutaneous veins are abnormally large; the knee is stiff, if not immov- 
able; and the leg, more or less flexed, is swollen and cedematous, while the 
thigh is remarkably atrophied. In proportion as the ligaments yield, the 
deformity of the joint increases, owing chiefly to the displacement of the head 
of the tibia, which allows the muscles to draw the leg outwards, so as to give 
it a twisted and contorted appearance. Occasionally, though rarely, there is 
an actual enlargement of the diseased bones. The fluctuation, which consti- 
tutes so prominent a symptom in the earlier periods of this complaint, often, 
in a great measure, if not entirely, disappears during its progress, owing to 
the adventitious deposits upon the synovial membrane, and the absorption of 
the redundant synovial fluid. Whenever this is the case, the swelling, instead 
of being soft and yielding, will be comparatively firm and resisting; but it 
still possesses some degree of elasticity, often so deceptive as to lead to the 
idea that the joint contains a good deal of fluid, and which nothing but the 
most careful examination can dispel." (Gross.) 

Lastly, though not always, the involved structure commences to suppu- 
rate, and the matter may either be absorbed, or may escape at different places 
about the knee — very rarely, though, in the ham — forming numerous fistulous 
openings, and leading to caries and necrosis of large portions of the diseased 
bones. 

THERAPEUTIC HINTS.— Aeon., after exposure to severe cold. 

Arnica, after a fall or blow, and Rhus tox., after a twist, sprain or 
strain, may severally be entirely sufficient to ward off all serious consequences. 

Arsen., third stage; discharge of fetid pus; oedema of the legs; hectic 
fever ; sleeplessness ; emaciation ; exhaustion. 

Bellad., red, shining swelling, with throbbing pain and enlarged blood- 
vessels along the limbs. 

Bryon., pale swelling, with stitching pain from slightest motion. 

Calc. carb., scrofulous individuals; too early and too profuse menstru- 
ation;' pot-belliedness; looseness of the bowels; glandular swellings. 

Iodium, second and third stage; fistulous openings, discharging a thin, 
watery ichor, and being surrounded by pale, spongy edges, which bleed easily; 
feverishness ; emaciation. After the abuse of mercury. 

Kali hydr., doughy, spongy swelling of the knee, without fluctuation; 
skin tense at times, red in spots and hot. Inside a feeling of heat ; gnawing, 
boring pain at night, necessitating a constant change of position. After a fall. 

Laches., Lycop., compare the preceding chapter. 

Mercur., after suppressed itch; nightly pains, etc. 



BURSITIS — PODAETHEOCACE. 845 

Puis at., fever, dryness of tongue, without thirst; diarrhoea, scanty and 
delaying menses. 

Silic, violent, lancinating pains; caries; fistulous openings; cachectic 
condition. 

Sulphur, psoric individuals. Besides, compare Coxarthrocace. 

Bursitis. 

The vursoB mucosa are closed sacs, analogous in structure to synovial 
membranes, and secreting a similar synovial fluid. Those concerning us now 
are situated over the patella and the inner side of the head of the tibia. 
Being greatly exposed to external pressure and irritation, they are subject to 
inflammations like the synovial membrane, constituting an affection known 
under the name of Bursitis, or House-maid's kuee, the latter on account 
of its frequent occurrence among female servants, who induce it while work- 
ing in a kneeling position. It is distinguished from synovitis by its super- 
ficial nature and the regularity of its tumefaction. In acute cases it is 
attended with severe pain, swelling and fever; it may terminate in suppura- 
tion, or, when becoming chronic, in the formation of a solid tumor. 

THERAPELTIC HINTS —Ant. crud., "the integument is hard 
and horny, smooth and slightly discolored, with a sensation as if being 
pricked with needles, or of being destitute of feeling." (Gilchrist.) 

Apis mel., "inflamed, fluctuating; biting, stinging in the part." (Gil- 
christ.) 

Arnica and the remedies mentioned in the foregoing chapters may like- 
wise need consideration in special cases. 

Arsen., "dark color, bluish generally, with much effusion, and intense 
burning relieved by external warmth." (Gilchrist.) 

Fragraria vesca, "burning-smarting, worse when warm and in warm 
weather." (Gilchrist.) 

Pulsat., "smarting itching, relieved by cold." (Gilchrist.) 

Silic, in chronic bursitis; pain as if sticking or itching. 

Sticta pulm. has been found, by Dr. E. C. Price, of great efficacy. 

Sulphur, "inflamed, with a feeling of formication." (Gilchrist.) 

Podarthrocace, Abscess of the Ankle-joint. 

Commencing with pain, this affection soon shows signs of a swelling just 
in front of each malleolus, filling up the hollow which naturally exists there. 
So also gradually disappear the grooves at the side of the tendo Achillis, and 
the whole joint swells considerably. By and by, if suppuration takes place, 



846 MOTORY APPARATUS. 

the pus may escape at different places, forming, like in the knee-joint disease, 
fistulous openings, and may lead to considerable destruction of the affected 
bones. 

THERAPEUTIC HINTS —Compare the preceding chapters. Only 
one remedy, not mentioned there, I must add here, namely : 

Angust. In a case where none of the very carefully selected remedies 
seemed to have any effect, this remedy at once arrested the morbid process 
and brought it to a perfect cure. In this case, the condyles of the tibia were 
quite seriously involved, and it was on account of a remark of Aegidi, 
"Angustura acts especially upon the long bones," that this remedy was given 
with so happy a result. 

Malum Pottii, Kyphosis, Angular Curvature of the Spine; 
Spondylarthrocace. 

When the disease has already developed to a visible backward curvature 
of the spine (hunchback), its diagnosis is easy enough, only that it comes too 
late. Of much greater importance are the symptoms of the initial stage : 
the child cries whenever it is taken hold of beloiv the ribs, tvith spasmodic draw- 
ing up of the legs, and shortness of breath. Besides this there are: periodical 
pains in the epigastric region ; listlessness and disinclination to move ; disposi- 
tion to lie flat on the stomach or side, only rarely on the back. Finally as 
the disease progresses, one or more spinal processes project backward in an 
acute angle, the head sinks backward between the shoulders, and when walk- 
ing the child props the arms on the thighs or knees, instinctively supporting 
the spine, and avoiding all motions which would necessitate a bending of the 
spine. All this is produced by a tubercular affection, or according to other 
writers, by an inflammatory process of the vertebra?, causing the bones to be- 
come carious and to crumble away, or to form abscesses. Probably both 
views are correct, The tuberculous form seems hardly ever to induce con- 
gestive abscesses, which are more apt to occur in endosteitis. Both forms no 
doubt grow out of a general contamination of the system, scrofidosis, and 
where this condition exists, an unlucky fall or wrench may be sufficient to 
induce the development of the disease. So also it has been observed to often 
follow after measles, and especially whooping-cough. The disease is always 
of a slow and tedious nature. 

THERAPEUTIC HINTS —As the spinal column gradually loses its 
fitness to sustain the body in an erect position, the horizontal position will 
make itself in many cases necessary; but too long a confinement in bed has 



BUNION — INGROWING TOE-NAILS. 847 

other quite serious objections, and it has, therefore, been an object of many 
physicians to invent means by which the strain of the spinal column may be 
relieved. The most simple and effectual of these means seem to be Sayre's 
starched bandage, by which chest and abdomen are enveloped in fold after 
fold, until a compact casing of the material surrounds the trunk, capable of 
retaining the bony column in a fixed position. This is done while the patient 
is suspended by the arm-pits, and the head held in an erect position ; the 
weight of the body straightens the spine. As soon as the starch is well dried 
and stiffened, the patient is liberated and left to his freedom. 

Calc. carb., or phosph. after Sulphur, when the known scrofulous 
symptoms call for its use. 

Natr. mur., has been recommended by Kafka as a constitutional ad- 
juvans to Phosphor. 

Phosphor., main remedy of Kafka. Its symptoms will indicate its 
use in special cases. 

Psorin., proposed by Lilienthal as being fairly indicated by its 
symptoms. 

Silic, iDdicated by its characteristic action upon inflammatory pro- 
cesses of bony structures, and also by the peculiar symptom: "sweating of 
the head only." 

Sulphur, is according to Jahr, the remedy to commence with, if indi- 
cated by the general condition of the patient. 

If excited by external injury: Aeon., Arnica, Hyper., Khus tox. 

Other remedies recommended: Angust., Arsen., Asaf, Aurum, Bellad., 
Calc. jod., Hepar, Lycop., Mercur., Mezer., Phosph. ac, Plumbum, Pulsat. 

Compare also Rachitis and the foregoing chapters. 

Bunion. 

What bursitis is to tne knee, bunion is to the metatarsal joint of the 
great toe, an inflammation of the bursaB situated in this joint, in consequence 
of undue pressure of shoes or boots. 

Arnica often relieves the acute symptoms, and Calc. carb. frequently 
cures chronic cases. 



Ingrowing Toe-nails. 

Compare Colchic, Graphit., Kali carb., Magnet, austr., Mar. ver., 
Natr. mur., Phosphor., Silic. 

Perchloride of Iron has been used externally to dry the inflamed parts. 
(Wahle.) 






NERVES. 

The anatomical diseases of the peripheral nerves comprise : 

1. Neuritis, Inflammation of the Nerves. 

This may be acute or chronic. The acute form, usually brought on by 
external injuries, or neighboring destructive processes (sloughing cancer), 
begins with chilliness, or an actual rigor, being followed by fever, headache 
and sleeplessness, and is attended by severe pain, starting and extending 
from the injured spot over the region to which the nerve is distributed. In 
some cases a red line in the skin indicates the course of the inflamed nerve, 
and the skin-surface of its distribution exhibits a marked degree of hyperoes- 
thesia with the subjective sensation of numbness and formication. 

The chronic form is characterized by pain and paresthesia in the area of 
distribution of a certain nerve, by motor and sensory irritation with subse- 
quent paralysis, by painful swelling of the nerve. 

The most important remedy for neuritis in consequence of external in- 
jury is Hyper, perf. (Hering.) 

2. Atrophy of the Nerves 

Is most frequently the consequence of inflammation, compression or central 
disease, and can only be reached so far as the original disease is amenable to 
treatment. 

3. Hypertrophy and Neoplastic Formations in the Nerves. 

Hypertrophy of peripheral nerves, that is an increase of the nerve- 
fibres in number, great thickness of the medullary sheath and even of the 
axis cylinder, or oftener an interstitial hypertrophy of the connective tissue, 
is of a mere anatomico-pathological, but of no clinical interest. 

Neoplastic formations in the nerves, also called neuromata, are made 

(848) 



ANESTHESIA. S-19 

up either of true nerve-tissue (Neuromata Tera), or are composed of any other 
tissue, giving rise to Fibromata, Myxomata, Sarcomata, Carcinomata, Syphil- 
itic gummata, Lepra nervorum, all known under the general name Neuro- 
mata spuria. 

Their Etiology is obscure, and "an exact anatomical diagnosis can be 
accomplished with certainty only by means of the microscope. When no 
tumors can be demonstrated by external examination, their presence can be 
concluded only with some probability from the existing nervous disturbance." 
(Erb.) 

The functional diseases of the peripheral nerves comprise: 

1. Hyperesthesia, Anaesthesia. 

By meaiis of the sensory nerves we receive external impressions. Light 
affects the optic, sound the auditory, perfume the olfactory, sapid substances 
the gustatory nerves, palpable things the nerves of touch, and heat, cold, etc., 
the nerves of general feeling. 

These nerves are so constituted that they bear external influences to a 
certain extent with perfect ease, although we find in even healthy individuals 
a great difference in this respect. Some perceive the slightest, others only 
more powerful influences; but, as a general rule, the ordinary influences of 
the outer world are borne by all with equal ease. 

In this disease, however, it is often different. We observe that ordinary 
light, the slightest noise, the least touch, etc., are unbearable. This condition 
is called morbid sensitiveness. It is frequently in combination with a state of 
fidgetiness and restlessness, and then it is called nervousness. 

Post-mortem examinations do not reveal the least alterations of the 
nerves, and its seat may just as well be referred to the primitive forces of 
the mind, of which the corresponding nerves are merely the bodily organs, by 
which the mind lies open to external influences. 

Anaesthesia of the sensory nerves is the opposite to morbid sensitiveness 
— a want of natural sensibility; to which we might add numbness, pithiness, 
either in consequence of pressure upon a nerve, or in consequence of central 
disturbances, by which its normal action is interfered w T ith. 

THERAPEUTIC HINTS.— Compare Boenninghau sen's Repertory. 
Sensitiveness to light: (principally) Aeon., Arsen., Bellad., Euphras., 
Mercur., Rhus tox., Sulphur. 

Sensitiveness to noise: Aurum, Coffea, Lycop., Sepia, Spigel. 
Sensitiveness to smell: Aurum, Bellad., Lycop., Mercur., Phosphor., 



Sepia. 



Sensitiveness to taste : Bellad., China, Coffea. 
54 



850 NERVES. 

Sensitiveness to touch: Arnica, Bellacl., Coffea, Hepar, Lycop., Nux 
vom., Pulsat.j Sepia, Spigel. 

Nervous debility: China, Coccul., Nux vom., Phosphor., Pulsat., Silic. 

Fidgety disposition: Anac, Bellad., Hyosc., Mercur., Rhus tox., Sepia, 
Staphis., Stramon., Zincum. 

Pithy, numb feeling: Coccul., Hyosc, Lycop., Oleand., Opium, Phosph. 
ac.j Stramon. 

2. Neuralgia. 

Neuralgia literally means a pain of the nerves. In this sense of the 
word, any and every pain would be a neuralgia; because there is no pain 
possible without sensitive nerves. 

This is not the sense in which the term neuralgia is used. 

Hasse defines it iu the following language: "Neuralgia characterizes it- 
self physiologically as an irritation in the course of one or several sensory 
nerves, which irritation may exist on any part of the nerve, from its origin 
down to its termination, and which irritation is felt as pain; not, however, 
only in the place where the irritation exists, but also in different other places 
of the same nerve; sometimes even through its whole length." Such irrita- 
tion and consequent pain may be occasioned by the most different causes, so 
that neuralgia may be a symptom of very different conditions. Structural 
changes of the nerves themselves, however, are very rarely found, and then 
only in paralytic conditions. Those coarser structural changes which we 
have called tumors of the nerves, or neuroma, may exist without any neu- 
ralgia; and the most violent neuralgia may not show a trace of structural 
change on post-mortem examination. We cannot, therefore, so clearly define 
neuralgia pathologically as other forms of disease ; as, indeed, it is only a 
symptom of the most different conditions. 

Such conditions are either peripheral or central. 

1. Peripheral Causes are either organic changes of the nerves them- 
selves — most frequently in consequence of external injuries — or organic 
changes in neighboring parts of the nerves, as inflammation, caries, and ex- 
ostoses of the bones, especially in the neighborhood of the foramina, through 
which the nerves make their exit; also tumors— especially carcinoma and 
aneurisma — and affections of the liver, uterus, ovaries, kidneys, etc. 

2. Central Causes are structural changes in the brain and spinal cord, 
and their membranes, consisting of tumors, softening, sclerosis and deposits 
of morbid products. Besides these causes we may also mention exposure to 
cold, metallic poisoning — especially by mercury and lead — and miasmatic 
influences, which latter cause a periodical type, like intermittents. 

Symptoms. — 1. Pain. It is of various kinds: boring, cutting, tearing, 



CEPHALALGIA. 851 

burning, like lightning, but always described as excruciating. It generally 
comes in paroxysms, and is felt in many cases distinctly running along the 
course of a certain nerve. It is often provoked or aggravated by softly 
touching or stroking the parts, whilst hard pressure frequently relieves it. 

2. Concomitant symptoms. They consist of affections of the motory nerves, 
causing spasmodic motions in those parts in which the affected sensory nerve 
branches out, prosopalgia and almost always distortions of the face ; of affec- 
tions of the vasomotory nerves, which manifest themselves in paleness of the 
skin and chilly sensations, followed by heat and turgor, sometimes by profuse 
perspiration or profuse secretion or scantiness of urine ; of affections of the 
trophic nerves, causing change of color in the hair, falling off of the hair, or 
thickening or atrophy of various tissues, or a disposition of the skin to various 
inflammatory processes, such as erythema, erysipelas, pemphigus, urticaria 
and zona. 

The most important special forms of neuralgia are : 

1. Cephalalgia; Hemicrania or Migraena, or Nervous Sick 

Headache. 

Cephalalgia or headache, or pain in the nerves of the head, may be at- 
tendant upon the most various morbid conditions of the body, to which some 
persons are more liable than others. We have headache from anaemia and 
from active hyperemia, also toxic, hysterical, rheumatic and sympathetic 
headache. 

Hemicrania or Migrama, or nervous sick headache on the other hand is a 
peculiar form of half-sided headache, which, by some, has been considered as 
a neuralgia of the temporal, frontal and occipital nerves, or as a hyperesthe- 
sia of the brain, or a cerebral neuralgia, or as a hysterical manifestation of 
some derangement of the menstrual function, while Du Bois Raymond took 
it for a neurosis of the vasomotor nerves, consisting of spasms of the vascular 
muscles of the affected side, causing paleness and contraction of the features 
and dilatation of the pupils, and Moellendorff considered it as a paralysis of 
the vascular muscles, which manifests itself in dilatation of the central reti- 
nal and choroidal vessels of the affected side, in a slower pulsation of the 
heart, in a soft and large pulsation of the carotids and temporals, and in cold 
hands and feet. Both agree in this, that hemicrania be due to alterations in 
the cerebral circulation, in the one case produced by spasm and in the other 
by paralysis of the vascular muscles, both induced by a disturbance of the 
sympathetic nerve either in its cranial or cervical portion. Dr. G. C. Savage, 
of Jackson, Tenn., says — that sick headache is often due to hypermetropia 
and astigmatism, either alone or combined, and offers as a cure properly fitted 
glasses. This view I can confirm. 



852 NERVES. 

This complaint, which is so frequently met with, returns periodically. 
It generally commences in the morning, increases during the course of the 
day as the sun ascends, and reaches its culmination in the evening; very 
often it attacks only one side of the head, or passes from one side to the other, 
or is confined to the top of the head, or to the forehead or occiput. It often 
reaches an almost unbearable pitch, is associated with nausea, and generally 
ends with gagging and vomiting of bitter, greenish, or slimy masses. In 
some cases one thorough vomiting is sufficient to relieve the pain, while in 
others both retching and pain continue for several hours, until, finally, a 
sound sleep relieves it all. During the paroxysm the patient is very sen- 
sitive to light, noise, strong smells and touch ; he seeks a dark, quiet place 
where he can lie undisturbed. 

Migrsena is most frequently met with in women of a hysteric, chl orotic, 
or anaemic tendency, and a weak and nervous constitution, also in married 
women who have no children, and in young widows. Men of weak constitu- 
tion, who read and study much in the night, or who lead a loose life, are like- 
wise subject to migrgena. In all, it seems that the habitual use of coffee and 
tea has a great deal to do with its periodical recurrence. 

THERAPEUTIC HINTS.— In all obstinate cases the eyes should be 
examined, and if there is any hypermetropia or astigmatism, proper eye- 
glasses should be provided. 

Aeon., in full-blooded individuals; rush of blood to the head; the pain 
is centered in glabella, excruciating, driving to despair. " Crampy pain at 
root of nose, making her feel as if going crazy." (Gilchrist.) 

./Ethusa cyn., pressing pain in the forehead, as though it would split; 
or as if there were a tight hoop around the head ; eyes appear protruded and 
the face is pale ; great anxiety and restlessness drives into the open air, which 
relieves. At its height, vomiting, belching; hiccoughing; finally diarrhoeic 
stool; some hours sleep and pain in the stomach for several days. 

Agar., pressing pain in right temple, as if a nail were thrust in, worse 
sitting, better moving about slowly ; dull, drawing headache, worse in morn- 
ing, extending into root of nose, with nosebleed or thick mucous discharge; 
headache from overwork at desk. 

Aram, carb., " feeling as if the head would burst; anxiety and in- 
clination to weep ; discharge of sharp, burning water from nose; pale, bloated 
face ; much thirst ; debility, compelling to lie down ; during the day and in 
the morning, perspiration, principally about the joints. Worse in the even- 
ing, and from wet poultices and pressing the teeth together ; better from 
pressure and warmth." (Gilchrist.) 

Amyl nitr., hemicrania, worse on left side; the affected side looks 
pale in comparison with the sound one. 



CEPHALALGIA. 853 

Anacard., "loss of memory; fluent coryza; loss of taste; diminished 
sensibility, particularly of smell, sight and hearing; sensation as of a hoop 
around the parts; coldness internally, with external heat; clammy perspira- 
tion of palms of the hands, worse in morning, periodically; also from rub- 
bing; better during dinner. Left side." (Gilchrist.) 

Ant. crud., headache after bathing in the river, from deranged stomach 
by alcoholic drinks ; thick, white coating ou tongue. 

Aranea diad., when the spells come at regular hours; Simmering be- 
fore the eyes; dizziness in the head, which obliges the patient to lie down; on 
rising a feeling as though the head and hands were bloated and swollen. 

Arg. nitr., pressive pain in the forehead on getting awake in the 
morning, gradually extending from the supraorbital ridge upwards to the 
coronal suture, with heaviness in the head and vertigo, which does not turn 
in a circle, but inclines the patient to reel to the one or the other side; dim- 
ness before the eyes; ringing in the ears; sense of relaxation in the stomach, 
as though it were hanging down loosely; all the symptoms better after eating 
a good dinner and drinking a glass of wine; worse after drinking coffee; or 
the pain is half-sided in one of the frontal protuberances, or close to the side 
of the glabella near the supraorbital ridge, or in one of the temples, some- 
times extending down into the bones of the face ; the pain is of a pressive, 
screwing, throbbing nature, and is always preceded by general indisposition ; 
chilliness ; loss of appetite ; growing dim before the eyes, and nausea. At 
its height it is attended with trembling of the whole body and a deadly nausea, 
which ends with vomiting. 

Arnica, periodical spells, commencing slightly in the morning in the 
forehead, with flickering before the eyes, which is aggravated by reading or 
writing, gradually extending through the temples into the occiput, and reach- 
ing its acme in the afternoon. A warm room is unbearable, but the open air 
does not ameliorate; must lie perfectly quiet, stretched out upon his back; 
worse from any motion, quick walking, bending, going up stairs, talking, 
thinking and after eating. Sour perspiration. 

Arsen., hemicrania in persons with affections of the liver; alternating 
bilious colic and migraena ; great sensitiveness of the head to the open air ; 
during the spells the patient is very restless, constantly moves the head and 
limbs to and fro, and imagines that he gets some relief from so doing; better 
from external warmth ; from wrapping the head up in warm cloths ; he feels 
extremely prostrated ; thinks he must die ; feels chilly and hovers near the 
stove. 

Aur. met., "melancholy mood, dejected, inclined to weep, and longing 
to die, almost driven to suicide; fiery sparks before eyes; roaring in ears; 
very sensitive smell; bloated, shining face; hysterical spasms with laughing 



854 NERVES. 

and crying alternately." (Gilchrist.) Swelling of cranial bones with boring; 
syphilitic and mercurial origin. 

Bellad., one-sided pain, especially on the right side; throbbing, beating, 
attended with vertigo, congestion of the head and eyes, and throbbing of the 
carotid arteries; or great paleness of the face; pain worse on lying down, 
better on bending head backward, and external pressure. 

Bryon., headache on first waking in the morning, gradually increasing 
until evening; pain as though the forehead would burst; worse from any 
motion, coughing or sneezing. Tongue thickly coated; violent thirst or only 
dry feeling in the mouth; gastric derangement; constipation or diarrhoea in 
the morning; the patient is very irritable and cross; gets angry easily. 

Cact. grand., pain in right temple by spells, brought on often by a 
glass of wine, by attending the opera, getting his dinner at too late an hour; 
it commences in the morning and increases as the day advances to an awful 
height, with vomiting. He must lie perfectly quiet; any attempt to keep 
up, any noise, light or exertion, increases the suffering terribly ; coustant dry 
nose. 

Calc. carb., chronic cases; some days before or after the menses, which 
are profuse, pain centering in top, as if she should go crazy; after suppressed 
eruptions; strange feeling of coldness in some part of the head, or in the 
whole head; pain worse from early in the morning after getting awake until 
afternoon ; cold, sweaty hands and feet. 

Calc. phosph., headache of children from going to school; from 
change of weather with other rheumatic pains, especially along sutures and 
symphyses. (Hering.) 

Camphora, throbbing pain like a hammer in the cerebellum, syn- 
chronous with the beats of the heart ; after sunstroke. Icy coldness of the 
whole body; cold perspiration. 

Chamcm., commences with flickering and fiery zigzags before the eyes, 
so that one cannot see or read, followed by terrible headache. 

China, the pain is increased from slight touch, from opening the eyes, 
or from keeping them shut; sometimes the pain is relieved by lying down, 
at other times the patient cannot lie down ; better while moving about gently, 
or sitting up erect. Nursing females after loss of vital fluids. 

Chin, sulph., intermittent neuralgia at regular hours. 

Coccul., the pain is worse after eating, drinking or smoking and at- 
tended with a sense of emptiness and hollo wness of the head. 

Coffea, when the pain drives to despair and the patient runs wildly 
about the room. 

Coloc, pain, tearing, and screwing together; great restlessness and 
anxiety, with sweat, which smells like urine ; urine scanty and fetid ; after 
chagrin and indignation. 



CEPHALALGIA. 855 

Ferrum, congestion of the brain; throbbing; crimson face, which, at 
other times, is quite pale and earthy-looking. The pain drives one out of bed. 

Gelsem., commences with dimness of sight and double vision ; vertigo; 
heaviness or lightness of head ; wild feeling, alternating with uterine pains ; 
worse about 10 a.m., and when lying down; better from shaking head, from 
sitting and reclining the head on a high pillow, from profuse emission of urine. 

Glonoin., congestion of the brain ; throbbing, pulsating pain from below 
upwards, with fulness and feeling of enlargement of the head ; it feels like 
the motion of waves in the brain ; congestion of the eyes ; ringing in the ears ; 
palpitation of the heart. During pregnancy, before the menses, or when the 
menses do not appear ; from heat of sun. 

Hepar, headache over the eyes pressing down upon the eyes; covers 
tightly even when hot and perspiring; extremely vehement from slightest 
cause; could murder any one without "hesitation. 

Ignat., throbbing pain in the occiput, worse from pressing at stool; 
from smoking, from the smell of tobacco-smoke ; for nervous subjects who get 
frightened easily, feel hurt easily, etc. ; intermittent from 9 a.m. to 2 p.m., 
worse from washing hands in cold water, bending head forward, stepping 
heavily ; better from soft pressure, lying on back, and heat. 

Iris vers., beginning with a blur before the eyes; of hepatic or gastric 
origin, with nausea and vomiting; mostly on right side, or changing sides 
in different attacks. 

Laches., temporal nerves of one side painful, w T ith throbbing in the 
temples ; heat in the head ; vertigo with paleness of the face ; pain in the left 
ovarian region ; bloatedness of the stomach ; frontal headache after suppressed 
coryza. 

Lil. tigr., terrible, tearing, crazy pain running from back up into top 
of head, with a feeling as if she would lose her reason, or would lose her soul 
when dying. Squeezing feeling about the heart. 

Melilot., congestive headache, better from bleeding of nose. 

Menyan., pressing pain in forehead and temples from above downwards, 
relieved by firm pressure with the hand. 

Natr. mur., commencing in the morning when getting awake; it gets 
worse from reading, writing and talking; and is frequently indicated when 
school-girls, who apply themselves closely to their lessons, get a severe head- 
ache. 

Nux vom., pressive, boring, dull pain, mostly over left eye, commenc- 
ing in the morning, increasing through the day, growing milder in the even- 
ing, attended with dimness of sight, stoppage of the nose, sour and bitter vom- 
iting; constipation; palpitation of the heart; worse from mental exertion, 
light and noise, in the open air, after eating; brought on by masturbation, 
hysteria, with profuse menses, sedentary life, close mental application, abuse 



856 NERVES. 

of coffee, with hemorrhoidal disposition, constipation, disturbances in the 
ganglionic system. 

Phosphor., intense pain in eyes and whole head, worse in left eye, in 
forenoon, or from stooping, better while eating, lying down, and after sleep- 
ing. Bloated face; puffiness under eyes ; blue rings around the eyes; pale, 
hippocratic countenance. 

Phosph. ac, dreadful pain on the top of the head, as though the brain 
were crushed, after long-continued grief. For youths who grow very fast 
and slender. 

Platina, cramping pain, as though the part were in a vise; especially 
above the root of the nose, with heat and redness of the face, tearful disposi- 
tion, and too early and profuse menstruation. 

Pulsat., tearing, pressing, stitching pain, mostly on right side of head, 
worse in the evening and at night, in the warm room, better from external 
pressure and in the open air, with aversion to eating and drinking; water 
tastes bitter ; nausea; vomiting; oppression of the chest, and chilliness ; mild, 
yielding disposition; scanty, delayed menses; disposition to looseness of the 
bowels. 

Rhus rad., commencing in the back of the neck, the muscles are sore 
to touch, it spreads up and over entire head ; worse in rest and cold, better 
on moving and warmth ; brought on by cold draught on back and neck, and 
cold, damp and rainy weather. 

Sanguin., the pain commences in the back part of the head, rises and 
spreads over the head, and settles especially above the right eye, with nausea, 
vomiting and chilliness; the patient is obliged to seek a dark room and to 
lie perfectly still; flushes of heat; burning of the soles of the feet; scanty 
urine at first, later profuse flow of clear urine. 

Sepia, the pain is jerking upwards, like an electric shock, or boring; 
worse from motion, better from holding the eyes shut; pale, yellowish, dirty 
color of the face; white tongue; aversion to food; sour taste after eating; 
constipation; obstruction of the portal system; leucorrhcea between menses; 
irregular menses ; bearing down of the womb. 

Silic, pressing, throbbing pain in the occiput upwards, also from occiput 
to eyeballs, especially the right one, worse from every quick exertion, press- 
ing to stool, etc., better from getting warm, and after sleep; the pain is at- 
tended with a peculiar exaggeration of the mind; when crossed, he has 
to restrain himself from doing violence; appetite good; while eating the pain 
is much milder, but grows so much the worse again afterwards; brought on 
by exposure of the back to any slight draught; better from wrapping the 
head up warmly. 

Spigel., different sorts of pains, frequently extending into the eye and 
side of the face, always worse from stooping, slightest motion, concussion, 



DIGEST TO CEPHALALGIA. 



857 



noise and during stool ; they are apt to appear at regular hours, either in 
the forenoon or in the night, and are mostly attended with paleness of the 
face, palpitation of the heart and oppression of chest. 

Sulphur, pain in the forehead and top of the head; heat in the head 
and coldness of the feet ; flying heat in the face ; nightly sleeplessness ; itch- 
ing of the skin ; suppressed eruptions ; looseness of the bowels early in the 
morning, driving out of bed; haemorrhoids, etc. 

Thuja, hemicrania of sycotic origin, mostly worse soon after midnight. 
" Intermittent from 9 p m. to 4 or 5 a.m., commencing slightly on crown of 
head, gradually expanding over whole head, and increasing to an excruciat- 
ing height, with restlessness, must get out of bed. After the attack paralytic 
weakness of the legs. Has had thirty years ago an intermittent fever, which 
was suppressed." (Kock.) 

Veratr., pain very violent, driving one to despair; or prostrating, 
causing fainting; cold sweat and great thirst; great nausea, vomiting and 
diarrhoea, or obstinate constipation. 

Zincum, in chronic cases of cerebral affections; great weakness of 
sight; stitching pain in the right eye; paleness of face; now and then vomit- 
ing; fidgetiness of the legs. 



Digest to Cephalalgia. 



Beating, throbbing: Arg. nitr., Bellad., j 
Ferrum, Glonoin. 

, , like waves, from below up- 
wards: Glonoin, 

Boring, dull : Nux vom. 

Bursting : Amm. curb., Bryon. 

Congestive : Aeon., Bellad., Ferrum, 
MelUot. 

Dull, drawing : Agar. 

Pressive: Arg. nitr., Nux vom., Pulsat. 

Like a hoop around: JSthusa, Anac. 

Screwing together: Arg. nitr., Coloc. 

, as though in a vise : Platina. 

Tearing : Coloc. 

and stitching : Pulsat. 



Forehead, pain as if it would burst or 
split : JEthusa, Bryon. 

, down to bones in face : Pulsat. 

and top of head : Sulphur. 

and temples, from above downward : 

MenyarUh. 

, pressive on awakening in the morn- 
ing : Arg. nitr. 



Forehead, pain in one of the frontal pro- 
tuberances: Arg. nitr. 

, from supraorbital ridge up to coro- 
nal suture: Arg. nitr. 

, over eyes, pressing down : Hepar. 

, over left eye : Nux vom. 

, jerking upwards, like an electric 

shock, or boring: Sepia. 

, in glabella : Aeon., Arg. nitr. 

, root of nose: Aeon., Agar., Platina. 

Temples, with throbbing: Laches. 

, in one of the, extending down into 

the bones of face : Arg. nitr. 

, through into occiput : Arnica. 

, right side : Bellad., Cact. grand., Iris, 

Pulsat. 

, , as if a nail were thrust in : 

Agar. 

, left side : Anac, Amyl nitr. 

, changing sides in different attacks : 

Iris. 

Eyes, affecting: Hepar. 

, , and side of face : Spigel. 

, , and whole head : Phosphor. 



858 



NERVES. 



Eyes, affecting left eye : Phosphor. 

Top, crown of head, as if brain were 

crushed : Phosph. ac. 
, , extending over whole head: 

Thuja. 
Occiput, throbbing: Ignat, 
'-, , synchronous with the beats of 

the heart : Camphora. 

- , upwards: Silic. 

, spreading all over head ; muscles of 

neck are sore to touch : Rhus rad. 

, and settling in right eye : San- 
gum., Silic. 

, terrible, tearing, crazy pain up to 

top of head : Lit. tigr. 

Commencing on waking in the morning : 
Natr. mur. 

< , increasing till evening: 

Bryon., Cact. grand. 

— , afternoon: Arnica, 

Calc. carb. 

, growing milder in even- 
ing : Nux vom. 

slightly, growing gradually to severe 

height, and decreasing again slowly: 
Stan num. 

Intermittent, at regular hours: Aranea 
diad., Chin, sulph., Spigel. 

, from 9 a.m. to 2 p.m. : Ignat, 

-. , from 9 p.m. to 4 or 5 a.m.: Thuja. 

- , either in forenoon or in night: 

Spigel. 

Periodical : Anac, Arnica, Thuja. 

Alternating with bilious colic: Ars.alb. 

Preceded by dimness before eyes and 
nausea : Arg. nitr. 

dimness of sight and double vision: 

Oelsem. 

■ blue before eyes : Iris vers. 

flickering and fiery zig-zags before 

eyes: Chamom. 

general indisposition, chilliness : Arg. 

nitr. 

BETTER. 
Lying down: China, Phosphor. 

on back : Arnica, Ignat. 

perfectly still : Sanguin. 

Reclining head on a high pillow : Gel- 

sem. 



Bending head backwards: Bellad. 

Holding eyes shut : Sepia. 

In a dark room : Sanguin. 

Sitting erect: China. 

Moving about gently: Agar., China, 
Rhus rod. 

Shaking the head : Gelsem. 

External pressure : Amm. carb., Bellad., 
Menyanth., Pulsat. 

, soft: Ignat. 

warmth: Amm. carb., Arsen., Ignat, 

Rhus rad. 

Wrapping head up warmly: Arnica, 
SUic. 

Open air: JEthusa, Pidsat. 

While eating : Anac, Phosphor., Silic. 

After eating a good dinner and drinking 
a glass of wine : Arg. nitr. 

After sleep : Agar., Phosphor., Silic. 

Bleeding of nose: Melilot. 

After profuse emission of urine : Gel- 
sem., Ignat., Sanguin. 

WORSE. 

Mental exertion : Arnica, Nux vom. 
Reading, writing, talking: Arnica, Natr. 

mur. 
Light and noise: Cact grand., Nux vom., 

Spigel. 
Motion : Arnica, Bryon., Sepia, Silic, 

Spigel. 

, must lie perfectly still : Cact. grand. 

Stooping, concussion: Arnica, Bryon., 

Ignat., Spigel., Phosphor. 
Sitting: Agar. 
Coughing,' sneezing: Bryon. 
Pressing at stool: Ignat., Silic, Spigel. 
Opening or shutting the eyes: China. 
In rest : Rhus rad. 
When lying : Bellad., Gelsem. 
Must out of bed: Ferrum, Thuja. 
Touch, slight: China. 
Rubbing: Anac 
Pressing teeth together : Amm.. carb. 



In cold : Nux vom., Rhus rad. 
Washing hands in cold water: Ignat. 
Wet poultices : Amm. carb. 
In warm room : Pulsat. 



DIGEST TO CEPHALALGIA. 



859 



In a -warm room, but open air does not 
relieve : Arnica. 



After eating: Arnica, CoccuL, Nux vom., 
Silic. 

drinking: Coccul. 

coffee: Arg nitr. 

smoking: CoccuL, Ignat. 



Xatr, 



Stan- 



Morning : Agar., Anac. 
Forenoon: Phosphor. 

, 10 o'clock: Gelsem., 

num. 
Evening: Aram. carb. 

and night : Pulsat. 

After midnight : Thuja. 



CAUSES. 
Close mental application : Nux vom. 

, at school: Calc. phosph. 

, , girls : Xatr. mur. 

Overwork at desk : Agar. 
Opera: Cact. grand. 
Grief: Phosph. ac. 
Chagrin, indignation: 
Cerebral affections: 
Suppressed coryza: 



Coloc. 
Zincum. 

Laches. 



Gastric derangement: Bryon., Iris. 

, from alcoholic drinks : Ant. crud., 

Nux com. 

Hepatic derangement: Arsen., Iris. 

Masturbation : Nux vom. 

Before menses, and if they do not ap- 
pear: Glonoin. 

, which are profuse : Cdc. carb. 

During pregnancy: Glonoin. 

Nursing and after loss of fluids: China. 



Heat of sun : Qmvphora, Glonoin. 
Bathing : Ant. crud. 
Draft on b;tck and neck: Rhus rod., Silic. 
Change of weather: Calc. phosph. 
Damp, rainy weather: Rhus rod. 



Sycosis: Thuja. 

Syphilis: Aur. met. 

Suppressed intermittent fever: Thuja. 

eruptions: Calc. carb., Sulphur, 



Mercurial poisoning : Aur. met. 



Full-blooded persons: Aeon. 
Youths, growing very fast: Phosph. ac. 
Nervous persons who get easily fright- 
ened, or feel easily hurt : Ignat. 

ATTENDING SYMPTOMS. 

Loss of memory : Anac. 

Wild feeling, alternating with uterine 
pains: Gelsem. 

Feeling as if going crazy: Aeon., Calc. 
carb. 

she would lose her reason : Til. tigr. 

she must die: Arsen. 

Inclination to weep: Amm. carb., Aur. 
met., Piatina. 

Longing to die: Aur. rmt 

Laughing and crying alternately: Aur. 
met. 

Runs wildly about the room : Coffea. 

Melancholy, dejected : Aur. met. 

, would lose her soul when dying : Til. 

tigr. 

Anxiety : Amm. carb., Coloc. 

and restlessness : JEthusa. 

Despair: Aeon., Coffea, Veratr. 

, almost driven to suicide: Aur. met. 

Mild, yielding disposition: Pulsat. 

Irritable, cross, angry: Bryon. 

Has to restrain himself from doing vio- 
lence : Silic. 

Could murder any one without hesita- 
tion: Hepar. 



Vertigo : Arg. nitr., Bellad., Gelsem. 
, inclines the patient to reel to the 

one or other side : Arg. nitr. 

, obliges to lie down : Aran. diad. 

, and paleness of face: Taches. 

Congestion : Aeon., Bellad., Glonoin. 
Heat: Taches. 

and cold feet: Sulphur. 

Cold feeling in some part of head, or in 

whole head: Calc. carb. 
Feeling of enlargement: Glonoin. 
as if head were bloated and swollen: 

Aran. diad. 



860 



NERVES. 



Feeling of emptiness and hollowness of 

head : Coccul. 
Heaviness or lightness of head : Gelsem. 
Swelling of cranial bones, with boring: 

Aur. met. 
Sensitiveness of head to open air: 

Arsen. 



Eyes appear protruded: JEthusa. 

congested : Glonoin. 

Blue rings around the eyes: Phosphor. 
Stitching pain in right eye: Zincum. 
"Weakness of sight: Zincum. 
Dimness before eyes: Arg.nitr. 
Objects appear smaller than they are: 

Platina. 
Fiery sparks before eyes : Aur. met. 
Flimmering, flickering before eyes : Aran., 

Arnica. 
Ringing in ears : Arg. nitr., Glonoin. 
Roaring : Aur. met. 



Puffiness under the eyes : Phosphor. 

Face bloated: Phosphor. 

and shining : Aur. met. 

and pale: Amm. carb. 

pale: JEthusa, Bellad., Sepia, Spigel, 

Zincum. 

, yellowish-dirty: Sepia. 

, hippocratic countenance: Phos- 
phor. 

on affected side : Amyl nitr. 

crimson during pain, at other times 

pale and earthy : Ferrum. 

, heat and redness: Platina. 

, flying in : Sulphur. 

Nose dry: Cact. grand. 

stopped up : Nux vom. 

bleeding : Agar. 

, fluent coryza: Anac. 

, sharp, burning water 

carb. 

, thick, mucous discharge from 

Sensitive smell : Aur. met. 



from : Amm. 



Agar. 



Loss of taste : Anac. 
Taste sour after eating: Sepia. 
, bitter, of water : Pulsat. 



Aversion to eating and drinking: Pulsat., 

S?pia. 
Appetite good : Silic. 
Thirst : Amm. carb., Bryon. 

-, great, and cold sweat: Veratr. 

Dry feeling in mouth, without thirst: 

Bryon., Pulsat. 
Tongue coated, thick, white: Ant. crud., 

Bryon. 

white: Sepia. 

Nausea, vomiting : Arg. nitr., Ipec, Pul- 
sat, Sanguin., Veratr. 
Vomiting now and then : Zincum. 

at its height : JEthusa, Arg. nitr. 

bitter, sour : Nux vom. 

Belching, hiccoughing: JEthusa. 
Stomach, pain for several days : JEthusa. 

bloated: Laches. 

relaxed, as though hanging down 

loosely : Arg. nitr. 
Diarrhoea : JEthusa, Pulsat. Veratr. 
early in morning, driving out of bed : 

Sulphur. 

early in morning : Bryon. 

Constipation : Bryon., Nux vom., Sepia, 

Veratr. 
Obstruction of portal system : Sepia. 
Haemorrhoids : Sulphur. 
Urine scanty and fetid : Coloc. 
at first, later profuse and clear : 

Sanguin. 
Pain in left ovarian region : Laches. 
Bearing down of womb: Sepia. 
Menses scanty, delayed : Pulsat. 

too early and profuse : Platina. 

■ irregular and leucorrhcea between : 

/Sepia. 






Oppression of chest: Pulsat, Spigel. 
Squeezed feeling about the heart: Lil. 

tigr. 
Palpitation of heart : Glonoin., Nux vom., 

Spigel. 
Throbbing of carotid arteries : Bellad. 



Paralytic weakness of legs after attack : 

Thuja. 
Fidgety of legs: Zincum. 



NEURALGIA OF FACE. 861 



Perspiration of palms of hands: Anac, 
Covers tightly, even when hot and per- 
spiring: Hepar. 



Burning of soles of feet : Sanguin. 

Icy coldness of whole body: Camphora. 
Coldness internally, with heat ex- 
ternally: Anzc. 

Cold, sweaty hands and feet : Cole. carb. j Itching of skin, sleepless: Sulphur. 
Chilliness : Arsen., Pidsat, Sanguin. Restlessness : Amen., Coloc, Thuja. 



Flushes of heat: Sanguin. 
Perspiration cold: Camphora, Veratr 
sour : Arnica. 



Debility, prostration: Arsen. 

, , compelling to lie down: Amra. 

carb. 

smells like urine: Coloc. ; , , causing fainting: Veratr. 

during day and in morning, about ; Trembling of the whole body : Arg. nitr. 

joints : Amm. carb. j Hysterical spasms: A ur. met. 

2. Neuralgia of the Trigeminus or Fifth Nerve, Proso- 
palgia, Neuralgia Facialis, Dolor Faciei Fothergillii, 
Tic douleureux. 

It attacks one or the other branch of the trigeminus, sometimes the n. 
supraorbitalis or infraorbitalis, n. facialis, n. inframaxillaris, and, therefore, 
some authors speak of a neuralgia supraorbitalis, neuralgia infraorbitalis, etc. 
The affection is almost always confined to one side; rarely does it attack both 
sides, but there appears to be no difference in favor of one or the other side. 
An extension from one side to the other has been occasionally observed. 

The pain is generally spoken of by the patient as indescribable, excru- 
ciating, coming on in paroxysms of shorter or longer duration, sometimes 
irradiating into the back part of the head and neck, down into the shoulder, 
intercostal spaces, breast and even the lower extremities. 

We likewise find the motory nerves affected, causing jerking of different 
muscles of the face, spasmodic closing of the eyelids, bending of the body 
double, trembling of the whole body, etc. We also find the vasomotory 
nerves affected, causing pulsation of the arteries, swelling of the veins, redness, 
or paleness, and heat of the face. The whole affected side of the face assumes 
a different expression, becomes shining, glistening, greasy, sometimes appear- 
ing puffed and at other times emaciated. 

When the ramus ophthalmicus is affected, we observe a reddening of the 
conjunctiva and flowing of tears; if, at the same time, the second branch is 
also affected, we observe a watery and slimy discharge from the nose; and 
when the second and third branches suffer, it is often attended with a flow of 
saliva. 

Sometimes there has been observed a partial sweat in the face during the 
paroxysm ; the hair of the affected side grows brittle and splits, or falls out. 

THERAPEUTIC HINTS.— Aeon., cheeks red and hot; the patient 



862 NERVES. 

seems beside himself for pain, screams and rolls about in the bed or on the 
floor. 

Allium cepa, " pains violent and continuous; chronic neurotis, which 
is wearing the patient out." (Gilchrist.) 

Arg. nitr., during the paroxysms, unpleasant, sour taste in the mouth. 
Wolf mentions Arg. nitr. as of geueral importance in this complaint. 

Asaf., "hysterical restlessness and anxiety; sensation of numbness of 
bones of face; twitching and jerking in muscles, worse in afternoon; better 
in open air. Left side." (Gilchrist.) 

Arsen., burning, stinging pain, as of red-hot needles, worse about mid- 
night; face pale and distorted ; puffed around the eyes; great restlessness; 
ameliorated by external warmth; typic paroxysms of a miasmatic origin. 

Bellad., cutting, tearing pain, shooting from the side of the face up 
into the temple, into the ear, and down into the nape of the neck ; worse 
from touch and motion ; hard pressure sometimes relieves ; the paroxysms 
mostly occur in the afternoon ; come and go suddenly ; the face is generally 
flushed ; the eyes water and the muscles of the face twitch ; the patient can- 
not bear light nor noise ; the right side is the most frequently affected ; after 
the abuse of mercury. 

Bismuth nitr., the most excruciating pains are somewhat relieved by 
taking cold water in the mouth and walking briskly about. 

Calc. carb., pain from right mental foramen along lower jaw to ear, 
attended with frequent urination ; worse from cold air ; better from warm air 
and warm applications. 

Caustic, right side, from the cheek-bone to the mastoid process, worse 
at night; better from rubbing with a cloth dipped in cold water; chilliness; 
scanty menses. 

Cedron, "unerring periodicity to the hour." (Gilchrist.) 

Chamom., the pain causes hot perspiration about the head, and ex- 
torts screams; the patient is wild and unruly, tossing and rolling about; 
menses unusually profuse. 

China, the pain is in the infraorbital and maxillary nerves, worse from 
the least touch, lying down, and in the night; great weakness after the par- 
oxysm. 

Chin, sulph., the paroxysms set in at the same hour every day; the 
intervals are free of pain, and there is no complication with gastric or other 
derangements. 

Cimicif., especially when the neuralgia is a reflex pain dependent 
upon ovarian disturbances. "Pain in left jaw, in lower jaw, lower teeth and 
articulation of lower jaw; pain in right superior maxillary bone and teeth; 
heat in one side of face, with lassitude all over." (Gilchrist.) 

Coloc, tensive tearing with heat and swelling, especially left side, also 



NEURALGIA OF FACE. 863 

right side; motion and touch increase the pain; better in perfect rest, and 
from external application of warmth ; brought on by chagrin and indignation. 

Ferrum, during the paroxysms the face gets fiery red, sometimes only 
in one spot; cannot keep the head quiet; at the intervals the face looks 
earthy and pale. 

Gelsem., orbital neuralgia in distinct paroxysms of acute pain, accom- 
panied with contractions and twitching of the muscles near the portion of the 
face affected; with extreme general nervousness and loss of control over the 
voluntary muscles, giving rise to odd, irregular motions. 

Hepar, in chronic cases; the pain streaks from the cheek-bone into the 
temple, ear, ala? nasi and upper lip of the affected side; it is worse in the 
fresh air. and better from wrapping up the face; at the same time coryza, 
hoarseness, much sweating and rheumatic pains elsewhere; especially after 
the abuse of mercury or metallic preparations. 

Iris, pain in the head, temples and eyes, attended with most distressing 
vomiting of a sweetish mucus, and occasionally (if attended by much strain- 
ing) of some bile. 

Laches., left side, orbital neuralgia; lachrymation ; previous to the 
paroxysm rising of heat to the head ; during the intervals a weak, nauseous 
feeling in the abdomen. Waking out of sleep the eyes feel as though they 
had been taken out and squeezed, and then put back again ; malarial affec- 
tions. 

Magn. carb., left or right side; shooting like lightning; worse from 
touch, draught, change of temperature; cannot stay in bed, must walk the 
floor. 

Magn. phosph., supraorbital and infraorbital nerves pain at inter- 
vals and relieved by external warmth. 

Mercur., tearing pains, worse at night in bed; it often starts from a 
decayed tooth and involves the whole side of the face, which may be red and 
swollen; profuse secretion of saliva; constant inclination to perspire; restless- 
ness and sleeplessness. Brought on by taking cold. 

Mezer., ciliary neuralgia, especially after operations on the eye; pro- 
sopalgia, left-sided, from over the eye to the eyeball, cheek, teeth, neck and 
shoulder: lachrymation; conjunctiva injected; parts sensitive to touch; 
worse from warmth; periodical from 9 a.m., increasing to 12 m., and decreas- 
ing gradually until 4 p.m., leaving the patient perfectly free from pain. 
Also boring, pressive pains, coming like lightning, which leave the parts 
numb ; they are worse from eating warm food, also from entering a warm 
room after walking in the fresh air; they are attended with chilliness and 
shuddering; twitching of the muscles of the affected parts, flow of saliva, 
redness of the fauces, burning in the threat, stiffness of the masseteric, red 



864 NERVES. 

spots on the nape of the neck, and formication in the skin of the chest ; after 
the abuse of mercury, or in syphilitic patients. 

Natr. mur., pain in the malar bones, worse when chewing; falling off 
of the whiskers; intermittent prosopalgia; after the abuse of quinine. 

Nux vom., tearing pain in the course of the infraorbital and middle 
branch of the trigeminus, with redness and watering of the eye ; flow of clear 
water from the nostrils and numbness of the affected side; the patient is 
morose, irritable, belches a great deal and is constipated ; after the abuse of 
coffee, liquors, quinine, etc. ; also intermittent prosopalgia; worse from noise, 
motion, cold air; better in a warm room, at rest and lying down. 

Phosphor., drawing and tearing pain in the jaws, root of the nose, 
eyes and temples, worse from slightest movement and touch, cannot speak 
nor eat, attended with bloatedness of the face, congestion of the head, tearing 
on the top of the head, vertigo, and ringing in the ears ; from taking cold 
over the wash-tub. 

Platina, boring pain, cramp-like; painful feeling of numbness in the 
malar bones and the mastoid processes and chin, as if the parts were between 
screws, attended with anxiety, weeping and palpitation of the heart ; profuse 
menses. 

Pulsat., twitching, tearing pain, worse in the evening and in a warm 
room ; in persons of a mild, tearful disposition, and phlegmatic temperament ; 
inclination to looseness of the bowels ; scanty menses ; after getting the feet 
wet ; after the abuse of quinine. 

Rhodod., right side; by wind and changes of weather, better from 
warmth, and relieved while eating and for some time after. 

Rhus tox., drawing, burning, tearing pain in the face, and a feeling as 
though the teeth were too long, attended with great restlessness, necessity to 
move about; relieved somewhat by the external application of cold ; dysenteric 
stools, with jelly-like evacuations; after exposure to rain. 

Sanguin., in upper jaw extending to nose, eye, ear, neck and side of 
head ; shooting, burning pains ; kneel down and hold head tightly to the 
floor. (Hering.) 

Sepia, intermittent prosopalgia, with congestion of eyes and head; also 
during pregnancy; jerking, like electric shocks, upwards. 

Spigel., tearing, shooting, jerking or burning pain in all directions, 
suddenly coming and going, attended with dark redness of the affected side ; 
flow of water from the eyes and nose ; twitching of the muscles in the face ; 
difficulty of breathing ; palpitation of the heart ; rheumatic pains elsewhere ; 
worse in damp weather, from touch and motion ; after suppressed inter- 
mittents. 

Stannum., intermittent supraorbital neuralgia from 10 a.m. to 3 or 



DIGEST TO NEURALGIA OF FACE. 865 

4 p.m., gradually increasing until attaining its acme, and then again decreas- 
ing as gradually ; after abuse of quinine. 

Staphis., the pain starts from a decayed tooth; is worse from slight 
and better from heavy pressure; it is attended with swelling of the gums, 
cold sweat in the face and cold hands. 

Stramon., prosopalgia, with many nervous symptoms: spasms of the 
chest hindering breathing; swooning; weeping; twitching of the muscles of 
the face ; frowning ; jerks through the whole body ; delirious talk, with open 
eyes. 

Sulphur, intermittent periodic neuralgia every twenty-four hours, worse 
generally at 12 m. or 12 p.m., or midsummer or midwinter; chronic cases, 
when other remedies relieve, but do not cure ; psoric tendency ; scanty, black, 
tarry menstrual discharges. 

Thuja, after suppressed gonorrhoea or eczema on the ear; worse after 
midnight. 

Veratr., drawing, tearing pain, attended with bluish paleness of the 
face; sunken eyes; coldness of the extremities; trembling and jerking; cold 
perspiration; great exhaustion; nausea and vomiting. 

Verbasc, violent pain, jerking like lightning, or pressive, numbing; 
aggravated by pressure, sneezing, talking, chewing or a draught of air; 
appears at the same hour every day, 11 a.m. till 4 p.m., and is attended with 
headache, redness of the face, vertigo, belching, and a discharge of tough 
saliva from the mouth. 

Zincum, burning, quick stitches, and jerking along the course of the 
infraorbital nerve, right side, attended with bluish eyelids ; numbness of the 
tongue; constricted sensation of the throat; worse from the slightest touch 
and in the evening. 

Digest to Neuralgia of Face. 



NATURE OF PAIN. 

Boring : Mezer., Platina. 

Burning: Arsen., Rhus tox., Sanguin., 

Zincum. 
Cramp-like: Platina. 
Cutting: Bellad. 

Drawing : Phosphor., Rhus tox., Veratr. 
Jerking : Sepia, Spigel, Verbose, Zincum. 
Lightning-like: Magn. carl., Mezer , 
Verbose 



Pressive : Mezer. 

and numbing: Verbasc. 

Shooting : Bellad. 

Stinging, as of red-hot needles, worse 
about midnight: Arsen. 

Stitches along the course of right infra- 
orbital nerve: Zincum. 

Tearing : Bellad., Mercur., Rhus tox., Spi- 
gel., Veratr. 

in the course of the infraorbital and 



Like electric shock upwards: Sepia. middle branch of the trigeminus: Nux 

Numbness in malar bones and mastoid torn. 

processes and chin, as if the parts were in jaws, root of nose, eyes and tem- 

between screws: Platina. pies: Phosphor. 



8GG 



NERVES. 



Tensive tearing, with heat and swelling, 

left side : Coloc. 
Twitching, tearing: Pulsat. 
Violent and continuous: Cepa. 

LOCATION AND DIRECTION 
OF PAIN. 

Ciliary, after operations on eye : Mezer. 

Orbital: Gelsem. 

, leftside: Laches. 

From over the eye to eyeball, cheek, 
teeth, neck and shoulder: Mezer. 

Supra and infraorbital: Magn. phosph. 

Supraorbital : Stannum. 

Infraorbital and middle branch of tri- 
geminus : Nux vom. 

and maxillary : China. 

, right side : Zincum. 

Cheek-bone to mastoid process, right 
side: Caustic. 

and chin: Platina. 

Maxillary, superior : Natr. mur. 

, , and teeth: Cimic. 

, , to ncse, eye, ear, neck and side 

of head : Sanguin. 

, , to temple, nose and upper lip: 

Hepar. 

Temples and eyes : Iris vers. 

Jaws, root of nose, eyes and temples: 
Phosphor. 

Right mental foramen along lower jaw 
to ear : Calc. carb. 

Left under-jaw, lower teeth, and articu- 
lation of lower jaw : Cimic. 

From decayed tooth : Staphis. 

, whole side of face red and swollen : 

Mercur. 

From side of face into temple, ear, down 
nape of neck: Bellad. 

Right side : Bellad., Caustic, Coloc, 
Rhodod., Zincum. 

Left side : Asa/., Coloc, Laches, Mezer. 

Right or left : Magn. carb. 

PERIODICITY. 

Intermittent: Arsen., Gelsem., Magn. 

phosph., Natr. mur., Nux vom., Sepia. 
, at regular hours: Cedron., Chin. 

sulph. 



Intermittent, from 9 a.m. to 4 p.m.: 

Mezer. 

, from 10 a.m. to 3 or 4 p.m : Stan- 
num. 

, from 11 a.m. to 4 p.m. : Verbasc 

, 12 noon or 12 midnight : Sulphur. 

, afternoon: Asa/., Bellad. 

, after midnight: Thuja. 

Spells come and go suddenly: Bellad., 
Spigel. 

, gradually increasing to highest pitch 

and then again decreasing as gradually : 
Mezer., Stannum. 

AMELIORATION. 

External warmth: Arsen., Calc carb., 

Coloc, Magn. phosph, Rhodod. 
Warm room : Calc carb , Nux vom. 
Wrapping up face : Hepar. 
In open air : Asaf., Pulsat. 
External application of cold: Rhus tox. 
Taking cold water in the mouth : Bism. 

nitr. 
Heavy, hard pressure : Bellad., Staphis. 
Rubbing with cold water : Caustic. 
Moving head : Ferrum. 
Walking the floor : Magn. carb. 
Walking briskly about: Bism. nitr. 
Kneeling down and holding head tightly 

to floor : Sanguin. 
Rest : Coloc, Nux vom. 
While eating and for some time after: 

Rhodod. 

AGGRAVATION. 

Warmth: Mezer. 
Warm room : Pulsat. 

, after walking in fresh air : Mezer. 

Warm food : Mezer. 
Cold air : Calc carb., Hepar, Nux vcm. 
Draught of air : Verbasc, Magn. carb. 
Change of temperature: Magn. carb. 

of weather : Rhodod. 

Damp weather : Spigel. 
Midsummer and midwinter: Sulphur. 
Evening : Pulsat, Zincum. 
Night : Caustic, China. 
, in bed : Mercur. 



DIGEST TO NEURALGIA OF EACE. 



867 



Touch: B:Ua:l., Mijn. carb., Spigel., Ver- 
bose. 

, slightest: Chini, Mezer., Phosphor., 

Staphis., Zincum. 

Motion : Bellad., Coloc, Nux vom., Phos- 
phor., Spigel. 

Talking : Verbasc. 

Chewing : Xatr. mur., Vei^bisc. 

Cannot speak nor eat : Phosphor. 

Lying down: China. 

Cannot stay in bed, must walk the floor: 
Magn. carb. 

keep head still: Fcrrum. 

After sleep : Laches. 

CAUSES. 

Chronic neuritis: Cepi. 

Pregnancy: Sepia. 

Suppressed intermittents : Spigel. 

Malaria : Arsen., Liches. 

Taking cold : Mercur. 

, over wash-tub : Phosphor. 

Getting wet: Rhus tox. 

of the feet: Pulsat. 

Abuse of quinine: Natr. mur., Xux vom., 

Pul-sat., Stannum. 

coffee, liquors: Xux vom. 

mercury: Bellad., Hepar, Mezer. 

Syphilis: Mezer. 

Suppressed gonorrhoea, or eczema on 

the ear: Thuja. 
Chagrin and indignation: Coloc. 
Chronic cases, when other remedies 

fail: Sulphur. 

ATTENDING SYMPTOMS. 
Swooning : Stramon. 
Delirious talk with open eyes: Stramon. 
Wild, unruly, tossing and rolling about: 

Chamom. 
Beside himself, screaming, rolling about : 

Aeon. 
Weeping : Piatina, Stramon. 
Frowning : Stramon. 
Anxiety : Asaf., Piatina. 
Tearful, mild disposition : Pukat. 
Morose, irritable: Xux vom. 



Headache : Verbose. 

Heat in head before spell: Liches. 

Congestion of head: Phosphor., Sepia. 

Tearing on top of head: Phosphor. 

Hot perspiration about the head: Cha- 



Congestion of eyes: Sepia. 
Conjunctiva injected: Mezer. 
Redness and watering of eyes: Nux vom. 
Bluish eyelids: Zincum. 
Lachrymation : Laches., Mezer. 
Flow of water from eyes and nose: 

Spigel. 
, and twitching of muscles of 

face : Bellad. 
Sunken eyes : Veratr. 
Light and noise unbearable : Bellad. 
Ringing in ears : Phosphor. 



Flow of water from nose: JViiac vom. 

Spigel. 
Coryza: Hepir. 



Vertigo: Phosphor., Verbasc 



Face, cold sweat in: Staphis. 

, bluish pale: Veratr. 

, pale and distorted: Arsen. 

, bloated: Phosphor. 

, puffed around the eyes : Arsen. 

, flushed: Bellad. 

, red: Verbasc. 

, dark red on affected side: Spigel. 

, fiery red, sometimes only in one 

spot; during intervals earthy and pale: 

Ferrum. 
— : — , hot on one side: Cimic. 

, red and hot : Aeon. 

, numbness of affected parts: Asa/.. 

Mezer., Xux vom., Piatina. 
Twitching of muscles: Asaf., Bellad., 

Gelsem., Mezer., Spigel., Stramon. 
Stiffness ofmasseters: Mezer. 
Falling off of whiskers: Natr. mur. 



Mouth, sour taste in: Arg. nitr. 
Flow of saliva: Mercur., Mezer., Ver- 
basc. 
Swelling of gums : Staphis. 
Teeth feel as if too long: Rhus tox. 



868 



NERVES. 



Numbness of tongue : Zincum. 
Fauces red, burning in throat: Mezer. 
Constricted sensation of throat: Zin- 
cum. 
Hoarseness: Hepar. 
Red spots on nape of neck: Mezer. 



Belching : Nux vom. 
Nausea and vomiting: Veratr. 
Vomiting of a sweetish mucus, or bile: 

Iris. 
Nauseous feeling in abdomen: Laches. 
Constipation : Nux vom. 
Dysenteric stools, jelly-like : Rhus tox. 
Looseness of bowels : Pulsat. 
Frequent micturition : Cede. carb. 



Menses scanty : Caustic, Pulsat. 

, black and tarry: Sulphur. 

profuse: Chamom., Platina. 

Neuralgia is a reflex from ovarian 
troubles: Cimic. 



Breathing difficult: Spigel., Simmon. 



Palpitation of heart : Platina, Spigel. 
Formication in skin of chest: Mezer. 



Chilliness: Caustic, Mezer. 
Coldness of extremities: Veratr. 
Cold perspiration : Veratr. 

in face and cold hands : Staphi 

Inclination to perspire: Mercur. 
Much sweating : Hepar. 



Restlessness : Arsen. 

, must move about: Rhus tox. 

and sleeplessness : Mercur. 

General nervousness : Gelsem. 



Lassitude all over: Cimic 
"Weakness after paroxysm : China. 
Rheumatic pains elsewhere: Hepar, 

Spigel. 
Jerks through the body : Stramon. 
Trembling and jerking : Veratr. 
Loss of control over muscles, with odd, 

irregular motions : Gelsem. 



3. Cervico-Occipital Neuralgia. 

Its seat is in the region of distribution of the sensory fibres of the upper 
four spinal nerves, most frequently only on one side, extending, therefore, 
over the upper part of the nape of the neck and the occiput, over the lateral 
region of the head, and in front towards the lower jaw. The occipitalis 
major frequently shows painful spots, one about half way between the mastoid 
process and the upper cervical spinous processes (occipital point), and the 
parietal point over the parietal eminence. Of the other nerves implicated 
such points can rarely be demonstrated. 

Compare Aeon., Bellad., Calc. carb., Caustic, Ignat., Kalmia lat., 
Laches., Nux vom., Pulsat., Rhus tox., Spigel., Sulphur. 



4. Cervico-Brachial Neuralgia 

Extends over the region of distribution of the four lower cervical nerves and 
a part of the first dorsal nerve, and may affect the back of the neck, the up- 
per, or the lower arm, even the hand and fingers. The painful points are nu- 
merous, but somewhat indefinite; they may be found: "over the brachial 
plexus from the axilla outwards; at the lower angle of the scapula; on the 



INTERCOSTAL NEURALGIA. 869 

posterior surface of the shoulder; on the median at the elbow; at the emer- 
gence of the cutaneous medius and lateralis from the fascia of the forearm ; 
on the ulnar above the internal condyle, and at the wrist; ou the radial nerve 
where it wiuds around the humerus, and above the wrist, on the spinous pro- 
cesses of the four lower cervical, and two or three upper dorsal vertebrae, and 
at their sides where the posterior branches appear under the skin." (Erb.) 
Compare Aeon., Arnica, Arsen., China, Ferrum, Graphit., Ignat., Ly- 
cop., Phosphor., Rhus tox., Sepia, Staphis, Sulphur, Veratr. 



5. Intercostal Neuralgia 

Has its seat in the region of distribution of the dorsal nerves, and not unfre- 
quently affects both sides of the chest, but most frequently the left side only 
between the fifth and ninth intercostal spaces. There is a feeling of tension, 
as though the patient were tightly bound around the chest, and occasional 
shooting pains in the direction of the intercostal nerves are occasioned by 
taking a long breath, by coughing, sneezing, sighing, or certain motions of 
the body; by pressure of the clothing or a slight touch, which generally is 
relieved again by hard pressure. 

The painful points are in the region near the spinous process of the ver- 
tebrae, where the dorsal nerves emerge from the spine (vertebral point) ; in 
the middle portion of these nerves, where the ramus perforans lateralis 
emerges beneath the skin (lateral point) ; in the region close to the sternum, 
and in the abdomen over the rectus muscle (sternal and anterior point). 

Differential Diagnosis. — Pleurisy differs by its rubbing sound and 
fever. 

Angina pectoris by its fits of suffocation. 

Rheumatism of the muscles of the chest by its more general diffusion over 
the chest and its aggravation by slightest movement. 

Compare Arnica, Arsen., Borax, Bryon., Calc. carb., Carb. veg., Caus- 
tic, China, Cimic, Mercur., Rhus tox., Sepia, Spigel., Sulphur. 

After shingles: Mezer., Secale corn. 

6. Lumbo-Abdominal Neuralgia 

Has its seat in the region of distribution of the lumbar nerves, and consists 
of pain in the lumbar region and on the abdomen, which is easily excited by 
raising a fold of the abdominal skin, or by touching it slightly, and by press- 
ure upon the region near the lumbar vertebrae. Frequently we find associ- 
ated with it a pain in different places of the crest of the ileum and on the 
seat ; and also pain which extends from the inguinal region to the symphysis 



870 NERVES. 

pubis and down into the scrotum or into the labia majora, which are refer- 
able to the superficial branches of the lumbar nerves. 

Its painful points are : " one or several in the lumbar region .near the 
spinal column (lumbar point) ; one about the middle of the cresta ilii (iliac 
point) ; one or several above the symphysis pubis, at the side of the linea alba 
(abdominal point); not unfrequently one in the scrotum or labium majus; 
and lastly, and less constantly, one in the inguinal region or in tho portio 
vaginalis uteri, or in the corresponding side of the vault of the vagina." 
(Erb.) 

Compare Argent., Bellad., China, Kalmia lat., Nux vom., Pulsat., Rhus 
tox., SpigeL, Staphis., Sulphur. 

7. Mastodynia, Neuralgia of the Mammae. 

Its seat is in the mammary glands, which are supplied chiefly from 
branches of the intercostal nerves. The breast becomes very painful, often 
without any visible change in its structure. In some cases, however, small 
tumors (neuromata) have been observed, which appear to be the starting- 
points of the neuralgia, and they either disappear soon or remain unaltered 
for years. The pain radiates sometimes into the axillse, into the back and 
down into the hips, and may be attended with vomiting. Lying on the 
affected side is impossible. Painful points may be found on the nipples or on 
the sides of the breast, or on the spinous processes of the second, third, fourth, 
fifth and sixth dorsal vertebrae. Mastodynia seems mostly connected with 
irregularities of menstruation, at which time it is generally the worst. But 
also lactation, external injury, ansemia, chlorosis and hysteria are counted 
among its causes. Its most frequent occurrence seems to be between the ages 
of sixteen and thirty. 

THERAPEUTIC HINTS.— Painfulness of the mammae before or 
during menstruation: Argent., Calad.,Calc. carb., Canthar., Cimicif., Conium, 
Kali carb., Murex purp., Nitr. ac, Rhus tox., Tabac. 

During the nursing of the child: Crot. tigl., Ferrum, Phell. aquat., 
Phosphor., Silic. 

8. Neuralgia ischiadica, Sciatica, Ischias postica, Malum 

Cotunnii. 

Its seat is in the n. ischiadicus, though not always in its entire length. 
Most frequently we find the pain extending from the nates down the posterior 
part of the thigh to the bend of the knee, down along the fibula to the ex- 
ternal ankle, heel and external portion of the foot; the internal border of 



SCIATICA. 871 

the foot is exempt; sometimes the pain is felt only in the sole of the foot 
(neuralgia plantaris), and seldom in the dorsum of the foot and toes. In 
rare eases both extremities are affected at the same time. The pain generally 
commences mildly and gradually grows worse; sometimes it is paroxysmal, 
generally worse towards evening and in the night, sometimes only during the 
day. Slight touch aggravates or provokes the pain, while a hard pressure 
sometimes gives relief. With some the pain is ameliorated by moving about 
constantly, while others cannot bear the slightest motion, so that coughing, 
sneezing, pressing at stool are almost killing operations to them. Sometimes 
the pain is attended with a cold sensation in the affected extremity, followed 
by heat. In other cases we find reflex symptoms of the motory nerves, mani- 
festing themselves as cramps in the calves of the legs and in the soles of the 
feet. It has even been observed that during violent paroxysms the heel was 
drawn up towards the buttock of the affected limb. 

Painful points are: "a point close to the sacrum, in the immediate 
vicinity of the posterior superior spine of the ileum ; a point where the sciatic 
nerve emerges from the pelvis; a point at the lower border of the gluteus, 
where the posterior cutaneous nerve emerges; a painful line corresponding to 
the course of the tibial nerve in the popliteal space ; a point over the head 
of the fibula; a point behind the outer ankle-bone and another behind the 
internal malleolus; several points on the dorsum of the foot, and occasionally 
points on the posterior surface of the thigh and on the calf of the leg, where 
the cutaneous branches perforate the fascia." (Erb.) 

The following Diagnostic sign is mentioned by Beurmann in Arch, de 
Phys. Norm et Pathol. : " The patient is made to lie in his bed on his back, and 
is told to allow the affected leg to lie perfectly passive. If now, with the leg 
fully extended the physician flexes it at the hip, the patient at once expe- 
riences acute pain, darting along the course of the nerve from the buttock 
downwards, and which is most severely felt in the neighborhood of the great 
trochanter. If, however, the leg be first flexed upon the thigh before the 
thigh is flexed upon the abdomen, it will be found that no such pain results 
from the movement. It would seem that this pain is due to tension of the 
sciatic nerve, which with the first of these movements is considerable, but 
which does not take place with the second, That this hypothesis is correct, 
Beurmann abundantly proves by various experiments which he conducted on 
the dead subject. This sign of sciatica appears to possess very considerable 
diagnostic value, and will probably suffice at once to distinguish sciatica from 
several conditions which may simulate it, such as crural neuralgia, hip-join c 
disease, etc." 

In regard to its Causes we are very much in the dark. Atmospheric 
influences, however, such as damp, cold weather, seem to be very apt to bring 



872 NERVES. 

it on. Therefore we find among the exciting causes, getting wet, sleeping on 
the damp ground or within moist walls, or taking cold in general. Likewise 
are mentioned direct influences upon the nerves, such as pressure of narrow 
boots, wounds from blood-letting, carcinoma, aneurisms, pressure of the 
pregnant uterus, deliveries by the forceps, diseases of the vertebrae and neu- 
roma. 

THERAPEUTIC HINTS.— Aeon., "the pain extended the entire 
limb, at first dull and dragging, soon becoming acute, tearing, lancinating, 
darting like lightning along the entire nerve, from above downward, and 
accompanied by numbness and tingling. Feet cold with occasional cold 
sweat. In the toes sharp shooting pains, alternating with numbness and 
tingling." (Thos. Nichol.) 

Arg. nitr., periodical pain from hip down to knee, with paralytic weak- 
ness and wasting away of the limb; during paroxysm sensation of expansion 
in limb; worse morning and noon. 

Arnica, when caused by overexertion, marching, fracture of limb, con- 
finement, etc., with formication and lame feeling; necessity to change the 
position of the limbs constantly, because everything upon which he lies seems 
too hard. 

Arsen., the burning pain is attended with anguish and restlessness, 
and is worse about midnight; brought on by staying in cold, damp cellars; 
it is somewhat relieved by external warm applications ; intermittent fever. 

Bellad., feverish; inclined to weep; wants to sleep and cannot sleep; 
pain worse from touch and motion; from least draught of air; from after- 
noon till midnight; better from letting limb hang down, and after perspiring; 
from warmth and when in erect position. 

Bryon., better during rest, and worse on motion. 

Chamom., pain excruciating; the patient acts as if beside himself; 
after anger or vexation. 

Calc. carb., if caused by working in water; or in case of complication 
with affections of the spinal bones; the pain starts from the small of the 
back, extends down into the limbs and keeps them in constant uneasiness. 

Caustic, tearing pain on the outer side of left limb from above down, 
as if the muscles were pinched; constant desire to move the foot. (Maren- 
zeller.) 

Cimicif., causes many reflex pains in different parts, dependent upon 
ovarian or uterine irritation. 

Coffea, tearing, stitching pain, in irregular spells, worse in the night, 
with restlessness and sleeplessness. 

Coloc, tearing downward, posteriorly, from hip to thigh, leg and foot, 



SCIATICA. 873 

left or right side, during the day, not at night; worse from motion and press- 
ure; must limp when walking, and be careful not to press the limb when sit- 
ting ; feels best when lying still. During paroxysm sweat and thirst. Eyelids 
burn even after sound sleep. After indignation. 

Dioscorea, pain in right leg, worse on motion; entire relief when lying 
still. (W. J. Martin.) 

Ferrum, remitting pains; worse in the night, driving out of bed; al- 
though at first scarcely able to stand upon the affected limb, by continued 
motion and walking about, the pain gradually becomes milder; pain in the 
left shoulder; the face is pale, emaciated, but flushes easily. 

Gnaphal., intense pain along the sciatic nerve, which is continued to 
its larger ramifications; feeling of numbness, occasionally taking the place of 
the sciatic pains, and then exercise on foot is excessively fatiguing. 

Hepar, the pain is worse from motion, touch and exposure to air; better 
from being wrapped up and keeping quiet. 

Ignat., throbbing pain in the hip, as though the joint would burst; in- 
termittent, at first every other day — later, daily ; attended w r ith chilliness and 
thirst, followed by heat without thirst ; disappearing during the summer season 
and reappearing in the winter. 

Iris vers., burning and sudden shooting down the limb, causing lame- 
ness; worse from moderate, not altered by violent motion. 

Kali bichr., pain relieved by walking and flexing the leg; worse from 
standing, sitting or lying in bed. 

Kali hydr., nightly tearing in right thigh and knee, worse lying on 
affected side ; abuse of mercury ; syphilitic taint. 

Laches., pain constantly changing locality, now 7 in the head, now in 
the teeth, now in the sciatic nerve, attended with nervousness, palpitation of 
the heart; burning like fire in the hypogastrium, lumbar region and behind 
the sternum; flushes of heat ; suppressed menses; constipation. 

Ledum, laming pain in the hip-joint, worse in bed, when getting warm ; 
the affected limb is cooler than the remainder of the body ; general coldness 
and chilliness. The pain frequently commences below and ascends. Great 
tenderness of the soles of the feet. 

Lycop., pain in the hip, stiffness and weakness, and formication of the 
affected limb; cold feet; incarcerated flatulence and constipation; urine high 
colored, turbid, or depositing a red, sandy sediment. 

Menyanth., the pain is of a crampy nature, and when sitting, the limbs 
are jerked upwards spasmodically. 

Mercur., drawing, tearing pain, worse at night in bed; restlessness; 
great inclination to sweat, without any relief; syphilitic taint. 

Mezer., drawing pain through the affected limb, with sensation of in- 



874 NERVES. 

ternal heat in the limb by external coolness of the skin ; worse from touch 
and motion, in evening and at night; better in the open air. 

Natr. mur., chronic cases with contraction of hamstrings ; intermittent; 
abuse of quinine. 

Nux vom., the pain is drawing, tearing, from below upwards, better 
from hot water application; constipation; during stool, great pain along the 
affected limb down into the foot ; sedentary life ; alcoholic drinks ; previous 
use of all sorts of liniments, etc. 

Plumbum, drawing, pressive pains in the sciatic nerve in the posterior 
part of the thigh, down to the knee, with difficult walking and great exhaus- 
tion after walking; tubercular diathesis, with dry, hacking cough. 

Phytol., neuralgic pain on the outer side of the thigh ; right side; press- 
ing and shooting, drawing and aching; worse from motion and pressure, and 
worse in the night; syphilitic taint. 

Pulsat., pain getting worse towards evening and in the night with in- 
clination to constantly change position; worse in warm room; better in open 
air. 

Rhus tox., the pain is attended with numbness, formication, paralytic 
stiffness of the affected limb; it is worse during rest, and when commencing 
to move; better from dry heat; it is mostly brought on by exposure to wet, 
by straining and lifting. 

Ruta, pain as if in the bones, worse in rest, must constantly be moving 
about during the paroxysm ; hamstrings feel shortened ; after injuries, con- 
tusions, etc. 

Sepia, during pregnancy, pain in paroxysms from three to five o'clock 
A.m., with considerable swelling of the veins of the affected limb ; also in 
chronic cases, when the pain localizes itself in the heel of the affected limb ; 
better during rest. 

Stilling., left side; syphilitic and gonorrhoeal origin. 

Sulphur, in chronic cases, when all other remedies fail; after the sup- 
pression of tetters. 

Tellur., worse when lying on the affected side. 

Valer., the pain is unendurable while standing, with a feeling as if the 
thigh would break off. 

Zinc, ox., pain in small of back at night, on turning in bed; feeling of 
lameness extending to hips; bruised pain especially in left lower limb, or in 
hip and knee; painful tension of muscles when moving; pulsation and buzz- 
ing in ears. (F. W. Payne.) 



DIGEST TO SCIATICA. 



875 



Digest to Sciatica. 



PAIN. 



Aching: Phytol. 
As if in the bones : Ruta. 
Bruised : Zinc. ox. 
Burning : Iris. 

, Avith anguish and restlessness: Arsen. 

Crampy : Jlenyanth. 

, with stiffness in hip and ham : 

Bellad. 
Drawing : Mercur., Mezer., Nvx vom., 

Plumbum, Phytol. 
Dragging : Aeon. 
Excruciating : Chamom. 
Formication: Arnica., Lycop., Bhustox. 
Lame feeling : Arnica, Ledum, Zinc. ox. 
Intense, changing with numbness: Gra- 

phit. 
Numbness : Aeon., Bhus tox. 
Intermittent, periodical, remittent: Arg. 

nitr., Arsen., Ferrum, Ignat., Ncitr. mur., 

Sepia. 
Irregular spells : Coffea. 
Pressive : Plumbum, Phytol. 
Shooting: Iris, Plumbum. 

, like lightning downwards : Aeon. 

Stiffness and weakness: Lycop. 

Stitching : Coffea. 

Tearing: Aeon., Caustic., Coffea, Coloe., 

Kali hydr., Mercur., Xux vom. 
Tingling: Aeon. 
Throbbing, as though joint would burst : 

Ignat. 

LOCATION AND DIRECTION. 

Right side : Calc. carb., Diosc., Kali hydr., 

Phytol., TeUur. 
Left side: Bellad., Calc. carb., Caustic, 

Stilling. 
, lower limb, or in hip and knee: 

Zinc. ox. 
Hip-joint: Ignat., Ledum, Lycop. 
Hamstrings feel shortened: Buta. 
Outer side of thigh : Phytol. 
Heel: Sepia. 
Changing locality, now in head, now in 

teeth, now in sciatic nerve : Laches. 



Down the limbs: Aeon., Graphit., Iris 

vers. 

, outer side of left limb : Caustic. 

from the small of back, keeping 

them in constant motion : Calc. carb. 
From hip down to foot: Ooloc.,Nux vom. 

to knee: Arg. nitr. 

, on posterior part : Plumbum. 

From below upwards: Ledum, Xux 

vom., Zinc. ox. 
Lame feeling extending to hips: Zinc. 



BETTER. 

During rest : Bryon., Sepia, Hepar. 
'When lying still: Coloc. 

, entirely relieved: Diosc. 

When letting limb hang down: Bellad. 
When walking: Bellad., Ferrum, Kali 

biehr., Bhus tox. 
When flexing the leg : Kali bichr. 
Constant desire to change position : 

Pulsat. 

to move the feet : Caustic., Zincum. 

Warm applications : Arsen. 
Hot water application : Nvx vom. 
Dry heat : Bhus tox. 
Wrapping up : Hepar. 
From warmth : Bellad. 
In summer: Ignat. 
In open air : Mezer., Pulsat. 
After perspiring : Bellad. 

WORSE. 
Morning and noon: Arg. nitr. 
During day only: Coloc. 
Evening and night: Mezer., Pulsat. 
Afternoon until midnight: Bellad. 
Night: Coffea, Kali hydr., Mtreur., Phy- 
tol., Zinc. ox. 

, driving out of bed : Ferrum. 

Midnight: Arsen. 

3 to 5 A.M. : Sepia. 

Getting warm : Ledum. 

In warm room : Pulsat. 

In bed : Ledum., Mercur., Kali bichr. 



876 



NERVES. 






Driving out of bed : Ferrum. 

Least draught of air: Bellad. 

Exposure to air : Hepar. 

In winter : Ignat. 

In rest : Rhus tox. 

Must change position, couch feels too 

hard : Arnica. 
Must constantly be moving: Rhus tox., 

Ruta. 
In lying on affected side: Kali hydr., 

Tellur. 
"While sitting : Bellad., Kali bichr. 
, must be careful not to press the limb: 

Coloc. 
While standing : Kali bichr. 
, thigh feels as if it would break off: 

Valer. 
When walking : Coloc. 

, fatiguing: GraphiL, Plumbum. 

When commencing to move : Rhus tox. 
From moderate, not altered by violent 

motion: Iris. 
Motion : Bryon., Diosc. 

and pressure : Coloc, Phytol. 

and touch : Bellad., Hepar, Mezer. 

On pressing at stool: Nux vom. 
On turning in bed: Zinc. ox. 

BROUGHT ON BY: 

Indignation: Coloc. 
Grief: Ignat. 

Anger or vexation: Chamom. 
During pregnancy : Sepia. 
Intermittent fever : Arsen. 
Tubercular diathesis : Plumbum. 
Spinal affections : Calc. carb. 
Syphilis: Kali hydr., Mercur., Phytol, 

Stilling. 
Suppression of tetters : Sulphur. 
Alcohol and quack medicines : Nux vom. 
Quinine : Natr. mur. 
Mercury : Hepar, Kali hydr. 
Cold, damp cellars : Arsen. 
Working in water : Calc. carb., Rhus tox. 
Straining, lifting, overexertion: Arnica, 

Rhus tox. 
Injuries, contusions: Arnica, Ruta. 



Sedentary life : Nux vom. 

ATTENDING SYMPTOMS. 

As if beside himself: Chamom. 

Weeping : Bellad., Pulsat. 

Anguish and restlessness : Arsen. 

Eyelids burn : Coloc. 

Pulsation and buzzing in ears : Zinc. ox. 

Face pale, flushing easily : Ferrum. 

Hypogastrium, lumbar region and be- 
hind sternum burning like fire : Laches. 

Constipation : Laches., Nux vom. 

and flatulence : I/ycop. 

Urine high colored, depositing red sand : 
Lycop. 

Left shoulder, pain in : Zinc. ox. 

Affected limb, paralytic, weak and wast- 
ing away : Arg. nitr. 

, paralytic stiffness : Rhus tox. 

, painful tension of muscles when 

moving: Zinc. ox. 

, lameness: Iris. 

, stiffness in hip and ham: Bellad. 

, sensation of expansion : Arg. nitr. 

—■ — , swelling of veins : Sepia. 

, contraction of hamstrings: Natr. 

mur. 

, tenderness of soles of feet : Ledum. 

Limbs are jerked upwards when sitting : 
Menyanth. 

Chilliness : Pulsat. 

and thirst : Ignat. 

and coldness general : Ledum. 

Cold feet : Aeon., Lycop. 

Cooler, affected limb, than the rest of 
body: Ledum. 

Feverish : Bellad. 

Heat without thirst : Ignat. 

, internal, in limb, and external cool- 
ness: Mezer. 

Flushes of heat : Laches. 

Sweat and thirst : Coloc. 

without relief: Mercur. 

Restlessness and sleeplessness: Arsen., 
Bellad., Coffea, Mercur. 

Cold sweat of feet: Aeon. 






ANAESTHESIA. 877 

9. Crural Neuralgia, Ischias Antica. 

Its seat is the crural nerve ; the pain is felt from the inner and lower 
portion of the thigh, down to the inner portion of the knee, the inner ankle, 
the inner portion of the foot, and the big and second toe. 

As Causes have been named : uterine swellings, especially of a cancer- 
ous nature; inflammation of the hip-joints and crural hernia. 

THERAPEUTIC HINTS.— Coffea, Phytol, Staphis. 
Compare Neuralgia and Sciatica. 

Anaesthesia. 

Anaesthesia takes place from two causes : 

1. Either from an inability of the sensory nerves to convey the external 
impressions to the central organs ; or — 

2. From an inability of the central organs to perceive external impressions. 
The first is the case, for example, where a nerve has been cut through. 

Any irritation below that cut, towards the periphery, is not perceived any 
more by the central organs; that part may be pinched, burnt, etc., but it is 
not felt. The latter may have its source in a disease of the spine or of the 
brain. In both cases the w T ant of feeliug is chiefly associated with paralysis 
of the corresponding parts. 

The degree of such anaesthesia varies from a mere numbness to torpor 
and deadness of the part. Its influence upon the vegetative functions in the 
affected parts shows itself as : decrease in natural warmth ; slowness of capil- 
lary circulation; want of perspiration; subcutaneous oedema; livid color of 
the skin ; brittleness of the nails ; ecchymosis, aud blisters filled with bloody 
serum, especially on the toes and fingers. 

Of the different forms of this affection I shall mention only the following: 

Anaesthesia of the Trigeminus. 

According to the extent to which this nerve has lost its ability to convey 
external impressions to the sensorium, we find a want of feeling in the corre- 
sponding portions of the skin and mucous membranes. The patient does not 
feel any external irritation in these parts ; when eating, knows not whether 
he holds anything in the affected side of the mouth or not; the saliva runs 
out of the mouth without his knowledge; and the glass held on his lips seems 
to him broken off where it touches the affected side. In addition, there is 
likewise found weakness of sight, loss of smell and taste. 

The reflex motions of the muscles of the face are gone, the eyelids do not 



b/5 NERVES. 

shut when the conjunctiva is touched, and the patient does not sneeze when 
the mucous membrane of his nose is irritated. Also the voluntary muscular 
motions of the affected side are more torpid, and the pupil is contracted and 
immovable. 

The seat of the affection is, accordiug to Romberg's observations, more 
towards the periphery of the fifth pair of nerves, when the ausesthesia is 
limited to some of its fibres. 

When, however, the ausesthesia affects not only the external surface of 
the face, but also the corresponding cavity of the eye, then the cause lies in 
one of the main branches of the trigeminus, either before or after its exit from 
the skull. When the anaesthesia extends over the whole ramification of the 
trigeminus, the cause of the affection then lies in the ganglion Gasseri, or im- 
mediately below it in the nerve. 

When, however, the affection is combined with disturbances of other 
cranial nerves, its seat lies in the base of the brain. A central anaesthesia 
affects crosswise, and involves at the same time other sensory and motory 
nerves of the head and body. 

Central Causes are: apoplexy, softening and tumors of the brain. 

Peripheric Causes: inflammation; softening; hardening and atrophy 
of the nerve and of the ganglion Gaeseri. Likewise the severing of the 
nerve or of one of its branches by surgical operations, or other external 
injuries, blows, wounds, etc.; or pressure upon it in consequence of tumors 
or foreign bodies, like musket balls, or fracture of the petrous portion of the 
parietal bone. 

These causes show at once all that might be said about its prognosis and 
curability. 

Just as the sensory nerves may be morbidly affected in a two-fold man- 
ner, either by an increase or a loss of their sensibility, so also are the morbid 
affections of the motory nerves of two kinds, either spasm, cramp, hyperkinesis; 
or paralysis, aklnesis — that is, increased or lost motility. 

Spasm, Convulsion, Cramp, Hyperkinesis. 

Spasms manifest themselves under different forms: 1. Either as short, 
slight jerks of certain muscles; or, 2. as violent, frequently-repeated contrac- 
tions of the same or different sets of muscles (clonic spasms) ; or, 3. as hasty 
motions which, although regular, are deficient in purpose and rhythm or are 
automatically repeated ; or, 4, as irregular, misdirected motions (in-coordi- 
nated spasms); or, 5. as trembling or tremor; or, 6. as a continuous rigidity 
of one or more sets of muscles (tonic spasms) ; and, 7. as a permanent con- 
traction of certain muscles (contractures). Their violence and extent are 
very different, and do not always correspond to the importance of their cause. 



SPASM, CONVULSION, CRAMP, HYPERKINESIA. 879 

Grave disorders in the central organs may be attended with but slight 
spasms ; whilst, vice versa, a slight reflex irritation may cause the most vio- 
lent convulsions. 

Their Causes are various : I may mention as predisposing ones, the age 
of childhood — the younger the child, the greater the predisposition. Almost 
any acute disease may be attended by spasms at the age, and frequently is 
preceded by them. Even in chills and fever, little children have spasms in- 
stead of a chill. As special forms of spasms in this early age I may mention 
eclampsia and trismus. In later years, up to the time of puberty, we find a 
predominating disposition to the different forms of chorea, stammering and 
squinting, and likewise the beginning of epilepsxj. From the time of puberty 
to middle age we find hysteria, epilepsy, eclampsia and tetanus. In still later 
years we find writing spasm and tremor. The female sex seems to be more 
disposed to spasms than the male. 

As Excitixg Causes we may mention — 

1. Mental emotions: fear, fright, anger, terror. Even the sight of con- 
vulsions has caused them in others. Epileptic fits have become epidemic in 
this way among the pupils of a whole asylum. 

2. Diseases in the central organs and their membranes, like apoplexy, 
softening, encephalitis, tumors, tubercles, inflammation of the cerebral and 
spinal membranes, and morbid processes in the bones which encase the central 
organs. 

3. Peripheric irritations of the nervous system, by strong light, tickling; 
also by wounds, blows and bruises of some organs, like the testicles or the 
uterus, or by irritation of large surfaces, like the mucous membranes — for 
example, the intestinal canal by indigestible food or worms, or the external 
skin by sudden taking cold, etc. 

4. Various conditions of the blood, such as (according to Marshall Hall) 
great loss of blood or stagnation of blood within the brain ; so, also, qualita- 
tive changes of the blood in exanthematic fevers, in pyaemia, uraemia and 
choice niia. 

5. Certain p>oisons: alcohol, narcotics, strychnine, secale, lead and 
mercury. 

The Prognosis of spasms depends entirely upon their causes. When 
they appear in consequence of organic lesions in the central organs, they are 
of a much graver nature than when in consequence of a mere peripheric 
irritation. 

Spasms which appear during the beginning or during the course of other 
diseases, like exanthematic fevers, are a sign that the disease, with which 
they are combined, is of a violent character, but are not quite so bad a sign, 
when they occur in children as in grown persons. Spasms from blood-poi- 
soning in uraemia and cholsemia are always a bad prognostic sign. 



880 NERVES. 

I shall now speak of the different forms of Spasmodic Diseases. 
1. Spasmus Facialis, Mimic Spasm of the Face. 

It affects those muscles of the face which are supplied by the seventh 
pair of nerves, either on one or both sides. 

In its clonic form it causes the most awkward appearauce of the face ; 
whilst one side looks perfectly quiet and natural, the affected side is continu- 
ally in motion, cutting all sorts of capers and jerks. The will has not the 
slightest influence over these distortions. They come on unprovoked, and 
may last a shorter or longer time. In some cases they are brought on by a 
usual effort to talk, chew, etc., disturbing these natural muscular actions 
greatly. 

The tonic spasm is different. The face appears as though, during a dis- 
tortion, it had suddenly become rigid, stiffened, so that it does not partake 
of the motions of the sound side, which manifests itself especially in laughing 
or whistling. This rigidity might give occasion to confound it with paraly- 
sis of the face. However, chin, lips and nose are drawn towards the affected 
side; the corner of the mouth of the affected side is drawn downwards, whilst 
the eyebrow is drawn upwards. The eyelids of the affected side cannot be 
perfectly closed, and the mouth not perfectly opened, thus interfering with 
talking and chewing. The muscles of the affected side are hard to the touch, 
and the patient has a feeling as if they were stretched. 

As the most frequent Cause of this complaint, may be mentioned : sud- 
denly taking cold by exposure to a sharp, piercing wind, rain or snow driven 
into the face. Likewise external injuries, especially bruises of the bones of 
the face and skull, decayed teeth, etc. Violent mental emotions, like anger 
or terror, and hysteric conditions have also been observed as causes of this 
complaint. 

THERAPEUTIC HINTS.— When caused by exposure to cold: com- 
pare Bellad., Hyosc, Mercur. 

When caused by external injuries : Arnica, Hyper. 

When caused by diseases of the bones, decayed teeth: Hepar, Mercur., 
Silic. 

When caused by anger: Nux vom. 

When caused by fright and terror: Hyosc, Ignat., Opium. 

Constant winking of the eyelids: Anac, Bellad., Stramon. 

Bisus sardonicus: compare Aeon., Alum., Anac, Asaf., Bellad., Bovista, 
Calc carb., Cicuta, Conium, Crocus, Cuprum, Hyosc, Natr. mur., Nux 
mosch., Phosphor., Platina, Ran. seel., Sepia, Stramon., Veratr., Zincum. 



CHOREA, ST. VITUS' DAXCE. 881 

2. Mogigraphia, Graphospasms, Writers' Cramp, Pianists' 

Cramp, etc. 

It commences first as a mere tired feeling of the hand, after long-con- 
tinued writing. By and by this feeling increases, and the writer has to make 
pauses frequently in order to rest the hand; lastly, it is quite impossible to 
hold the pen and to write, because, 1st, either a spasm of the extensors draws 
the fingers asunder, or, 2d, a spasm of the flexors of the first three fingers, or 
of only one of them, makes it impossible to hold the pen. Such spasms may 
be clonic or tonic. Sometimes the thumb and fingers are only slightly 
drawn together, and writing might be possible, if it were not for the strong 
trembling which attacks the hand and the whole arm up to the shoulder, as 
soon as writing is attempted. 

If writing be attempted with the other hand, it is not long before the 
same spasms attack it also. 

It is quite remarkable that all other manual acts can be easily executed, 
although in some cases cramps and tremors attend them likewise. 

Similar spasmodic affections have been observed also in the habitual per- 
formances of shoemaking, milking, playing musical instruments, setting type, 
sewing, etc. Its causes seem to be overexertion in writing, or disturbance in 
the co-ordinating apparatus. It is increased by anxiety and constant think- 
ing of it. 

The most important remedies are Bellad., Caustic, Gelsem., Ignat., 
lS~ux vom., Ruta, Secale, Silic, Stannum, Staphis., Zincum. Light and 
large penholders ought to be used. 

Chorea, St. Vitus' Dance 

Is defined now as a neurosis, the seat of which is supposed to be at times in 
the brain alone, at times in the entire nervous system; it is characterized by 
incessant inco-ordinate twitching sand jerkings of groups of muscles, either 
spontaneous in origin or excited by voluntary impulse, exclusively occurring 
in the waking state and accompanied by more or less developed psychical 
disturbance. (Von Ziemssen.) Dr. J. Lawrence Newton recognizes five 
forms: the true cerebral, the spinal, the uterine, the intestinal and rheumatic 
form. Chorea is prominently an affection of the period of bodily develop- 
ment, but is seen also : during pregnancy ; in consequence of disturbances of 
menstruation and sanguification (chlorosis, anaemia), and in frequent connec- 
tion with articular rheumatism. As Exciting Causes have frequently been 
observed: mental emotions, such as fright, or fear, etc. 

Symptoms. — 1. Involuntary motions sometimes extend to all the muscles 
which obey the will sometimes they are confined to certain groups of them, 
56 



882 NERVES. 

oftenest to the upper half of the body ; sometimes only one side is agitated, 
and in exceptional cases we find a crosswise agitation — an arm of the one, and 
the leg of the other side. Again, involuntary motions sometimes commence 
in a few muscles of the whole body. We then find the whole body in constant 
agitation, jerking, swinging, a ludicrous and sometimes pitiful sight. There 
is no interruption of these irregular motions, except during sleep, which is 
generally restless and unrefreshing ; and even then they recur, although in a 
less degree, when the patient dreams. On waking the same tumultuous 
scene commences again. 

2. The regular voluntary movements of the body are thus greatly inter- 
fered with, and at last cannot be executed at all. Dressing, writing and 
playing instruments become impossible, talking difficult, and exertions to 
overcome the difficulty have always had the contrary effect — increase of 
spasmodic action. 

3. The reflex motions, however, are not disturbed. If the patient itches 
somewhere, he can scratch himself without any trouble; so can he sneeze, 
cough and evacuate bladder and bowels, etc. 

4. All other involuntary motions of the body are perfectly free in their 
action ; there is no interference in breathing, in the pulsations of the heart, 
nor in the act of swallowing, and the peristaltic motions of the intestine are 
normal. 

5. The sensibility is in most cases normal. 

6. The mental functions, however, suffer considerably from a long dura- 
tion of the disease. The patient at length shows a loss of memory, weakness 
of mental capacity, and in some severe cases even imbecility of mind ; the 
disposition becomes fretful, irritable and peevish. 

Chorea is of a chronic nature and its duration extremely variable. It 
is apt to recur, and relapses are especially frequent after mental excitement. 
Under judicial homoeopathic treatment it is in most cases easily cured. 

THERAPEUTIC HINTS— Agar . , the spasmodic motions range from 
simple, involuntary motions and jerks of different muscles to a dancing-like 
turning of the whole body ; or attack crosswise, an upper right and a lower 
left extremity, or vice versa; frequent nictitation of the eyelids; redness of 
the inner canthus of the eyes; flow of tears from the eyes; sensitiveness of 
the lumbar vertebrae; ravenous appetite, but difficult swallowing; cervical 
glands swollen; worse during the approach of a thunder-storm. 

Ast. rub., trembling jactitation of arms and legs; unable to feed her- 
self or to walk ; frequent, clear, profuse urine ; after fright and mental de- 
pression. 

Bellad., throwing the body forward and backward in lying, a kind of 
constant changing from emprosthotonus to opisthotonus; boring the head 



CHOREA, ST. VITUS' DANCE. 883 

into the cushion ; grating of the teeth ; sore throat ; numbness in the fingers ; 
soreness of the last lumbar and the first dorsal vertebrae ; after mental ex- 
citement; fright. 

Calc. carb., sometimes only one-sided in voluntary motions ; sometimes 
amounting to falling down ; exceedingly headstrong ; period of second teeth- 
ing ; worm symptoms ; scrofulous habit ; onanism. 

Cauloph., in young girls with menstrual irregularities. 

Caustic, distortion, twisting and jerking of the limbs, even in the 
night, preventing sleep, paralysis of the tongue and the right side of the 
body; after suppressed eruption on head. 

Wm. Gross mentions a peculiar case of a young girl, who had the fol- 
lowing paroxysms : the child would lay down on her stomach, and inserting 
one of her knees into the hollow of the other knee, and drawing her feet 
upwards upon the buttocks, her body would commence jerking forward 
and backward, simulating the movements exercised during coitus; at the 
same time the muscles of her face became contorted, like risus sardonicus. 
After the attack the child was exhausted, but during the intervals she showed 
no particular symptoms; the spells were worst in the morning. 

Cimicif., chiefly on the left side only; worse during the menstrual 
period ; after suppression of the menses ; from rheumatic irritation ; frequent 
alternation of heat and cold in different parts of the body. 

Cina, the distortions often commence with a shriek, extend to the 
tongue, oesophagus and larynx, and continue even through the night ; they 
are attended with frontal headache; enlarged pupils; dark rings around the 
eyes; itching of the nose; pale, yellowish, earthy face; ravenous appetite; 
pain around the umbilicus; hard stools; turbid urine; emaciation; all point- 
ing to irritation of the intestines by worms. 

Coccul.j involuntary motions with the right arm and right leg; they 
cease during sleep; face puffed, somewhat bluish; hands look as if frozen; 
paralytic symptoms. 

Crocus, jerking in the muscles; spasmodic contractions of single sets 
of muscles; jumping, dancing, laughing, whistling; wants to kiss everybody; 
congestion of the head with bleeding of the nose ; suppressed menses. 

Cuprum, commences in one arm and spreads over the whole body, 
causing the most terrible contortions and awkward movements; inability to 
speak, or only imperfectly ; after fright. 

Hyosc, throwing about of the arms; misses what he reaches for; con- 
stant falling of the head from side to side; tottering gait; very talkative, or 
loss of speech ; laughs at everything that is told him ; smiling, silly expression 
of countenance ; after typhus. 

Ignat., especially when caused by fright or other mental excitement; 
worse after eating; better when lying on the back. 



884 NERVES. 

Lauroc, she tears her clothing; strikes at everything; spasmodic 
deglutition; indistinct articulation; she gets angry because she cannot be 
understood ; idiotic expression of the face ; cold, clammy feet up to the knees ; 
she can neither stand nor sit, nor lie down, on account of the incessant mo- 
tion ; wasting away ; after fright. 

Lil. tigr., convulsive contractions of almost all the muscles of the 
body, and a feeling as if she w T ould be crazy if she did not hold tightly upon 
herself. 

Mygale, constant jerking of head to the right side, occasionally drops 
his head suddenly on his shoulder, sometimes he twists his head around to 
the right shoulder; twitching of the muscles of back and arms; pain in 
knees when walking; in attempting to control these involuntary motions, he 
loses his breath, until he takes a deep inspiration. Twitching of muscles of 
face and upper extremities; convulsive movements of the shoulders; lower 
extremities in constant motion; drags her legs when walking; mouth and 
eyes open and shut in rapid succession. (Howard.) 

Natr. mur., chronic cases after fright or suppression of eruptions on 
the face; worse during full moon; paroxysms of jumping high up without 
taking notice of the things around him, thus hurting himself sometimes con- 
siderably ; or mere jerkings of the right side and the head. 

Nux vom., when attended with a feeling of numbness in the affected 
parts ; also after much drugging. 

Opium, twitching and trembling of head and arms; throws limbs or 
stretches arms at right angles to body; after fright. 

Phosphor., he walks like one paralytic, without noticing it himself; 
twitching of the limbs; great exhaustion; after Calc. carb. ; during second 
dentition; in general, during the period in which the body is growing. 

Secale, the morbid contractions usually commence in some muscles of 
the face and spread thence over the whole body, and increase even to danc- 
ing and jumping motions. 

Sepia, convulsive motions of the head and limbs; when talking (which 
is only a stammering), jerking of the muscles of the face; general muscular 
agitation; desire to constantly change position and place; ringworm-like 
eruptions on the skin every spring. 

Sticta, she cannot keep her feet to the ground; they jump and dance 
around in spite of her, unless held fast; when lying down, her limbs feel as 
though they were floating in the air as light as feathers. 

S tram on., the convulsive motions are often crosswise, or violent all 
over; preceded by formication in the limbs and a melancholy mood; worse 
during the equinoxes; inclination to pray; loss of memory; stammering; 
loss of speech; putting the hands to the genitals. 



HYSTERIA. 8S5 

Sulphur, in chronic cases; after suppressed eruptions; weak, faint, 
hungry spells about 10 a.m. 

Tarant., trembling of the body; all the limbs are agitated; is iu 
constant motion ; can run better than walk ; feels best in bed. Spasms sub- 
side on hearing the notes of a hornpipe; music lessens the symptoms. 

Ver. vir., most violent distortions of the body, universal, unaffected by 
sleep; lips embossed with foam; waked up by a continual champing of the 
teeth ; inability to swallow ; intense sexual excitement. 

Viscum alb., common mistletoe, is a popular remedy in England. 

Zincum, especially in those cases in which the general health suffers 
much from the disease, with great depression of spirits; worse after drinking 
wine. 

Hysteria. 

This hydra-headed complaint must be classed among the neuroses, in 
which at times part or the whole nervous system participates, without the 
presence of any apparent anatomical basis. Its most constant feature consists 
of an abnormal irritability, with neuralgic pains, and hallucinations in the 
sensory, and convulsions in the motor sphere; or the reverse, ausesthesia and 
paralysis. Although unmistakably a connection exists in many cases between 
the female genital organs and this complaint, it is nevertheless an erroneous 
assumption that hysteria is a disease exclusively peculiar to the female sex. 
However, the female sex does contribute the largest number of patients, espe- 
cially during the ages between 10 and 30 years; after the climacteric period 
its occurrence is rare. 

As important Etiological data must be mentioned : a peculiar psychical 
constitution, liable to changing emotions and little strength of will; disorders 
of the female genital organs, menstrual disturbances, non-gratification of the 
sexual appetite, or over-irritation; persistent depressing mental emotions, such 
as the sense of failure in one of the objects of life (childless women and old 
maids), love-sickness and jealousy, injured vanity and wounded pride, self- 
reproach because of secret sins, grief and anxiety, etc. ; educational influences, 
such as too great indulgence, or too great demands upon the mental capacity, 
by overburdening with lessons and overstimulating the ambition. 

The Symptoms of hysteria are exceedingly various and variable. We 
find in the sense of sight, photophobia, or dislike to particular colors, such as 
the red, or subjective light-phenomena, such as simple flashes, sparks, or more 
complicated figures, phantasms, and even visionary hallucinations; in the 
sense of hearing, oversensitiveness, or ringing, blowing, roaring, or hearing of 
voices; in the senses of smell and taste, various kinds of idiosyncrasies, such 
as aversions to different sorts of scent or taste which are not unpleasant to 



8SG NERVES. 

others, or a desire to smell asafcetida, or to devour chalk, coal and other such 
things ; in other sentient nerves, all kinds of pain and abnormal sensations, 
such as headache, tickling cough and pain in the larynx, soreness of the mouth 
and tongue, neuralgia of the mammary glands, heavy dull pain and oppres- 
sion in the chest and about the heart, cardialgias and gone feeliug in pit of 
stomach, tightness in the epigastrium, pains in the hypochondria, in the 
bowels, in the ovaries, in the womb, in the external genitals, in the bladder 
and urethra, in the coccygeal region, in the back — spinal irritation, and in 
the extremities. 

Or we find ancesthesia of the sense of touch, or in some of the limbs, or 
in a portion of them, or on one-half of the body, especially the left, or, but 
rarely, over the whole surface of the body. With the loss of cutaneous sensi- 
bility a similar loss of sensibility of the above detailed symptoms in the mus- 
cles, as Avell as in the hands and joints, may be united, and it may extend over 
the mucous membranes of eyes, nose, mouth, respiratory organs, genital organs 
and urinary passages. In the higher senses, amblyopia, amaurosis and deaf- 
ness have been observed. 

We find also spasms of various descriptions, such as globus hystericus in 
the throat, or the rising of a ball from the region of the symphysis toward the 
stomach ; spasmodic breathing, singultus, yawning, convulsive laughing or 
crying, or screaming; spasmodic retention of urine, spasm of the constrictor 
ani; local spasms in all possible sections of the muscular system of the head, 
trunk and extremities, even general convulsions, or similar to chorea and 
epilepsy. Or we find paralytic conditions of the pharynx and oesophagus 
(hindering deglutition), of the bowels (preventing a spontaneous expulsion of 
gases and feces), of the vocal cords (producing aphonia), of the bladder 
(causing retention of urine), of the extremities, either in the hemiplegic or 
paraplegic form, or crosswise, or of only one extremity, or of all four. In the 
palsied extremities a permanent contraction not unfrequently develops itself. 
Both paralysis and contraction may last for years and may be cured by all 
kinds of moral influences, or resist them all. 

We also find changes in the circulation, powerful palpitation of the heart, 
or weakness of its action, pale and cold extremities, red face and hot head, 
with perspiration; also unilateral sweating — all changing with normal con- 
ditions. 

In some cases haemorrhages have been observed from the nose, throat, 
stomach and lungs, and in rare cases from different portions of the skin 
(somatization), all mostly of a vicarious nature; salivation or its opposite, 
abnormal dryness of the mouth, occurs sometimes after hysteric fits; the hys- 
terical vomiting of large quantities of fluid seems to be in connection with a 
suppression or lessening of the renal secretion, and therefore likewise of a 
vicarious nature. The urine is often copious, clear, of low specific gravity 



HYSTERIA. 887 

(urina spastica) and frequently voided, especially after spasmodic attacks ; at 
other times its secretion is diminished and coupled with spasmodic closure of 
the neck of the bladder, so that the small quantity which exists must be re- 
moved by the catheter. Leucorrhcea has often been found to increase after 
hysterical attacks. 

The hysterical attacks themselves vary greatly in their forms, according 
as more or less a similar loss of sensibility of the above detailed symptoms 
combine in greater or less intensity. One form has been styled the hystero- 
epileptic, on account of the similarity of its convulsions to epilepsy, another 
the cataleptic, another the hysterical trance, to which some have added somnam- 
bulism, sleep-walking, magnetic sleep, hypnotism and ecstasy — an exhibition 
of elasticity of the term "hysteria" that leaves nothing to wish for and is 
truly marvelous. 

THERAPEUTIC HINTS— Being a functional disorder, hysteria is 
certainly amenable to treatment. Quite important here is the personal, 
psychic and moral influence of the physician upon his patient. The remedial 
agents are necessarily very numerous in a disease of so varied and variable a 
character. I shall, however, confine my remarks to but few characteristic 
hints of the several remedies, and refer for fuller descriptions to the chapters 
on spinal irritation, neuralgia, spasms, paralysis and uterine disorders. 

Aeon., fear to go into crowds; fear of death and predicting the hour 
of her death. 

Agar., crosswise complaints. 

Anac, forgetful, and irresistible desire to curse and swear. 

Arsen., spasmodic dyspnoea, with fear of death. 

Asaf., dryness of oesophagus ; globus hystericus. 

Au rum, melancholy; longing for death ; palpitation; alternate laugh- 
ing and crying. 

Bellad., congestions to head ; spasms; hallucinations. 

Calc. carb., fears she will lose her reason; coldness in and on head; 
cold, damp feet; palpitation after eating; chorea- like and epileptiform 
spasms. 

Caustic, paresis of upper eyelids. 

Chamom., exceedingly irritable, peevish and impatient. 

Coccul., tickling cough; choking in throat; oppression of chest; 
paralysis of tongue or pharynx. 

Conium, old maids; non-gratification of the sexual appetite; globus 
hystericus. 

Cuprum, spasmodic affections. 

Gelsem., paralytic symptoms in throat, in limbs; spasms from reflex 



888 NERVES. 

irritation; cataleptic immobility, with dilated pupils, closed eyes, but con- 
sciousness. 

Hyosc, illusions; silly expressions and silly actions; jealousy; disap- 
pointed love. 

Ignat., choking in throat and constriction of chest, with sighing- 
breathing; tickling cough which may be suppressed by an effort of will; 
feeling of goneness and gnawing in pit of stomach; grief. 

I odium, rapid failing of strength and emaciation in spite of eating 
freely. 

Laches., sensation of a lump in throat which descends on swallowing, 
but returns at once; suffocating sensation, with constant efforts to remove all 
external pressure from throat and chest; feels worse on waking; jealousy. 

Lil. tigr., hurried manner without accomplishing anything; weak, 
nervous; uterine troubles ; palpitations. 

Lycop., full and satiated; rumbling in upper left side of abdomen; 
sandy or pale urine. 

Magn. mur., fainting fits at dinner, nausea and trembling, relieved 
by eructations ; spasmodic complaints. 

Merc, sol., profuse saliva; perspiration without relief. 

Moschus, anguish and fear of death; swooning; tetanic spasms. 

Natr. mur., desire for salt; somnambulic states; pain in urethra after 
micturition. 

Nitr. ac, longing for fat, herring, chalk, lime, earth; twitchings in 
various parts ; trembling; great weakness. 

Nux mosch., inclined to laughter; drowsy; great dryness of mouth; 
leucorrhoea in place of menses. 

Nux vom., pressure and pain in pit of stomach; belching; longing for 
chalk; tendency to faint; chronic spasms, with numbness. 

Pallad., feels best in company and wants to be flattered; easily wounded 
pride. 

Phosphor., alternation of laughing and weeping; sense of weakness in 
abdomen; dry, hard stools; increased sexual desire. 

Platina, pride, haughtiness; illusions; spasms alternating with cata- 
lepsy, or with dyspnoea; sexual erethism; physical symptoms alternate with 
mental symptoms. 

Pulsat., mild, tearful, yielding, timid; peevish; changeable; loss of 
smell and taste; no appetite and no thirst; increased mucous secretion from 
different orifices. 

Sabina, irritable in temper; abortion in third month. 

Sepia, sensation of something twisting about stomach and rising to 
throat, with stiffness of tongue, speechlessness, and rigidity all over ; spasms ; 
fainting with profuse sweat; undisturbed consciousness and inability to move. 



TRISMUS AND TETANUS. 889 

Stannum, feels fainty from going down stairs; cannot sit down slowly, 
drops down ; rises without difficulty. 

Staphis., great indignation on least occasion. 

Stramon., hallucinations; desire for light ; great sensitiveness; weep- 
ing and laughing alternately ; sexual excitement. 

Sulphur, flushes of heat; heat on top of head; cold feet; sensation of 
hunger in forenoon. 

Tarant., choreic restlessness of limbs; music has a soothing influence. 

Valer., ecstasy; overexcitable, changeable disposition and ideas; jerk- 
ing, twitching, trembling. 

Veratr. alb., cold sweat on forehead and elbows. 

Zincum, fidgetiness of feet and lower extremities. 

Trismus and Tetanus 

Are characterized as tonic contractions of the voluntary muscles, alternating 
with convulsive concussions. It is seldom that the disease is at once fully 
developed. Several days before its outbreak, chilly sensations are occasion- 
ally felt, even shaking chills, and aura-like pains from the injured part of the 
body. There are at first drawing pains in the neck and stiffness in the nape 
of the neck, with some difficulty of swallowing. These symptoms increase ; 
the head becomes immovable and drawn backwards, the masseter muscles 
grow rigid, the lower jaw is set, and deglutition still more difficult, even im- 
possible. This state of things is called trismus or lockjaw. But frequently 
the tonic spasm gradually extends over all the dorsal muscles, down to the 
sacrum, and over the muscles of the chest and abdomen, so that the whole 
body becomes as hard and rigid as a piece of wood. The muscles of the ex- 
tremities are not quite so severely affected, and sometimes not at all. The 
muscles of the face are likewise less severely involved ; but still they partici- 
pate more or less. There is a peculiar tension and painful expression in 
them. The eyeballs are rigidly drawn towards the inner canthus, and during 
the convulsive exacerbations the forehead becomes corrugated; the eyebrows 
frown, the eyes stare, the lips are drawn asunder, showing the teeth; the 
tongue is thrust between the teeth, and frequently severely bitten. There is 
often risus sardonicus. This is tetanus. 

The general tonic spasm of the voluntary muscles, however, has its re- 
missions, that is, the rigidity of the muscles yields occasionally to a more re- 
laxed state, until either without any external cause, or by some external in- 
fluence under a sudden general convulsive concussion, the highest degree of 
rigidity again sets in. Sometimes these recurring concussive jerks are so vio- 
lent that the patient is thrown backwards and forwards, while in other cases 
they resemble only electric shocks. In this way the disease progresses, alter- 



890 NERVES. 

nating with rigidity, partial relaxation and convulsive concussions. The 
contractions are so violent that in most of the cases single bundles of muscu- 
lar fibres are torn and extravasation of blood takes place. The following 
forms of these spasms have been recognized : Opisthotonus, a bending of the 
body backwards, even to such a degree that the patient lies upon his heels 
and the back of his head; emprosthotonus, a bending of the body forwards; 
pleurothotonus, a bending of the body sideways; and orthotonus, being 
stretched out straight. The most frequent form is opisthotonus; all other 
forms are quite exceptional. 

As long as the spasm prevails, the will has not the slightest influence 
over the muscles. On the contrary, an effort to check the spasm only in- 
creases the rigidity of the muscles, and likewise do all reflex irritations, so 
that, as is well known, even the slightest touch, movement of the bed, or even 
a draught of air, is sufficient to instantly cause the most violent convulsive con- 
cussions. 

The respiratory action is, of course, greatly interfered with, inasmuch as 
all the respiratory muscles are involved in the affection ; where the remissions 
are of but short duration, we find dyspnoea in a high degree, and sweat, 
sometimes even danger of suffocation. 

The pulse during the remissions usually is normal, or only slightly accel- 
erated; butduring the paroxysms it may reach 180, and the heart may sud- 
denly cease acting during the attack. The temperature rises in many cases 
to 112.73° F., while in others it does not increase, or only slightly towards 
evening. 

There is great pain in the muscles during their contractions, and espe- 
cially is there a painful sense of pressure in the pit of the stomach, with ex- 
treme anxiety and excitement. 

There is usually distressing thirst, and in some cases actual hunger, 
neither of which can be satisfied; the bowels, as a rule, are constipated, and 
micturition is often impossible ; the urine has, in some cases, been found to 
contain albumen, and in others sugar. 

The skin is generally hot and covered with perspiration, as in violent 
muscular exertions, and is followed by sudamina. 

The functions of the brain seem entirely unmolested; the patient has to 
suffer all these tortures in full consciousness. 

Sleep is entirely absent, and if the patient loses himself for a moment in 
consequence of exhaustion, he is at once roused again by violent concussions. 
This is the character of all kinds of tetanus. 

Trismus or Tetanus neonatorum presents, on the whole, the same 
features; commencing at first with stiffness of the jaws and consequent in- 
ability to suck and swallow, the tonic spasms extend gradually downward 



TRISMUS AXD TETANUS. 891 

and also implicate the extremities. Signs of collapse soon appear, and recov- 
ery is still more uncommon than in cases of adults. 
The exciting Causes of tetanus are : 

1. External injuries of peripheric nerves of the extremities, face and gen- 
itals; likewise parturition and abortus. In newborn children, inflammation 
of the navel. 

2. Rheumatism in consequence of talcing cold. 

3. Lesions of inner organs: injuries of the uterus, pleuritis and hepatiza- 
tion of the lung. 

4. Poisoning by strychnine or brucine. 

An anatomical basis of this affection is not known. 

THERAPEUTIC HINTS.— Aeon., trismus and tetanus; contorted 
eyes ; face changing color, now red, now pale again ; throat feels dry and 
stiff. 

Angust., opisthotonus from external injury; tetanic pains from injured 
foot up to back and neck; jaws stiff; two weeks after a needle had been run 
in foot. " Tremulousness of the muscles of the neck in the beginning." 
(Gilchrist.) 

Arnica, after bruises; hot head, cool body; longing for alcoholic 
drinks ; internal chilliness with external heat. 

Bellad., at the commencement, when there is: extreme excitement and 
sensitiveness of the skin ; sudden jerks and shrieks during sleep ; twitching 
of the muscles of the face and limbs; squinting; inability to swallow; later: 
convulsive motions; spasmodic respiration; dilated pupils; staring, open 
eyes. Wound healed but left a dark, tender spot; foot and leg swollen. 

Calc. carb., inflamed umbilicus of infants. 

Camphora, antidote to strychnine. 

Cicuta, suddenly becoming stiff and immovable; tetanic stiffness of the 
whole body; opisthotonus; face puffed and bluish, or deadly pale and cold; 
eyes fixed, staring at one point ; foam at the mouth ; spasm of the chest, after- 
wards trembling; cannot recollect; the spasms are renewed from slightest 
touch, even from opening the door, and from loud talking. 

Cupr. ac., 6 in a case of locked jaw, and severe substernal pain, after 
removal of a large submaxillary tumor in an old man. (Gilchrist.) 

Gelsem., "irritable, cannot be spoken to; heat in head, fulness of the 
face, and cold feet." (Gilchrist.) 

Hydr. ac, "cyanotic appearance, cold; the heart beats slower and 
slower, until it almost ceases, then suddenly rises in frequency, with each 
return of the paroxysm." (R. Hughes.) "The suddenness and rapid estab- 
lishment of the attack, with opisthotonus, would seem to be pathognomonic." 
(Gilchrist.) 



892 NERVES. 

Hyper., after running a pin in right foot, pain runs up the limb through 
spine to neck and face; muscles of neck and jaw become rigid, and also the 
muscles of chest and abdomen. (W. F. Hocking.) Piercing wounds from 
pointed instruments should always be treated with Hyper, to prevent any 
untoward symptoms. (Hering.) 

Laches., peculiar tetanic look, half closed. eyes and stiffness of neck; 
partial lockjaw; rigidity and pain in muscles of back. After cutting off two 
outer phalanges of third right toe, by being run over by a carriage wheel; 
soft parts of toe looked gangrenous nine days after accident. (M. L. Sircar.) 

One week after frost-bitten toe which had ulcerated, rigors, shooting 
pains in back, opisthotonus and trismus; remission midnight till noon; after 
midnight profuse sweat and agitated sleep; throat sensitive to contact; 
swallowing fearful. (I. Heber Smith.) 

Ledum, "peripheral cases, traumatic, in which the parts become cold 
as ice, and the spasms begin in the wound." (Gilchrist.) 

Lycop., drawing of the head towards the right side, with stiffness of 
the neck, face and jaw; dizziness; heaviness in the head; weak eyes; dry 
and stuffed-up nose; dry, difficult stool; restless sleep; full of anxious 
dreams; much depressed in spirits. 

Moschus, stiffness of the body, with full consciousness; spasms in the 
abdominal muscles. 

Nux vom., intermitting fits of spasms; disturbed respiration; con- 
sciousness not disturbed ; renewal of spasms from slightest reflex irritation. 

Phytol., has caused the following symptoms: extremities stiff; hands 
firmly shut; feet extended and toes flexed ; pupils contracted; teeth clenched ; 
lips everted and firm; general muscular rigidity, opisthotonus; respiration 
difficult and oppressed; convulsive action of the muscles of the face and 
neck, followed by partial relaxation, which again was succeeded by the same 
tetanic condition. 

Platina, opisthotonus alternating with spasms, with full consciousness; 
profuse menses; overbearing, proud disposition. 

Rhus tox., in consequence of taking cold from getting wet. 

Secale, after abortus, spasms with full consciousness, afterwards great 
exhaustion ; heaviness in the head and tingling in the legs. 

Stramon., opisthotonus and trismus, with congestion to the head; red 
face; heat of the body; profuse urine; deep, snoring sleep. During the 
attack singing and declaiming. 

Ver. vir., opisthotonus. Other remedies: Amm. carb., Amyl nitr., 
Arsen., Cannab., Curare, Hyosc, Ignat., Lauroc, Nicotine, Opium, Phy- 



CATALEPSY — EPILEPSY. 893 

Catalepsy 

Is a sudden loss of all voluntary motoiy power, so quickly befalling all 
muscles that the different parts of the body remain precisely in the same po- 
sition in which the attack finds them, thus making the patient appear like a 
statue. At first the muscles are rather rigid; but they gradually grow more 
pliant, assume a waxy flexibility, so that the limbs may be brought into any 
position, in which they continue to remain. The sensibility and conscious- 
ness of the patient is usually gone; he perceives nothing and recollects noth- 
ing; whilst in other cases some sensibility seems to remain; and in still 
others, sensibility and consciousness are entirely undisturbed. The patient 
sees, hears and knows everything that is going on around him, but is per- 
fectly unable voluntarily to move a single muscle of his body; the link which 
makes the body an instrument of the soul seems broken. Such fits end in 
simple forms of the disease often quite as sudden as they come on. The 
patient draws a long breath, sighs, yawns, and acts as though he was waking 
out of a deep sleep, and goes on with his interrupted work without even 
suspecting that anything has happened to him. Such attacks sometimes 
follow others at short intervals, and they may last only a few minutes at a 
time. Graver attacks last hours and days. Skoda mentions one that lasted 
several months. 

Cataleptic spells are frequently combined with hysteria, melancholy, 
ecstasy, St. Vitus' dance, somnambulism and other nervous derangements. 
The disease is of rare occurrence and its real exciting causes seem to be 
mental agitation, anger, fright, sudden joy or fear, grief, disappointment, 
vexation, ecstasy or religious excitements, etc. 

Catalepsy is, by itself, not fatal. 

THERAPEUTIC HINTS.— If caused by anger and vexation: Cha- 
mom., Bryon. 

If caused by fright: Aeon., Bellad., Gelsem., Ignat., Opium., 

If caused by sudden joy: Coffea. 

If caused by grief: Ignat., Phosph. ac. 

If caused by jealousy : Hyosc, Laches. 

If caused by sexual erethism: Platina, Stramon. 

If caused by disappointed love: Ignat., Laches. 

If caused by religious excitement: Stramon., Sulphur and Veratr. 

Epilepsy 

Is characterized by spells of sudden loss of consciousness and motor disturb- 
ances, under the form of more or less extensive convulsions. These spells 



894 NERVES. 

recur at irregular periods in the beginning; the intervals are usually free 
from morbid symptoms ; later, however, they are marked by various mental 
and bodily disturbances. The real seat of the disease has been sought in the 
pons and medulla oblongata, although a participation of other parts is not 
denied. Constant anatomical changes are thus far unknown, yet according 
to the latest investigations, certain histological changes in the bulb of the 
medulla seem to take the lead of all the others. 

One of its most prominent Causes is a hereditary disposition, developing 
the disease usually before puberty, or not later than the twentieth year. 
Other occasional causes are : lesions of peripheral nerves, of the brain or the 
spinal cord ("reflex-epilepsy"); psychical impressions and emotions, sexual 
irregularities, digestive disturbances, overexertion and great fatigue. In short 
the list of causes is a very large and varied one, and in many instances the 
cause may be as obscure as the nature of the disease itself. 

The epileptic seizures are in about one-half of the cases preceded for a 
day or two by one or the other, or several of the following Premonitory 
Symptoms: sadness and dejection of spirits, or excitement, loquacity, irri- 
tableness, quarrelsomeness or distrust; dizziness, headache and confusion of 
the head ; dark coloration of the skin of the face and neck (rare) ; unusual 
deep sleep and general well-feeling, or restless sleep and leaden weight in 
limbs, or slight trembling; voracious appetite, bad smell from the mouth. 

The immediate prodroma or so-called aura epileptica, which must not liter- 
ally be taken only as a sensation of breath blowing upon the patient (scarcely 
ever recognized), but in the wider sense as symptoms which precede immedi- 
ately the outbreak of the fit, and which last but a short time — these immedi- 
ate prodroma are of great variety. We have a sensitive aura, consisting of 
tickling sensations, or dragging, tearing pains from the periphery (tips of 
toes or fingers) towards the head ; one-sided headache ; pains in epigastrium ; 
or loss of feeling in one extremity, or one-half of the face, taking a centri- 
fugal direction. 

A vasomotor aura consisting of: paleness, coldness and numbness of one 
extremity, commencing on the fingers and toes ; or redness in spots in various 
parts of the body; a motor aura consisting of: spasms, trembling or shaking 
motion of different groups of muscles, rumbling in the bowels, straining at 
stool and on passing w T ater, drawing up of the testicle, palpitations, etc. The 
aura of the special senses consists of: impressions of light and color, or seeing 
of corporeal figures ; hearing of sounds and voices ; sensations of disagreeable 
smell; sensations of a sweet taste. In isolated cases a profuse secretion of 
tears or perspiration, or an abundant flow of saliva has been observed. 

Of these various premonitory symptoms in the individual case, one or 
several, or none at all may be present; or the one or the other, or several of 
them may occur repeatedly, without being followed by an actual attack. 



EPILEPSY. 895 

The seizure itself is characterized by a loss of consciousness and general 
convulsions. The loss of consciousness is either sudden and complete, the 
patient being stricken down as if by lightning, without regard to attitude or 
surroundings ; or a little more gradual, tarrying a second or two, so that the 
patient can assume some recumbent position voluntarily, to save himself from 
injury by falling. 

The convulsions are, in rare cases, preceded by a short and sudden relax- 
ation of all the muscles; generally they commence with a tonic spasm, the 
extent of which is variable, attacking either the entire muscular frame, or 
one-half of the body (opisthotonus, emprosthotonus), or only some groups of 
muscles, those of face, throat and larynx — the unearthly shriek in some cases 
is caused by a laryngeal spasm — or the tonic spasm is wholly wanting, and 
the scene begins at once with clonic twitchings. During the stage of tonic 
spasm the color of the face is not in all cases alike ; in some the attack begins 
with pallor, in others with a dark redness of the face, or the color changes 
from pallor to redness. All this often lasts only a few seconds, sometimes 
from one-quarter of a minute to one minute. 

The clonic sjiasm now following, attacks almost all the voluntary muscles 
of the extremities, trunk and head, and its violence is often so great as to 
cause fractures, dislocations, breaking of teeth, deep lacerations of the tongue 
and rupture of muscles. This tumultuous state is at times interrupted by 
tonic spasms, so that the patient again becomes rigid. The face assumes a 
cyanotic color, the eyeballs protrude, and respiration is forcibly quickened, 
and at times arrested. After the lapse of from half a minute to three min- 
utes, and only in very exceptional cases still longer, the convulsions either 
stop suddenly, or wear off by degrees until the patient lies quiet, with relaxed 
muscles, in a deep coma for some minutes longer, when the turgor diminishes 
and consciousness finally and gradually returns ; or the paroxysm is immedi- 
ately followed by a deep sleep, varying from half an hour to several hours 
and longer. After consciousness is fully restored the patient feels tired, un- 
nerved, and as if bruised all over, or, in lighter cases, he may find himself 
wholly in his previous condition, and without recollection of what has hap- 
pened to him. 

The light form, Epilepsia lllitior, is characterized by loss of conscious- 
ness without any visible outward spasms, or at most accompanied only by 
fixation of the eyeball. 

The transition forms of epileptic attacks consist of spells with loss of con- 
sciousness and local spasms. 

The irregular forms of epileptic attacks are characterized by spasmodic 
symptoms of a local character with no loss of consciousness and sensation, or 
at the utmost 'with only a slight confusion and obscuration of the senses. 
Sometimes the spasms are entirely wanting, and are replaced by motions of 



896 NERVES. 

walking and running. At other times there are recurring attacks of mental 
disturbance, such as the delirium epilepticum during which an inclination sets 
in to wander about, or to use obscene language, or to act indecently or fool- 
ishly. Very serious cases amount to & furious mania, in which the patient is 
driven by an irresistible force to perform acts of violence, to annihilate every- 
thing iu his reach, to commit the most shocking murders, etc. The sufferers 
often relate afterwards that they have had hallucinations of a repulsive and 
frightful character. The average duration of this maniacal condition may 
last from two to four days ; it may pass off in a few hours. 

The epileptoid states show themselves like epilepsy, also paroxysmally, 
and constitute the principal feature of the disease, wdiile the symptoms of the 
intervals are so little pronounced that no other nervous or mental affection 
could be recognized in them. Of such the epileptic vertigo is the most fre- 
quently occurring and the best known. 

The frequency of epileptic paroxysms varies within extremely wide limits ; 
some patients have one seizure a year, others several in one day. In many 
patients the attacks occur principally during the night, with others during 
the day. So exists also a great variety in regard to the forms of the attacks. 
Some have only hard or grave attacks, others only the light ones, while still 
others have all the different forms mingled in alternation. 

The interparoxysmal condition is characterized most frequently by a weak- 
ened memory, by a depression of spirits, by gloominess, irritableness, nervous- 
ness, distrust and a disposition to get easily angered. Patients decline into 
marked hypochondria or melancholy; the physiognomy and bearing are 
altered, the lips of the patients grow thick, their features coarse, finally as- 
suming the expression of imbecility. 

In regard to Differential Diagnosis, I shall mention only its simula- 
tion. An interesting case was detected by Dr. MacDonald upon the following 
grounds; "First, Clegg was a convict, sentenced to hard labor, — this furnished 
a strong motive for feigning, and suggested suspicion; second, the occurrence 
of a paroxysm during my visit to the w 7 ard ; third, the readiness with which 
he spoke of his complaint, and called attention to the cicatrices on his face 
and head; fourth, the marked change in his facial expression when he sup- 
posed he was unobserved; fifth, during the spasms the thumbs were not closed 
within the palms, the nails were not livid, muscular rigidity could readily be 
overcome, and the hands, after being forced open, immediately closed ; sixth, 
the sphincters were not relaxed ; and, seventh, there were no ecchymoses, ex- 
travasations, or minute petechial spots observable upon forehead, throat, or 
chest. The presence or absence of pallor was not determined by observation 
in Clegg's case, nor was any value attached to the condition of the pupils." 

Prognosis. — As bad signs are to be reckoned : attacks which come in 
irregular groups; great frequency of the paroxysms; sudden attacks without 



EPILEPSY. 897 

anv premonitory symptoms ; vomiting, asphyxia, half-sided convulsions, with 
subsequent paralytic symptoms ; long-continued coma, delirium, mania, stu- 
pidity after waking up. 

More favorable signs : short attacks and long intervals between ; premon- 
itory symptoms before the attack; milder convulsions, with little embarrass- 
ment in respiration; brief or only partial loss of consciousness, and no dis- 
turbance of the health in the intervals. Still better is it, when the paroxysms 
become less frequent, shorter and milder. The outbreak of cutaneous erup- 
tions and ulcers is quite favorable. In regard to Causes, we find it unfavor- 
able when the disease is inherited, or is not cured during the age of puberty, 
or comes on in middle life, or is caused by disorganization of the brain or by 
continued peripheric irritations of the nervous system, like masturbation. 
More favorable are those cases which come on during the period of dentition, 
or are caused by disturbances in the nutritive functions, sueh as chlorosis, 
anaemia, lead or alcoholic poisining; in fact, in all cases where it is possible 
to remove the cause. 

THERAPEUTIC HINTS —Agar., nictitation of the eyelids; itching, 
burning and redness of the fingers and toes, as though they had beeu frozen; 
after fright ; suppressed eruptions. 

Amyl nitr., by inhalation. 

Arnica,' 00 "sees eyes all around him sometime before and after the 
attack ; feels sore and achy when sitting, especially when lying in bed ; upper 
chest, head and face feel flushed and hot, while extremities are cold; anxious, 
wild expression of countenance ; conscious during the whole paroxsvms." 
(J. F. Edgar.) 

Arg. nitr., in boys with old-looking face; after chewing tobacco. 
Pupils dilated a day or two before the fit. 

Arsen., preceded by a sense of warm air streaming up the spine into 
the head; vertigo; loss of consciousness and falling down. Afterwards con- 
fused and stunned. During the intervals, pressive pain in the occiput ; burn- 
ing in the spine ; sweet taste in the morning ; after eating heavy food burning 
in the stomach and bowels ; stool irregular, mostly diarrhoeic, with burning 
in the anus; also burning in the glans penis during micturition; frequent 
cramps in the calves of the legs. 

Art. vulg., when there are a number of attacks right after each other. 

Bellad., the convulsions commence in the arm; previous, and at the 
time, congestion of the head; throbbing in temples; during the attack "the 
right hand clutches at the throat;" during the intervals, peevish, angry, 
scolding, swearing; or fearful and full of anxiety; vertigo; growing dark 
before the eyes; ringing in the ears; headache, with twitching in the face; 
57 



898 NERVES. 

flushes of heat in the face; red face; enlarged pupils; jerking and starting 
in sleep. 

Bufo, after fright or onanism; attacks at night followed by some hours 
of coma; loss of consciousness and falling down; tonic and clonic spasms ; 
turgescence and distortion of face; livid face; convulsive agitation of mouth 
and eyes; bites tongue; bloody salivation; involuntary emission of urine; 
repeated shocks through the whole body ; the lower extremities are more in 
motion than the upper ones ; copious perspiration running down the face. 

Calc. ars., pain and oppression in the region of the heart before the fit. 

Calc. carb., before the attack: chewing motion with the mouth ; stretch- 
ing of the limbs; great restlessness; palpitation of the heart; sense of some- 
thing running in the arm, or from the pit of the stomach down through the 
abdomen into the feet. After the attach : headache; dizziness; sweat on the 
head; great thirst; canine hunger; vomiting and diarrhoea. During the in- 
tervals: stupid, peevish ; anxious about getting well; vertigo; headache be- 
fore breakfast; pale, puffed face; perspires easily, especially on the head; 
hardness of hearing ; eats a great deal and yet loses flesh ; thick, swollen 
belly ; too frequent and too profuse menses ; swelling of the glands about the 
neck. Causes: fright; protracted intermittent; suppression of chronic erup- 
tion. Worse during the solstice and full moon; excited by chagrin or fear; 
by drinking cold water ; by letting the legs swing when sitting. Frequently 
indicated after Sulphur. 

Cauloph., epileptiform spasms during or near the menses. 

Caustic, before the attack: imbecility of mind; heat of the head, fol- 
lowed by sweat all over ; great pressure in the pit of the stomach, extending 
all over the chest and hindering breathing. During the spell: sometimes 
bleeding of the nose; very red face; biting of the tongue; drawing the head 
towards one side; urine is passed involuntarily. Afterwards: soporous con- 
dition; headache; noise in the head ; exhaustion. During the intervals: on 
the scalp and glabella small, round, soft lumps; sweats easily on the head ; 
stoppage of the nose; tongue coated white on both sides; sour or sweetish, 
badly-tasting eructation, like ink or rotten wood; pain in the small of the 
back, and constant coldness of the shoulders and joints of the feet; great 
restlessness, which urges him to run away. Causes: suppressed itch; pro- 
tracted intermittent; softening of the brain. Worse during new moon; 
drinking cold water as soon as the pressure in the stomach commences pre- 
vents the attack. 

Chin, ars., after the attack cold perspiration, eructations and a feeling 
of such utter prostration, that the patient believes he cannot endure it long. 
(Payne.) 

Cicuta, epileptiform spasms from venous congestion of the abdomen in 
children and women. Bluish, puffed face; eyes staring upon one point; 



EPILEPSY. 899 

electric shocks; trembling; difficulty of being roused from sleep; small, 
painful ulcers on the edges of the tongue. 

Cimicif., epileptiform spasms at or near the menstrual period. 
Coccul., for women of great nervous and paralytic weakness, with 
suppressed or very painful menstruation ; vertigo with nausea. 

Cuprum, before the attack: nausea, retching and throwing up of 
phlegm; bloated abdomen; drawing sensation in the left arm; the arm is 
drawn involuntarily close to the body ; formication and tearing in the right 
hand; shuddering; gooseflesh; palpitation of the heart; or sudden shriek 
and falling down, without any premonitory signs. During the spell: the 
fingers become dead ; involuntary discharge of urine ; bluish color of the pit 
of the stomach and chest ; chest and head covered with perspiration. After 
the spell: weeping; headache; profuse discharge of a clear, watery urine; 
long trembling and shaking of the right hand; sleep. During the. intervals : 
anxiety, tendency to be frightend ; burning in the chest and abdomen, with 
chilliness of the remainder of the body ; burning and tearing in the small of 
the back; numbness of the arms. In clearly idiopathic cases, with no or- 
ganic lesions ; worse about new moon ; after mental excitement ; fright. 

Digit., when caused by excessive nightly emissions or onanism, with 
great weakness of the genital organs. 

Gelsem., epileptiform convulsions after suppressed menses, with severe 
spasm of the glottis ; epilepsy, with dull feeling in the forehead and vertex, 
and some pain and fulness in the region of the medulla oblongata before the 
attack. 

Glonoin., great congestion of the head and heart; during the spasms 
he spreads his fingers and toes asunder. 

Hyosc, before the attack: vertigo; sparks before the eyes; ringing in 
the ears; gnawing and sensation of hunger in the pit of the stomach. Dur- 
ing the spell: purple, bluish face; projecting eyes; shrieks; grating of teeth ; 
foaming; discharge of urine. After the spell: soporous condition, snoring. 
During the intervals: tearing and beating in the right eye, which weeps and 
seems protruded; constipation. Causes: jealousy; disappointed love; grief. 
The attempt to swallow fluids renews the attack. 

Hyper., epileptiform spasms, always after striking the body against 
anything. 

Ignat., epilepsy caused by fright and suppressed grief; especially suit- 
able for children. 

Indigo, before attacks: furious, excitable, easily angered; between the 
attacks: exceedingly melancholic and timid, or gloomy. (L. M. Ken yon.) 

Ipec, epileptiform spasms, with shrieks; opisthotonus; pale, puffed 
face and gastric derangements. 

Laches., the patient goes to sleep before an attack, and then is seized 



900 NERVES. 

with a spasm; creeping sensation from nape of neck down the spinal column; 
giddiness; headache; peculiar feeling in throat; bloated stomach and bowels; 
cold feet. In those cases which are caused by onanism, or are in connection 
with a morbid excitement of the sexual organs ; fluor albus ; frequent emis- 
sion of semen; also after jealousy. 

Nux vom., painful spot in the abdomen in the region of the solar 
plexus ; pressure upon this spot renews the attack ; during interval, consti- 
pation; headache every morning; no appetite for breakfast and nausea after 
eating. 

CEnanth. croc, recommended by Drs. Davidson and Oehme. 

Opium, nightly attacks; combined with mental derangements; after 
the attack long, soporous sleep. 

Plumbum, heaviness and numbness of the legs before the spell; 
swollen tongue; afterwards: long-continued stupid feeling in the head, and 
want of clear consciousness. 

Pulsat., fits before menses; swelling of abdomen before menses; mensem 
too light and scanty; headache principally over right eye; sensation of a 
lump rising in throat, which causes nausea while eating. (G. W. Cox.) 

Secale, shows toxicologic effects, which hint strongly to it, but its 
sphere of action has not yet been defined. 

Sepia, fits every two, three weeks, usually in the morning; before 
staring of eyes, turning of head towards left side, sense as of floating in the 
air, loss of consciousness. Several days before attack: noises in head and 
hardness of hearing and deep sleep. During pregnancy no attacks, but after 
confinement worse. During intervals flushes of heat, bodily restlessness, must 
move about. Sultry weather unbearable, also foggy. Before menses cutting 
pain in bowels, dryness of skin. Sepia* one dose, every seventh evening ; 
better. Later, Pulsat.* Cuprum*. Lastly, Sepia 200, better. From Oct. 
26th, 1876, to Nov. 26th, 1877. (Kunkel.) (Allgem. Horn. Zeitg., March 
28th, 1882.) 

Silic, before the attack: feeling of great coldness of the left side of the 
body; shaking of the left arm; slumber, with starting. The spasms spread, 
undulating from the solar plexus up towards the brain ; violent screaming; 
groaning; tears drop out of the eyes; foam at the mouth. Afterwards: warm 
perspiration; slumber; paralysis of the right side ; for scrofulo-rachitic indi- 
viduals; during sleep at night; worse about new moon. 

Stannum, is recommended as one of the most important remedies, with- 
out particular indications; except that its sphere of action is said to have a 
strong bearing upon the genital organs of both sexes. 

Stramon., epileptiform spasms; thrusting the head continually in 
quick succession to the right ; continued rotatory motion with the left arm ; 



DIGEST TO EPILEPSY 



901 



pain in the pit of the stomach ; obstinate constipation ; deep, snoring sleep ; 
low-spirited ; fear of death ; desire to be alone. 

Sulphur, before the spell: crawling and running as of a mouse down 
the back and arms; or a sudden feeling as if-a mouse were running from the 
right foot up the leg to the right side of the abdomen. After the attack, 
which consists of various convulsive motions, he wipes the tears from his eyes; 
soporous sleep ; great exhaustion ; jerkings in arms and about the mouth in 
cold air. Chronic cases always of psoric taint ; suppressed itch. 

Tarant., during attack squinting of eyes which remain open; after- 
wards dejection and dizziness for twenty-four hours. 

Ver. vir. and Zizia are likewise recommended. 

Bromide of Ammonium (Kitchen), Bromide of Potassium (old school), 
Cyanide of Potassium (J. Dufty). 



Digest to Epilepsy, 



BEFORE THE ATTACK. 

Loss of consciousness : Arsen. 

Imbecility of mind : Caustic. 

Furious, excitable, easily angered: In- 
digo. 

Some time before sees eyes all around 
him: Arnica. 

Sense of floating in the air: Sepia. 

Vertigo : Arsen., Hyosc, Laches. 

Headache: Laches. 

Dull feeling in forehead and vertex, pain 
and fulness in region of medulla: Gel- 
sem . 

Throbbing in temples, congestion : Bel- 
lad. 

Feeling of warm air streaming up the 
spine into head : Arsen. 

Heat of head, followed by sweat all 
over: Caustic. 

Several days before, noises in head: 
Sepia. 

Turning head towards left side : Sepia. 



Dilated pupils a day or two before : Arg. 
nitr. 

Staring eyes : Sepia. 

Sparks before eyes: Hyosc. 

Hardness of hearing several days be- 
fore : Sepia. 

Ringing in ears : Hyosc. 



Chewing motion with the mouth: Calc. 

carb. 
Swollen tongue : Plumbum. 
Nausea, retching, throwing up of phlegm: 

Cuprum. 
Peculiar feeling in throat : Laches. 
Gnawing and sensation of hunger in pit 

of stomach: Hyosc. 
Pressure in pit of stomach, extending 

over chest and hindering breathing : 

Caustic. 
Bloated stomach and bowels: Cuprum, 

Laches. 
Pain and oppression in .region of heart: 

Calc. ars. 
Palpitation of heart : Calc. carb., Cup- 



Shaking of left arm: Siiic. 

Drawing of left arm, which is drawn 

close to the body: Cuprum. 
Formication and tearing in right hand : 

Cuprum. 
Heaviness and numbness of legs: Pium- 

bum. 
Stretching of limbs: Calc. carb. 
Sense of something running in the arm, 

or from the pit of the stomach down 

through the abdomen into the feet : Calc. 

carb. 



902 



NERVES. 



Crawling and running as of a mouse 
down the back and arms ; or a sudden 
feeling as if a mouse were running from 
the right foot up the leg to the right 
side of the abdomen : Sulphur. 

Creeping sensation from nape of neck 
down to spinal column: Laches. 



Slumbering with starting: Silic. 

Deep sleep : Sepia. 

Goes to sleep and then is seized with a 

fit: Laches. 
Cold feeling of the left side of body: 

Silic. 
Cold feet : Laches. 
Shuddering, gooseflesh : Cuprum. 



Great restlessness : Gale. carb. 

DURING THE ATTACK. 

Conscious: Arnica. 

Loss of consciousness : Sepia. 

and falling down : JBufo. 

Shrieks: Ilyosc, Ipec. 

Sudden shriek and falling, without pre- 
monitory signs : Cuprum. 

Groaning: Silic. 

Congestion to head and heart : Glonoin. 

Drawing head towards one side: Caustic. 

Thrusting head in quick succession to 
the right: Stramon. 

Undulation from solar plexus up to 
brain : Silic. 

Head and chest covered with perspira- 
tion: Cuprum. 



Eyes projecting : Hyosc. 

staring upon one point: Cicuta. 

open and squinting : Tarant. 

and mouth convulsively moved: 

Bufo. 

, tears drop out of: Silic. 

Nose bleeding: Caustic. 

Face bluish, purple : Cicuta, Hyosc. 

distorted : Bufo. 

livid : Bufo. 

pale : Ipec. 

puffed : Cicuta, Ipec. 

very red : Caustic. 

turgescent : Bufo. 



Copious perspiration running down 

the face: Bufo. 
Mouth and eyes convulsed : Bufo. 

, foaming at the : Hyosc, Silic. 

, bloody salivation: Bufo. 

Grating of teeth : Hyosc. 
Biting tongue : Bufo, Caustic. 
Spasms of the glottis : Gelsem. 



Gastric derangements : Ipec. 

Bluish color of pit of stomach and chest: 

Cuprum. 
Urine, involuntary emission of: Bufo, 

Caustic, Cuprum, Hyosc. 



Left arm, rotatory motion with : Stramon. 

Right hand clutches at the throat : Bel- 
lad. 

Fingers become dead : Cuprum. 

and toes are spread asunder: Glonoin. 

Convulsions commence in the arm : Bel- 
lad. 

Tonic and clonic spasms : Bufo. 

Lower extremeties are more in motion 
than the upper : Bufo. 

Opisthotonus: Ipec 

Shocks through whole body: Bufo. 

Electric shocks ; trembling : Cicuta. 

AFTER THE ATTACK. 

Stupid and want of clear consciousness : 

Plumbum. 
Confused and stunned: Arsen. 
Sees eyes all around him : Arnica. 
Weeping : Cuprum. 
Dejected and dizzy for twenty-four 

hours: Tarant. 
Dizziness : Calc. carb. 
Headache : Calc. carb., Caustic, Cuprum. 
Sweat on the head : Calc. carb. 
Wipes tears from his eyes : Sulphur. 



Great thirst and canine hunger: Calc. 

carb. 
Eructations : Chin. ars. 
Vomiting and diarrhoea: Calc carb. 
Frofuse discharge of clear, watery 

urine: Cuprum. 
Long trembling and shaking of right 

hand: Cuprum. 



DIGEST TO EPILEPSY. 



903 



Paralysis of right side: Silic. 
Sleep : Cuprum. 
Slumber: Silic. 

Soporous sleep : Caustic, Opium, Sul- 
phur. 

and snoring : Hyosc. 

Coma: Bufo. 



Cold perspiration : Chin. ars. 
Warm perspiration : Silic. 
Exhaustion : Caustic, Sulphur. 
Utter prostration : Chin. ars. 

DURING THE INTERVALS. 

Stupid, peevish : Calc carb. 
Desire to be alone: Stramon. 
Low-spirited: Stramon. 
Melancholy, timid, gloomy: Indigo. 
Anxious, wild expression : Arnica. 

about getting well : Cdc carb. 

Anxiety, easily frightened : Cuprum. 

, or fearful : Bellad. 

Fear of death : Stramon. 
Peevish, angry, scolding, swearing: Bel- 
lid. 
Mental derangements : Opium. 



Vertigo : Bellad., Calc carb. 

with nausea: Coccul. 

Headache before breakfast : Calc carb. 

every morning: Xux vom. 

over right eye: Pulsat. 

, occiput pressive: Arsen. 

, with twitching in the face: Bellad. 

Head, face, upper chest hot and flushed: 

Arnica. 

perspires easily: Cole carb., Caustic 

On scalp and glabella, small, round, soft 

lumps: Caustic 



Tearing and beating in right eye, which 

weeps and seems protruded : Hyosc 
Pupils enlarged : Bellad. 
Glowing dark before eyes: Bellad. 
Nictitation of lids: Agar. 
Ringing in ears: Bellad. 
Hardness of hearing: Gale. carb. 
Stoppage of the nose: Caustic 
Face Hushed, hot, red: Bellad. 



Face pale, puffed : Cdc. carb. 

, in boys, old-looking: Arg. nitr. 

, jerkings about mouth and in arms in 

cold air: Sulphur. 



Tongue coated white on both sides: 

Caustic 
, small painful ulcers on edges of: 

Cicuta. 
Taste, sweet in the morning: Arsen. 
Glands about neck swollen: Calc. carb. 
Lump rising in throat, causing nausea 

Avhile eating: Pulsat. 
No appetite for breakfast and nausea 

after eating: Nux vom. 
Eats a great deal and yet loses flesh : Calc 

carb. 
Eructations, sour or sweetish, badly 

tasting, like ink or rotten wood: Caustic 



Pain in pit of stomach: Stramon. 

Burning in stomach and bowels after 
eating heavy food : Arsen. 

Constipation : Hyosc, Nux vom., Stra- 
mon. 

Irregular, mostly diarrhceic stool, with 
burning in anus: Arsen. 

Painful spot in region of solar plexus; 
pressure on this spot renews the attack: 
Xux vom. 

Burning in abdomen and chest, with 
chilliness of remaining body: Cuprum. 

Thick, swollen bellv : Calc carb. 



dans 



penis 



during: mic- 



Burning in the 

turition: Arsen. 
Frequent emissions of semen: Laches. 
Menses too light and scanty: Pulsat. 

too frequent and profuse: Calc carb. 

suppressed and painful: Coccul. 

Before menses, swelling of abdomen ; 

Pulsat. 

, cutting pain in bowels: Sepia. 

Fluor albus : Laches. 



Spine, burning in: Arsen. 
Small of back, burning and tearing in 
Cuprum. 

, pain in : Caustic 



904 



NERVES. 



Arms, numbness of: Cuprum. 

Itching, burning and redness of fingers 

and toes, as though they had been fro- 
zen: Agar. 
Frequent cramps in calves: Arsen. 
Sore and achy when sitting or lying: 

Arnica. 
Chilliness of body, with burning in chest 

and abdomen: Cuprum. 
Coldness of shoulders and joints of feet : 

Caustic. 

of extremities : Arnica. 

Heat, flushes of, head, face and upper 

chest: Arnica. 

, in flushes: Sepia. 

Sweats easily about head: Calc. carb , 

Caustic. 
Dryness of skin : Sepia. 



Sleep, snoring: Stramon. 

, difficult of being roused from : Ci- 

cuta. 

, jerking and starting in : Bellad. 

Restlessness, must move about : Sepia. 

, urges him to run away: Caustic. 

Sultry, foggy weather unbearable: Sipia. 
Paralytic weakness: Coccul. 

ATTACKS PREVENTED BY: 
Drinking cold ■water as soon as the 

pressure in the stomach commences: 

Caustic. 
Pregnancy: Sepia. 

ATTACKS WORSE OR EX- 
CITED. 

Several right after each other : Art. vulg. 
Every two or three weeks, usually in 

the morning : Sepia. 
In the night: Bufo, Opium. 
, during sleep : Silic. 



During new moon: Caustic, Cuprum, 
Silic. 

During solstice and full moon: Calc. 
carb. 

After mental excitement : Cuprum. 

fright: Cuprum. 

chagrin or fear: Calc. carb. 

Drinking cold water: Calc. carb. 

Attempt to swallow fluids : Hyosc. 

Pressure upon a painful spot in the re- 
gion of the solar plexus : Nux vom. 

Striking the body against anything: 
Hyper. 

Letting the legs swing when sitting: 
Calc. carb. 

At or near the menses : Cxuloph., Cimic. 

After confinement : Sepia. 

Suitable for children : Ignat. 

scrofulo-rachitic individuals: 

Silic. 

psoric taint : Sulphur. 

ATTACKS CAUSED BY: 

Fright : Agar., Bufo, Calc. carb., Ignat. 

Grief: Hyosc, Ignat. 

Jealousy : Hyosc, Laches. 

Disappointed love : Hyosc. 

Softening of brain : Caustic 

Chewing tobacco : Arg. nitr. 

Venous congestion of abdomen in 
women and children: Cicuta. 

Onanism : Bufo, Digit., Laches. 

Symptoms of genital organs of both 
sexes: Stannum. 

Suppressed menses : Coccul., Gekem. 

Protracted intermittent: Calc. carb., Cau- 
stic 

Suppressed eruptions: Agar., Calc. carb., 
Caustic, Sulphur. 

Calc. carb. is frequently indicated after 

Sulphur. 



Eclampsia Acuta. 

This is an afFecticm entirely analogous in its external symptoms to epi- 
lepsy — sudden loss of consciousness, frequently setting in with a shriek ; tonic 
and subsequently clonic convulsions, winch are followed by a comatose sleep. 



ECLAMPSIA ACUTA. 905 

•But it is entirely different from epilepsy, in that it always accompanies some 
other morbid derangement, with the course of which it either ceases, or 
ends fatally. 

Nothnagel, on the contrary, confines Eclampsia to such cases of epilepti- 
form spasms, "which, independently of positive organic diseases, present 
themselves as an independent acute malady, and in w T hich the same processes 
arise, generally in the way of reflex excitement, and the same mechanism in 
the establishment of the paroxysms, comes into play as in the epileptic 
seizure itself." 

1. Eclampsia Gravidarum et Parturientium, Puerperal Convulsions. 

Its occurrence is rather rare — one in about five hundred pregnancies, 
and perhaps less than that. During pregnancy it is of a very rare occurrence, 
and even then is scarcely ever noticed before the sixth month. It occurs 
most frequently during the act of parturition, seldom during the lying-in 
period. Primiparse are most subjected to it, and it sets in mostly during the 
dilatation of the os uteri, or immediately after the expulsion of the child. 
According to Frerichs, it has been observed that such women suffer frequently 
with albuminuria during pregnancy, though this is not invariably the case. 
During the lying-in time these convulsions are generally the commencement 
of inflammation of the womb. The attack itself is characterized by the same 
convulsive features as are described under epilepsy. When setting in during 
pregnancy, these convulsions generally cause contractions of the womb and 
abortus ; when at the beginning of labor-pains, they frequently retard the 
natural progress; but when towards the end of parturition, they are apt to 
hasten the expulsion of the foetus. After the birth of the child the contrac- 
tions of the womb generally cease; and this may give rise to haemorrhages, 
retention of the placenta and inflammatory processes of the womb. The 
convulsions themselves may continue for hours afterwards, though they are 
mostly of less intensity. The influence upon the child is, according to Scan- 
zoni, not necessarily fatal; about one-half of them are said to die. The later 
the convulsions begin the greater is the chance for the child, and vice versa. 
The Prognosis is doubtful ; the earlier they commence the more so. 

THERAPEUTIC HINTS— As albuminuria is frequently a fore- 
runner of this terrible complaint, the patient ought to be carefully treated 
during pregnancy. Compare Albuminuria. 

Atrop. sulph. (Szoutagh.) 

Bellad., deep red face; enlarged pupils; screaming; jerking and 
general convulsions; all which are signs of cerebral congestion. 

Chin, sulph., albuminuria; tetanic spasms with loss of consciousness 



906 NERVES. 

during parturition and afterwards ; swollen veins on the head and neck ; 
pulse frequent, intermittent and weak. 

Cuprum, during the lying-in time; sour-smelling sweat; miliary erup- 
tion; anxiety; easily frightened; heaviness of the head; soreness of the 
abdomen to pressure; burning in the small of the back; numbness of the 
arms. "Spasms commence with cramps in fingers and toes; hands and feet 
turn outward." (Gwynn.) 

Gels em., during pregnancy, and where there is an anaemic condition 
present; protracted labor; rigid os uteri. 

Hyosc., cold perspiration; pale face; suffocating spells and convul- 
sions during parturition; facial muscles greatly agitated. 

Ignat., twitching of muscles of mouth and eyes; wild expression; eyes 
upturned; constantly attempting to pull her hair; laughing and crying; 
nervous, excitable. (I. D. Johnson.) 

Laches., the convulsions commence upon the left side of face, and con- 
tinue longer and are more severe about the neck and throat than elsewhere. 
(Minton.) 

Opium, during parturition; cessation of labor-pains; coma; retention 
of stool and urine ; after a fright. 

Platina, after parturition ; profuse haemorrhage ; yawning; convulsions. 

Stramon., excited, scolding, striking, spitting, crying and laughing; 
face flushed, pupils dilated, in great terror. Spasms ; writhing and floun- 
dering in manifold gyrations; every muscle in play. (O. P. Baer.) 

Ver. vir., during parturition; also after blood-letting, during the puer- 
peral convulsions, causing furious delirium ; cold, clammy perspiration ; 
turgid and livid face; hideous expression of countenance; great activity of 
arterial system. 

Also compare the hints under the head of Epilepsy. 

2. Eclampsia Infantum, Convulsions of Children. 

By this term is understood convulsions of children, during which they 
lose their consciousness more or less completely, which come on in spells, run 
an acute course and are generally connected with some other morbid process. 
There exists no stricter definition as yet. 

Eclampsia attacks by preference boys during the first years — stout as 
well as sickly — especially during dentition. It often breaks forth at the 
commencement of exanthematic fevers, also instead of the chill in intermittent 
fever; succeeds a sudden fright of the mother in the event of her suckling 
the child immediately. It may be caused by fright, fear of punishment, 
strong light, tickling, or violent pain; intestinal irritations from worms, in- 
digestible food, such as raisins, cakes, the pulp of oranges, etc. These con- 



ECLAMPSIA INFANTUM. 907 

vulsions are characterized by loss of consciousness ; spasms all over ; conges- 
tion of the head ; cyanotic appearance of the face, or, in anaemic children, 
paleness of the face; snoring; rattling breathing; sometimes vomiting or 
involuntary discharge of urine and feces. They sometimes follow each other 
in rapid succession, and may terminate life unexpectedly in consequence of 
asphyxia ; as a rule, however, they yield readily to the appropriate homoeo- 
pathic remedy. 

THERAPEUTIC HINTS— Aeon., great restlessness; high fever; 
dry skin, after fright; from irritation of seat-worms; from taking cold; in 
consequence of inflammatory affections of the spine ; during teething. 

Apis, shrieking; boring the head into the pillows; inflammatory affec- 
tions of the brain. 

Arsen., spasms, preceded by burning heat of the whole body, with 
constant licking of the dry, cracked lips; wants to drink constantly, but 
little at a time; is hasty in all its motions; grasps the tumbler or anything 
it wants eagerly ; is very restless, with anxious expression of the face. 

Bellad., glowing red, as well as a pale face, w T ith enlarged pupils; 
great heat in the head ; great vascular erethism ; drowsiness, with inability 
to sleep; starting and jerking during sleep; grating of teeth; especially 
during dentition ; scrofulous diathesis. 

Calc. carb., the anterior fontanelle remains wide open; glandular swell- 
ings about the neck ; teething process is either very slow or else too rapid ; 
much perspiration about the head; greatly inclined to take cold; hard, swol- 
len abdomen; rather inclined to looseness of the bowels; often indicated 
after Bellad. ; one of the most important remedies during dentition ; scrofu- 
lous diathesis. 

Camphora, anaemic subjects; coldness of the whole body. 

Chamom., one cheek is red, the other pale; hot perspiration on the 
head, especially on the hairy portion ; great thirst ; bloated bowels ; colicky 
pains; greenish discharges; sour vomiting; constant moaning and groaning ; 
restlessness; the child wants to be carried about all the time. During sleep 
a suspicious working of the muscles of the face, as if smiling ; during denti- 
tion ; also, after nursing the breast of a woman laboring under the effects of 
a recent fit of passion. 

Cicuta, especially when the child, without any premonitory signs, be- 
comes suddenly stiff, w T ith his eyes fixed upon one point; also in violent 
spasms of the head and the upper portion of the body ; with bluish and 
puffed face ; also in convulsions from worms. 

Cuprum, in anaemic conditions; shrill cries during the attack; drowsy 
and stupid condition during the intervals, with nausea and vomiting of slime; 
bloated abdomen, with involuntary, thin discharges from the bowels; also 



908 NERVES. 

when the child loses its breath from crying, and draws its feet spasmodically 
upwards and backwards upon the nates. 

Cypripedium pub., in the premonitory stage, when there is a morbid 
irritability of the brain, in consequence of which the child is very excitable, 
laughs and plays at unwonted hours; is very wakeful and laughs even in 
sleep. 

Gelsem., during dentition, with sudden loud outcries; feverishness. 

Hyosc, congestion of the head; bloated and dark face; protruding 
eyes; shrieks; foam at the mouth; involuntary discharges of urine; from 
fright or fear. 

Ignat., violent convulsions; often tonic spasms predominant; nervous 
temperament ; during dentition ; during the commencement of exanthematic 
fevers ; after fright, or when children have been punished and go to sleep 
soon afterwards. 

Ipec, pale face; nausea; vomiting; almost always when caused by 
eating indigestible food ; raisins, pound-cake, the pulp of an orange, etc. ; or 
when the eruption of an exanthematic fever strikes in by taking cold. 

Melilot., during dentition with great congestion to the head. (Bo wen.) 

Opium, trembling of the whole body, convulsive motions of the ex- 
tremities; soporous condition with snoring; retention of stool and urine; 
after a fright ; or from nursing soon after a sudden fright of the mother. 

Platina, in anaemic subjects ; tonic spasms without loss of consciousness ; 
trismus; pale, sunken face; after the spell the child lies on its back, draws 
up its limbs and spreads its knees. 

Stannum, renewal of convulsions with the cutting of every tooth; also 
in consequence of worms. 

Stramon., congestion of the head ; heat all over the body; red face; 
spasmodic thrusting of the head in all directions ; profuse urine ; deep, snor- 
ing sleep. 

Sulphur, often when all other remedies fail ; after suppression of erup- 
tions; diarrhoea in the morning; during the eruptive state of scarlatina. 

Ver. vir., convulsions with opisthotonus; anaemic subjects in conse- 
quence of diarrhoea. 

Zincum, screaming and starting in sleep ; anxious look when getting 
awake ; heat of the body and nightly restlessness ; twitching and jerking of 
different muscles, more on the right side than on the left; irritable mood; 
great appetite ; bloated abdomen ; involuntary discharge of urine. Accord- 
ing to Kafka, during dentition in children with pale blood. 



TREMOR, TREMBLING. • 909 



Tremor, Trembling. 

This affection is of very frequent occurrence, and of various forms. 
Sometimes the head trembles, while the motions of the arms go on normally. 
Some persons tremble during rest as well asAvhen in motion; others, only 
during rest; a majority, however, during motion. Duriug sleep all trembling 
ceases; also frequently when in a horizontal position, or in a position in 
which the trembling extremity rests firmly upon support elsewhere. Keflex 
motions are performed sometimes tremblingly, sometimes normally, while all 
automatic motions almost always remain undisturbed. Exertion of the will 
sometimes aggravates, sometimes masters the tremor ; and during intense in- 
terest upon a subject it may cease entirely. Trembling may be partial, con- 
fined to the upper extremities, or extend over all the muscles, so that even 
the muscles of the face and jaws are involved. It is mostly of a transient 
character; sometimes part and parcel of a disease; sometimes, however, it 
becomes habitual, chronic, life-long. In children, it is found only occasion- 
ally, never of long duration. Old age is especially subject to it (tremor sen- 
ilis). We find it likewise more amongst women than men. Brain and spinal 
diseases (softening and atrophy) are mostly attended by it. 

It is brought on especially by the vapors of mercury ; lead-poisoning ; 
opium-eating, and abuse of alcoholic drinks, and tobacco. It may be the re- 
sult of typhus, and an effect of sexual excesses. Temporarily it may be 
caused by mental excitements, overexertions of the muscles, too much coffee 
or tea-drinking, and too low a temperature. To the latter corresponds the 
trembling during the chilly stage of intermittens. Likewise we find trem- 
bling easily excited after being tired out, mentally depressed, or exhausted 
in any way; and therefore it is frequently found during convalescence, after 
epileptic fits, catalepsy, neuralgia, and during the periods of menstruation 
and lactation. 

The mercurial tremor greatly resembles paralysis agitans (of which next), 
in its extent, its secondary paresis and the accompanying cerebral and psychi- 
cal symptoms. The lead tremor is, as a rule, limited to the upper extremities 
and some facial muscles (orbicularis, levator anguli oris), and is accompanied 
by numerous other symptoms of lead-poisoning. The alcohol tremor usually 
begins in the hands, from whence it may spread all over the body; it is worst 
in the morning during fasting, and alleviated by the use of spirits. The 
opium tremor is always associated with other opium symptoms, such as con- 
tracted pupils, constipation, etc.; and the nicotine tremor most frequently 
attacks only one side, or at least one side more than the other, and is gener- 
ally accompanied with various nervous disturbances such as muscular weak- 
ness, dizziness, neuralgia, myosis, etc. 



910 NERVES. 

THERAPEUTIC HINTS —Compare multiple sclerosis, paralysis 
agitans. 

Mercurial tremor: Carb. veg., China, Hepar, Laches., Nitr. ac, Sul- 
phur, etc. 

Lead tremor: Alum., Bellad., Hepar, Nux vom., Opium, Platina, Stra- 
mon, etc. 

Alcohol tremor: Arsen., Ipec, Nux vom., etc. 

Opium tremor: Bellad., Chamom., Ipec, Mercur., Nux vom., etc. 

Nicotine tremor: Arsen., Chamom., Coccul., Cuprum, Ignat., Nux vom., 
etc. 

Other tremors: Calc. carb., Cicuta, Mercur., Opium, Plumbum, Platina, 
Pulsat., Rhus tox., Stramon., Sulphur. 

The feeling of internal trembling: Calc. carb., Iodium, Rhus tox., 
Staphis. 

Paralysis Agitans, Shaking Palsy, 

Consists of a gradually increasing motor weakness and a trembling in the 
voluntary muscles of the body, the latter preceding the paralytic symptoms. 
In its external manifestation it appears as a tremor of high degree ; but dif- 
fers from it by its constantly increasing intensity, and by its liability to ter- 
minate in paralysis and death. 

It commences lightly, as a feeling of weakness, with slight trembling of 
the upper extremities or of the head. The patient is still able to execute all 
voluntary motions, and the trembling at first is not constant and may be 
mastered by the influence of the will. In some cases the tremor is limited to 
only one-half of the body, but in others it increases in intensity and becomes 
a perfect shaking of the whole body, by which even the bed upon which the 
patient rests is set in motion. In general the trembling is independent of 
voluntary or passive movements, and by this it is distinguished from chorea 
and from the trembling in disseminated sclerosis of the nervous centres. 

Sleep, and easy position, which at first will stop the shaking, eventually 
lose this effect ; and the skin of the patient becomes sore in different places 
from the friction occasioned by the continued shaking, which the patient is 
unable to control. There are, however, more or less frequent spells of remis- 
sion. In some cases the patient has an irresistible desire to run, either for- 
wards or backwards, which at first he can resist to a certain degree, succeed- 
ing in making some uncertain steps on his toes; but at once he falls into a 
hasty run, until he regains control over these involuntary motions. At 
length, however, he cannot walk at all, but must be held back from these 
pitching forward or backward motions. 

To all this are gradually added: general exhaustion, great sensitiveness 



911 

of the whole body, paralysis of the voluntary muscles, difficult deglutition, 
relaxation of the sphincters, with involuntary discharge of feces and urine, 
bed-sores, until, attended by the loss of mental capacity and delirium, death 
relieves the patient. 

Its Causes are obscure. It is said to have followed the taking of cold 
and after mental excitements ; and its seat is supposed to be in the pons and 
upper part of the medulla oblongata, although other autopsies do not sustain 
this supposition ; thus far its anatomical basis is undecided. 

The Prognosis is unfavorable. 

THERAPEUTIC HINTS.— Compare Arsen., Bar. carb., Caustic, 
Lycop., Mercur., Phosph. ac, Rhus tox., Stramon., Tarant., Zincum. 

Paralysis, Akinesis, 

Is an abolition of the faculty of exciting the normal function of the motor 
nervous apparatus and the muscles. A mere diminution of voluntary mova- 
bleness, attended with a sense of fatigue, is termed Paresis. The latter may 
gradually pass into paralysis. 
Paralysis may arise: 

1. From destruction of functional incapacity of those parts of the 
cerebrum, or of the ganglia at the base of the brain, or of the cerebellum, in 
which volitional impulses are probably converted into motor excitations 
(central paralyses). 

2. From diminution or abolition of the conductivity of the motor nerves 
on any place of their course, from their origin in the brain and spine to their 
terminations {paralyses of conduction). 

3. From abolition of excitability and contractibility of the muscles 
{myopathic paralyses'). 

The Causes of paralysis are: wounds, occurring of course more fre- 
quently in the peripheral nerves than in the brain or spine {traumatic para- 
lyses); diseases of parts in the neighborhood of the nerves, such as exostoses, 
caries, aneurisms, echinococci, enlarged glands, hernia?, tumors, etc. ; diseases 
of the nervous system, such as neuritis, myelitis, encephalitis, cerebral and 
spinal apoplexies, softenings, scleroses, tumors, etc. ; disturbances of the circu- 
lation, such as ischsemia, embolism, thrombosis, venous stasis, etc.; poisoning 
of the blood, by vegetable alkaloids, such as woorare, ergotine, nicotine, sapo- 
nine, hydrocyanic acid, camphor, etc., and metallic preparations, such as lead, 
etc.; acute diseases, such as acute exanthemata, erysipelas, typhoid fever, 
cholera, dysentery, acute articular rheumatism, diphtheritis; chronic infec- 
tious diseases and cachexia, such as syphilis and scrofulosis; catching cold; 
exhaustion of the nervous system, by forced marches, excesses in venere, night 



912 NERVES. 

watching, excessive mental exertion, etc. ; reflex action from some primary 
disease, injury or irritation of the nerves at the periphery — reflex paralyses. 

Paralysis may extend over a single muscle, or a group of muscles; over 
one-half of the body (Hemiplegia), usually caused by a lesion in the brain 
on the opposite side, though it may also be of spinal origin ; or over both 
halves of the body symmetrically, commencing, usually in the lower extremi- 
ties and spreading to trunk and upper extremities (Paraplegia). 

As concomitant and secondary symptoms of paralysis may be mentioned: 
relaxation or contraction of the affected muscles ; want of all reflex and auto- 
matic movements, when there is interruption of the conduction in the peri- 
pheric motor nerves (or when the muscles are destroyed); an increase of 
reflex activity so long as the reflex mechanism is not destroyed ; associated 
movements in the paralyzed parts, in many cases where the paralysis is of 
centric origin above the centre of such associated movements; disturbances 
of automatic movements, especially of respiration in lesions of the lateral 
columns of the spinal cord in the dorsal and cervical regions; when the 
respiratory centre in the medulla oblongata is affected, asphyxia is soon pro- 
duced; in purely cerebral paralyses respiration continues undisturbed; re- 
tention or involuntary passage of urine or of the contents of the bowels in 
various forms of paralyses; anaesthesia, if the disease affects a peripheric mixed 
nerve trunk, or when the cause of paralysis affects coincidently sensory 
nerves either in the brain or spine ; hyperoesthesia of the parts and paresthesia, 
(formication, numbness, creeping, burning, etc.) in consequence of irritations 
set up in the neighborhood of morbid processes, which cause paralysis; dis- 
turbances of the intellectual faculties are found only in paralysis of cerebral 
origin ; coldness of the parts with passive hyperemia and cyanosis, especially 
in traumatic paralyses; atrophy of the skin, vulnerability of the skin, so that 
slight exposure to cold, pressure or irritation produces sores ; deformity of the 
nails ; falling off of the hair on the paralyzed limb ; atrophy of the muscles 
and bones; cirrhosis of the muscles, and increase of the interstitial tissue; en- 
largement and hypertrophy of the lymphatic glands. All these trophic changes 
are especially found in traumatic paralyses, less often in spinal, and still 
more rarely in cerebral paralyses. 

The Diagnosis between these three forms may be broadly stated as 
follows : 

Peripheral paralyses are limited to the region supplied by one or a 
few nerve trunks ; they are almost always associated with ansesthesia ; reflex, 
automatic and associated movements are absent; spasms occasioned by cen- 
tral disease do not extend to the paralyzed muscles; trophic disturbances, 
especially atrophy of the muscles are well marked at an early date ; absence 
of all signs indicating spinal or cerebral disease. 

Spinal paralyses occur most frequently as paraplegia : attacking sym- 



PARALYSIS, AKINESIS; 913 

metrical groups of muscles belonging to the lower extremities, trunk, belly, 
and upper extremities, progressively in accordance with the height which the 
disease has reached in the spinal cord (lumbar, dorsal or cervical regions) ; 
they are frequently accompanied by numbness, formication, etc., in the feet, 
by pain in the back, and a sensation of constriction around the body ; they 
are characterized by incontinence or retention of urine, by priapism, pollu- 
tions, spermatorrhoea and impotence; respiration is affected only when the 
corresponding part of the cord is involved ; myosis in cervical lesions ; con- 
vulsive movements proceeding from the brain do not extend to the paralyzed 
parts ; trophic disturbances may and may not be present ; psychical affections 
and affections of special senses are usually absent. 

Cerebral paralyses, from extravasation of blood, embolism, tumors, 
etc., are usually hemiplegia upon the opposite side of the body ; sometimes, 
however, it is limited to particular nerves and plexuses; reflex actions are 
almost always preserved and frequently increased in energy; associated and 
automatic movements are usually unaltered ; motor irritation (contractures, 
twitchings and spasms) are not unfrequent in the affected parts; epileptic 
convulsions occur also in the paralyzed parts; atrophy of the muscles scarcely 
ever occurs, except in paralysis of the pons; psychical disturbances and dis- 
turbances of the higher senses are quite characteristic, and frequently aphasia 
(intellectual) or alabia (peripheric disturbance of speech) occur. Cerebral 
paraplegia is very rare, and generally occurs in the form of two separate 
hemiplegia?, one side being more severely attacked than the other. 

Myopathic paralyses commence in particular muscles and gradually 
spread to others, frequently from one muscular fasciculus to another; they 
are preceded by atrophy : they are accompanied by fibrillar contractions and 
pain in the muscles, a diminution of the electrical excitability, and the pres- 
ence of a demonstrable local cause. 

THERAPEUTIC HINTS— Aeon., from congestion of spinal cord, 
attended with numbness of the parts. 

^Esc. glab., is recommended for paralytic affections of the lower ex- 
tremities. 

/Esc. hipp., for paralysis of the upper extremities; back and legs 
weak. 

Agar., paralysis of lower limbs with slight spasms of arms; pain in 
lumbar region and sacrum ; crosswise affections. 

Alum, met., paralysis from spinal diseases; loss of sensibility of the 
feet; inability to walk except with open eyes, and in the daytime. 

An ac, after apoplexy; loss of memory ; imbecility of mind; loss of will. 

Apis mel., one side paralyzed, the other twitching; cerebral origin. 

Arg. nitr., paraplegia from exhaustion. 
58 



914 NERVES. 

Arnica, in consequence of exudations within the brain or spine; in 
consequence of apoplexy, of concussions, of weakening diseases, of protracted 
intermittent fevers and ischias. 

Arsen., when associated with great prostration and neuralgic pains; 
also in spinal affections with gressus gallinaceus, and as an antidote to lead- 
poisoning. 

Bar. carb., general paralysis of old age, with loss of memory and 
trembling of the limbs; also after apoplexy in old age, and especially in 
paralysis of the tongue. 

Bellad., apoplexy; congestion of the head; paralysis of the one and 
spasm of the other side of the body ; paralysis of the face ; locomotor ataxy. 

Cauloph., paraplegia in consequence of retroversion and congestion of 
the womb after child-birth, with partial loss of sensation in the affected limbs ; 
considerable emaciation, anaemia and general debility. 

Caustic, paralysis of the face or tongue or hemiplegia, with giddiness, 
weakness of sight, weeping mood; hopelessness; fear of death ; drawing, 
lame feeling in the affected part; after exposure to severe, cold winds; 
catarrhal and rheumatic conditions ; suppressed itch or other chronic erup- 
tions; apoplexy. 

China, after great loss of blood. 

Cina, paraplegia with unnatural hunger. (Lounsbury.) 

Coccul., paralysis of face or tongue or pharynx; paraplegia; rheumatic 
lameness; in weakened and nervous subjects, who are inclined to fainting fits 
and palpitation of the heart; also when the paralytic affection originates in 
the small of the back after taking cold, with cold feeling of the extremities 
and oedema of the feet ; likewise after apoplexy. 

Colonic, after «a sudden suppression of general perspiration or of sweat 
of the feet by getting wet. 

Conium, paralysis from periphery upwards; old women; humid tetters. 

Cuprum, after apoplexy, when there is congestion in the chest, strong 
palpitation of the heart, or slow, weak and small pulse; the eyelids keep 
closed and twitch; when opening the eyes, the eyeballs move about; paraly- 
sis after cholera and typhus; paralysis commencing at the periphery and 
progressing towards the centre. 

Curare, nervous debility from loss of fluids or after exhausting illness. 

Dulcam., after taking cold, and suppressed eruptions; paralysis of the 
upper and lower extremities, and the tongue; the paralyzed arm feels icy cold. 

Ferrum, after great loss of vital fluids. 

Gelsem., loss of motion, but not sensation; paralysis of the organs of 
delutition, and in aphonia, succeeding diphtheria; locomotor ataxia; para- 
plegia. 

Graphit., rheumatic, peripheric paralysis of the face. 



PARALYSIS, AKIXESIS. 915 

Hepar, after mercurial poisoning. 

Hyosc, after spasms. 

Ignat., after great mental emotions and night- watching in the sick- 
chamber; hysterical paraplegia. 

Kali carb., trembling; paralytic weakness, with cramps in fingers and 
hand; also paralytic weakness in the hip-joint. 

Kali phosph., after exhaustion of nerve power, after hysteria. 

Laches., especially left side; awkward, stumbling gait; gressus galli- 
naceus; after apoplexy. 

Mercur., rigidity and immobility of all the limbs, although they can 
be easily moved by others ; indescribable malaise of body and soul ; trem- 
bling of limbs and body ; paralysis agitans. 

Natr. mur., paralytic condition of the lower limbs ; painful contraction 
of the ham-strings ; after intermittent fevers, diphtheria, sexual excesses and 
violent fits of passion. 

Nux vom., incomplete paralysis of the face, arms or legs, with vertigo; 
weak memory; darkness before the eyes; ringing in the ears; loss of appetite; 
burnino; in the stomach; flatulence; vomiting after eatino- and drinking-; 
constipation ; especially in drunkards ; after apoplexy, mental overexertion. 

Oleand., painless stiffness and paralysis of the limbs; insensibility of 
the whole body; or hyperesthesia, skin sore from the ordinary friction of the 
clothino;; trembling of the knees when standing, and of the hands when 
writing ; preceded by spells of vertigo a long time before paralysis develops 
itself. 

Opium, paralysis and insensibility after apoplexy; in drunkards; in 
old people ; retention of stool and urine. 

Ox. ac, paralysis from inflammation of spinal cord; limbs stiff; par- 
oxysms of dyspnoea. 

Phosphor., paralysis in consequence of spinal affections; after sexual 
excesses ; after confinement ; tingling and tearing pain from the back down 
into the limbs; gressus vaccinus. 

Picric ac, after tonic and clonic spasms; on standing keeps legs wide 
apart, looks steadily at objects as if unable to make them out; limbs feel as 
if in an elastic bandage, particularly the legs; waiting palsy; progressive 
locomotor ataxy. 

Plumbum, paralysis complete with atrophy of the affected parts, pre- 
ceded by trembling ; mental derangement. 

Psorin., after debilitating acute diseases. 

Rhus tox., rheumatic paralytic affections after getting wet, and after 
great or unwonted muscular exertions, strainings, etc.; in consequence of 
typhoid processes; with painful stiffness, tearing, drawing and aching of the 
whole body; sometimes with tingling and numbness of the parts, or con- 



916 NERVES. 

tinued cold feet for a long time ; worse during rest, and when commencing to 
move, from washing in cold water, with every change of the weather ; better 
from dry heat near the stove, from continued gentle moving about, and flexion 
of the limbs. 

Ruta, facial paralysis after catching cold. 

Secale, paralysis after spasms and apoplexy, with rapid emaciation of 
the affected parts, and involuntary discharges from bowels and bladder. 

Silic., paralysis of the left hand, with atrophy and numbness in the 
fingers ; paralysis of the legs, always worse in the morning, with heaviness of 
the head and ringing in tjie ears. 

Stannum, hemiplegia, especially on the left side, with a feeling of a 
heavy load of the affected arm and corresponding side of the chest, and 
frequent night-sweats. 

Stramon., after convulsions; also paralysis of the one and spasms of 
the other side. 

Sulphur, after typhus, exanthematic fevers, suppressed itch or chronic 
eruptions and spasms ; also when other remedies seem to fail. 

Tarant., numbness and formication and loss of motor power. 

Terebinth., paralysis of right arm and left leg. (Berridge.) 

Zincum, worse after drinking wine; great restlessness of feet; after 
suppresed foot-sweat. 

Besides, compare the following, which are partly taken from Jahr: 
for — 

Paralysis of the eyelids: Arnica, Arg. nitr., Bellad., Canthar., Coccul., 
Cupr. ac, Euphorb., Gelsem., Hyosc, Nitr. ac, Opium, Plumbum, Khus tox., 
Sepia, Spigel., Stramon., Veratr., Zincum. 

Paralysis of the face: Bellad., Caustic, Coccul., Graphit., Nux vom., 
Opium. 

Paralysis of the tongue and organs of speech: Aeon., Arnica, Arsen., 
Bar. carb., Bellad., Caustic, Coccul., Cuprum, Dulcam., Hepar., Hydr. ac, 
Hyosc, Laches., Mur. ac, Opium, Plumbum, Stramon. 

Paralysis of the organs of deglutition: Bellad., Canthar., Caustic, Coccul., 
Cuprum, Gelsem., Laches., Silic, Stramon. 

Paralysis of the bladder: Arsen., Bellad., Canthar., Dulcam., Gelsem., 
Hyosc, Laches., Lycop., Natr. mur., Opium. 

Paralysis of the rectum and sphincter ani: Caustic, Coloc, Hyosc, Ly- 
cop., Opium, Phosphor., Ruta, Zinc sulph. 

Paralysis of all the limbs: Arnica, Arsen., Colchic, Dulcam., Gelsem., 
Mercur., Nux vom., Rhus tox., Sanguin. 

Paralysis of the upper extremities : Aeon., iEsc hipp., Arnica, Bellad., 
Calc carb., Caustic, China, Coccul., Colchic, Dulcam., Lycop., Mercur., 
Nitrum, Nux vom., Rhus tox., Sepia, Tart, emet., Veratr. 



PARALYSIS, AKINESIS. 917 

Paralysis of right arm and left leg: Terebinth. 

Paralysis of the hands: Ambra, Arsen., Caustic., Cuprum, Ferrum, Natr. 
mur., Rhus tox., Ruta, Silic. 

Paralysis of the fingers: Ambra, Calc. carb., Cuprum, Natr. mur., Se- 
eale, Silic. 

Paralysis of the lower extremities: Alum., Arnica, Bellad., Bryon., China, 
Coccul., Colchic, Dulcam., Kalicarb., Mercur., Nuxvoin., Phosphor., Plum- 
bum, Rhus tox., Secale, Sulphur, Veratr. 

Paralysis of the feet: Arsen., China, Oleand., Plumbum. 

Hemiplegia: Alum., Anac, Arg. nitr., Arnica, Bellad., Caustic, 
China, Coccul., Dulcam., Graph.it., Hyosc., Kali carb., Laches., Mercur., 
Phosph. ac, Plumbum, Rhus tox., Sepia, Stannum, Staphis., Stramon. 

Left-sided hemiplegia: Arnica, Arsen., Bellad., Caustic, Laches., 
Rhus tox. 

Righf-sided hemiplegia: Arnica, Bellad., Caustic, Rhus tox. 

Paralysis of one and spasms of the other side: Bellad., Laches., Stramon. 

Paraplegia : Coccul., Lauroc, Nux vom., Secale and others. 

Paralysis in consequence of— 

Mental emotions: Arnica, Ignat., Natr. mur., Stannum. 

Bodily exertions: Arsen., Arnica, Rhus tox. 

Spasms: Arsen., Caustic, Coccul., Cuprum, Hyosc, Lauroc, Nux vom., 
Plumbum, Rhus tox., Secale, Silic, Stannum, Stramon., Sulphur. 

Apoplexy: Arnica, Anac, Bar. carb., Caustic, Cuprum, Laches., Nux 
vom., Plumbum, Secale, Stanuum, Stramon., Zincum. 

Taking cold: Arnica, Caustic, Colchic, Dulcam., Mercur., Rhus tox. 

Getting wet: Caustic, Nux vom., Rhus tox. 

Suppression of sweat: Colchic 

Onanism, sexual excesses: China, Coccul., Ferrum, Natr. mur., Nux 
vom., Sulphur. 

Rheumatism: Arnica, Bar. carb., Bryon., Canthar., Caustic, China, 
Coccul., Ferrum, Gelsem., Lycop., Ruta, Sulphur, Tart. emet. 

Intermittent fevers: Arnica, Arsen., Laches., Natr. mur., Nux vom., 
Rhus tox. 

Typhus fever: Coccul., Cuprum; Nux vom., Rhus tox., Sulphur. 

Diphtheria : Arsen., Gelsem., Laches., Natr. mur. 

Cholera : Cuprum, Secale, Sulphur, Veratr. 

Suppressed eruptions: Caustic, Dulcam., Hepar, Sulphur. 

Poisoning by arsenicum: China, Ferrum, Graphit., Hepar, Nux vom. 

Poisoning by lead: Cuprum, Opium, Platina. 

Poisoning by mere : Hepar, Nitr. ac, Staphis., Stramon., Sulphur. 



918 NERVES. 

Infantile Wasting Palsy, Essential Infantile Palsy. 

As the name indicates, a disease of childhood, by some considered of 
spinal origin from inflammation in the anterior cornua and lateral columns, 
and terminating in progressive atrophy of the muscles affected. 

The attack is often ushered in by febrile . symptoms of varied intensity 
and duration (from twelve hours to several days), or by convulsions; or more 
or less general paralysis sets in suddenly without any prodroma. Usually 
the paralysis localizes itself in one or two limbs, or only in some groups 
of muscles, or attacks limbs and trunk together, but never the head 
nor the sphincters. The intellectual faculties remain unimpaired. The 
affected muscles soon become flaccid and flabby, and the ligaments relaxed. 
In about two weeks or thereabout the wasting of the muscles shows plainly, 
especially on the legs, arms and shoulders; the bones grow thinner; the 
diseased limb ceases growing. The skin appears tough, cool, of a bluish 
color, and frequently somewhat oedematous. The relaxation of the ligaments 
in conjunction with the contraction of remnants of sound muscles causes 
subluxations and luxations of the joints, so that deformities, like club-foot, 
genu varum, etc., are of frequent occurrence. 

With all this, sensation remains normal, or in seme cases it is heightened 
to hypersesthesia. 

Improvement often takes place, and usually the arms recover their power 
quicker than the legs. 

THERAPEUTIC HINTS.— Compare Paralysis and Spinal Diseases. 

Aeon., if the disease commences with the peculiar Aconite fever. 

Bellad., Calc. carb. and phosph., during dentition. 

Phosphor., fatty degeneration of the muscles. 

Sulphur, Psorin., if there is any psoric taint. 

Thuja, after vaccination. 

Besides : Arsen., Caustic, Coccul., Gelsem., Plumbum, Secale. 

Hydrophobia, Lyssa, Rabies. 

" Hydrophobia in the human subject is an acute infectious disease, 
produced by a specific virus, which is inoculated almost without exception, 
by the bite of a rabid animal (dog, wolf, fox, cat, skunk, horse, ox, etc.), 
most frequently that of the dog. Infection from man to man may be said 
practically never to occur." (Bollinger.) Neither is it known that the 
consumption of the meat or milk of rabid animals ever produced the disease; 
but numerous observations make it quite probable "that dogs may, by their 
bite, produce hydrophobia in the human subject, even during the period of 



HYDROPHOBIA, LYSSA, RABIES. 910 

incubation of the disease." (Bollinger.) A wound from the bite of a dog 
should, therefore, always be considered with suspicion ; but instead of killing 
the dog on the spot, as is frequently done by ignorant people, he should be 
put under strict surveillance until it is proved whether he is mad or not. 
This will remove, in many cases, the fear and anxiety of those conceimed; 
for the bite of a mere vicious dog, cannot produce hydrophobia. 

And it ought also to be stated here, that not everyone who is bitten by 
a mad dog, must necessarily become ill and die of hydrophobia. " Out of 
8do human beings bitten by rabid dogs, 299 (or nearly one-half) cases ended 
fatally. But if we include also. the bites of dogs suspected of being rabid, 
the proportion becomes decidedly more favorable, 8 per cent, only of those 
bitten becoming ill and dying. Out of 1,362 human beings that had been 
bitten by rabid dogs, and dogs suspected of being rabid, there occurred 105 
fatal cases. How great an influence is exerted upon this final result by indi- 
vidual predisposition, or by other factors which are accidentally brought into 
play at the time of the bite (clothing, deposit of the saliva upon the garments, 
the extent of the haemorrhage, the nature and location of the wound), is 
difficult to determine." (Bollinger.) 

The nature of the wound may be very trifling: a mere abrasion of the 
skin, capable of absorbing the virus, may be sufficient for a fatal termination. 
Large wounds have been considered less dangerous than small ones, because 
the virus, it is said, is more easily washed out by the flow of blood ; but with 
this, facts do not agree. In regard to their location, wounds in the face are 
the most dangerous, next, those on the hands and on the body, lastly, those 
on the lower and upper extremities. 

The wounds usually heal readily, with a striking absence of any inflam- 
matory tendency, and then follows the period of Incubation w r hich varies 
greatly in length. It seldom is less than two weeks, most frequently lasts 
from three to six months, and in extremely rare cases two years and more. 
During all this time the persons bitten feel for the most part quite well, only 
of some it is said, that touching the scar produced peculiar sensations, such as 
shuddering, feeling of anxiety, and sighing. 

The Premonitory Symptoms are in many cases very little character- 
istic. The original wound usually is presented by a mere scar, and becomes 
in exceptional cases only inflamed and swollen, and of a reddish or bluish 
hue. At times tearing pains proceed from the wounded parts, or peculiar 
sensations, such as prickling, boring, or burning. In some cases little blis- 
ters have been observed under the tongue. The patient loses his appetite, 
complains of headache, and becomes depressed and gloomy, and then again 
ill-natured, apprehensive, excitable, and agitated by an indescribable feeling 
of anxiety, especially when he himself refers his bad feelings to the bite as 
the cause. He speaks of it and its impending fatal result in a remarkable 



920 NERVES. 

quick and sharp manner. He now becomes sleepless and restless, and the 
ominous symptom of aversion to fluids, and great sensitiveness to every breath 
of air and reflection of light, is the beginning of the 

Second stage, the stage of hydrophobic spasms. However, it should be 
stated that this stage in some cases sets in abruptly, without any precursory 
symptoms, with a sudden inability to drink, which is soon followed by general 
convulsions of a paroxysmal character, or brought on by an attemjJt to drink 
water, by a sudden fright, or by any agitation. 

The inability to drink depends upon peculiar spasms of the muscles of 
deglutition, induced by an attempt to drink, or by the mere sight of water or 
glistening objects, so that after a while, notwithstanding the most intense 
thirst, the patient will rather endure the latter, than be subjected to these 
agonizing spasms — hxjdrophobia. With it are associated spasms of the muscles 
of respiration, induced by a draught of air, or by the opening and closing of 
a door — aerophobia — which cause dyspnoea and a feeling of suffocation, sigh- 
ing and groaning respiration, and the utterance of shrill, inarticulate sounds, 
resembling almost the hoarse bark of a dog. The general convulsions appear 
with variable degrees of intensity, from slight muscular contractions, trem- 
bling of the limbs, to the most severe convulsions of a clonic character, less 
frequently amounting to tetanic convulsions. These paroxysms are some- 
times associated with maniacal raging and hallucinations, which the patient 
vents upon those around him, by abusing them and snapping at them. They 
are of variable duration, lasting from one-half to three-quarters of an hour. 
However, in exceptional cases they are absent, and the patient is able to 
swallow fluids, although the act is accompanied by pain. In some cases 
drinking succeeds when the patient is left alone, or when he closes his eyes, 
and uses the aid of a straw. So also are warm drinks, such as milk, soups, 
also wine, often more easily taken than water. But in most cases the SAval- 
lowing is impossible for fluids as well as for solids. 

The paroxysms are followed by periods of rest of equally variable dura- 
tion, during which the patient recognizes his surroundings, and answers 
questions correctly; but his voice is suppressed, and he appears extremely 
apprehensive, or talkative, and is in most cases sleepless. At other times an 
intellectual disturbance continues even during the absence of the spasms, and 
the patient sees objects which are not present, or imagines that his sufferings 
are caused by those around him, and he consequently rages and defends him- 
self against these imaginary attacks and insults. 

The face of the patient is red, and expresses the greatest mental and 
physical misery and the most horrible agony. The eyes are wild, rolling, 
staring and livid; the eyeballs are injected, the pupils dilated, and the retina 
exceedingly sensitive to light. In some cases the face is pallid and cyanotic 
and the expression stupid. 



HYDROPHOBIA, LYSSA, RABIES. 921 

The mouth is full of viscid saliva, which, as it cannot be swallowed, is 
constantly discharged or incessantly ejected in all directions. The tongue 
usually is moist and clean, at times slightly coated, seldom dry and thickly 
coated. The thirst is excessive, and accompanied by burning pains in the 
throat. The appetite is usually not affected. There is constant distress in 
the precordial region and dyspnoea; the boivels are constipated, and the urine 
is scanty, dark colored, cloudy, and frequently contains sugar, but no albu- 
men. The temperature usually rises to 100.4° F., seldom to 105 or 106° F. 
The skin is generally moist, and even covered with perspiration. During 
the paroxysms the extremities are cool and livid. After this paroxysmal 
stage, which may last from one and a half to three days, follows 

The third stage, or the stage of paralysis, into which the patient sinks 
gradually, if he be not carried off suddenly during a hydrophobic paroxysm. 
Then the convulsions become more feeble and cease entirely ; the muscles 
still continue to twitch; the pupils are contracted or are of unequal size; the 
eyes are fixed, and strabismus frequently appears; "the saliva is no longer 
ejected, but runs from the open mouth; the voice becomes harsh and weak, 
the breathing short and rattling, and the pulse very small, irregular and 
rapid; the skin is covered with a clammy perspiration." (Bollinger.) In 
some cases priapism with frequent seminal emissions has been observed. 

Towards the last many patients are again enabled to drink without any 
difficulty, " and this was considered of old to be a sure sign of death. Death 
itself may take place amid convulsions, or from asphyxia. It may also ap- 
proach quietly, seldom with symptoms of coma or suffocation." (Bollinger.) 
This last stage lasts, as a rule, only from two to eighteen hours. 

The most prominent morbid anatomical changes found on post-mortem 
examination are: hyperozmia of the brain and its membranes, also of the 
spine and its membranes, of the lungs, and of the kidneys. The sinuses and 
peripheral veins are generally distended with dark colored blood, only 
slightly coagulated. 

Upon microscopic examination, Klebs found : " In all the swollen por- 
tions of the lymphatic system, and particularly in the submaxillary gland, a 
deposit of finely granular, strongly refractive corpuscles of a faint brownish 
color, closely packed together in clusters, at some points in the form of a 
long row, and at others branching out so as to form large star-shaped figures, 
following in general the course of the blood-vessels." Whether these corpus- 
cles will prove to be the vehicles for the transfer of the specific infecting 
material, is as yet undecided. 

We cau now more easily form an opinion as to the value of the old, but 
frequently renewed view, that hydrophobia in man is simply an affection of 
the nerves, which may be induced by anxiety and excitement; that it is a simple 
myth. This imaginary origin and essence of hydrophobia is sternly rebuked 
by the sad fact, that so many persons, among all nations, succumb to the 



922 NERVES. 

dreadful malady every year. If these persons were only hysterical women 
or hypochondriacal men, there might be some show for such au assertion, 
but the virus, if once implanted, spares neither childhood nor age. 

That it is a simple neurosis, a traumatic tetanus, is contradicted by the 
fact that hydrophobia has nothing common with traumatic tetanus. Accord- 
ing to Rose, these are the diagnostic points of difference between the two: 
" In traumatic tetanus a continuous spasm is present, to which there is finally 
added an increased reflex excitability; consciousness remains clear until the 
death-struggle; the organs involved in the act of swallowing are generally 
unaffected ; the tetanic spasm begins in the masseter muscles and in those of 
the cervical region ; the disease is fatal only when it breaks out within a few 
weeks after the injury. In rabies, on the other hand, clonic convulsions 
occur; reflex convulsions are noticeable from the outset; loss of conscious- 
ness often ensues at an early stage ; the masseter muscles and those of the 
neck are not affected by the spasms; the disease makes its appearance after 
a period of incubation, lasting often for months ; its course is uniformly acute ; 
its termination fatal; its prominent feature consists of an affection of the 
organs involved in the process of deglutition." 

The Prognosis is a grave one. 

THERAPEUTIC HINTS.— Prophylaxis. 

" While in cases in which Cauterization is resorted to, scarcely 33 per 
cent, of human beings bitten by rabid animals fall victims to the disease; in 
cases where this operation is not practiced, exactly 83 per cent, of those bitten 
encounter certain death." (Bollinger.) Brefeld gives the following direc- 
tion: "After the wound has first been syringed out with warm water, it is to 
be gently and thoroughly bathed and cleansed by means of soap-suds and a 
sponge, or with a solution of potash. The wound is next to be cauterized by 
means of caustic potash, and for several succeeding weeks (from four to six) 
a suppuration of the cauterized wound is to be kept up; a simple ointment, 
like resin cerate, being used as a dressing, or compresses saturated with a two- 
grain solution of potassa. Whenever cicatrization proceeds too rapidly, the 
cauterization by means of a strong solution of potassa is to be repeated." 

" The application of suction to the wound, either by the mouth of the 
sufferer, if the position of the w T ound permits, or by some other person, con- 
stitutes decidedly one of the most efficient measures, and one that can always be 
applied upon the spot" (Bollinger.) It is self-understood that the lips of 
the operator should be entirely free from any cracks or wounds. Instead of 
the mouth, the dry cupping-glass may be applied, where the seat of the 
wound permits it. 

" The best remedy," says Hering, " is heat applied at a sufficient distance 
to prevent actual scorching of the wounded part." Take a hot iron, a live 
coal, or even a burning cigar, and hold it so near to the wound and its cir- 



HYDROPHOBIA, LYSSA, RABIES. 923 

cumference that the .patient feels the heat strongly, and continue until he 
commences to shudder. It is well to apply oil or fat around the wound, and 
necessary that all moisture which oozes from the w T ound should be carefully 
wiped off. This ought to be repeated three or four times daily, for one hour, 
until the wound has healed. 

So may also the Turkish bath be of great use. 

There are a number of remedies, and among them a number of secret 
preparations used as prophylactics. 

Hahnemann recommends Bellad. in the smallest dose, at first repeated 
every th^rd or fourth day, and later at longer intervals. William Gross, 
Hering and Hartmann have also recommended it. 

Hydrophobin. or Lyssin has been introduced by Hering, and its 
provings show its adaptedness to such cases. 

Canthar 15 ., has been found effective by Hartlaub and Trinks. 

Anagallis arvensis and Meloe majalis are popular remedies. 

The developed malady requires first of all "the removal of every cause of 
excitement; the separation of the patient from everything calculated to dis- 
turb or render him anxious; the maintenance of the utmost quiet; the em- 
ployment of a friendly tone of address (in place of coercive measures) ; and 
the endeavor to calm the sufferer by kind treatment." (Bollinger.) 

Bellad., congested face; wild staring look; pupils dilated; sensitive- 
ness to sunlight or shining things; throat sore; spasms of throat; hoarse, 
barking voice; inability to swallow; oppression; anxiety; hallucinations; 
biting and snapping; convulsions. 

Canthar., when swallowing is prevented by inflammation, and not only 
from spasms of the throat ; spasms follow the pain caused by swallowing ; 
also when there is priapismus. (Hartmann.) 

Hydrophobin. or Lyssin, when the skin becomes bluish-red, with 
edges hard and swollen. (Hering.) 

Hyosc., general convulsions more prominent than spasms of the throat; 
does not spit and snap at those around, but abuses them otherwise. Sleep is 
interrupted as if by a sudden fright, followed by convulsions. After the 
abuse of Bellad. in massive doses. 

Laches., in the worst state of the developed disease it may be better 
than any other remedy. (Hering.) 

Spiraea ulmer., during a frantic paroxysm a patient devoured with 
eagerness a piece of the root of this plant. One-quarter of an hour after, he 
became conscious, vomited gall and fell into a profound sleep for 24 hours. 
He was well afterwards. (Kuhner, in Med. Journal, Vol. VII, p. 51, Russia.) 

Stramon., Hahnemann says "that according to the totality of the 
symptoms of a given case, it may be indicated as well as Bellad. or Hyosc." 
Characteristics appear to be the fear of imaginary objects, and the great 
mobility and restlessness, with screaming. 



THE BLOOD. 



This being the fluid which nourishes all parts of the system, which 
sustains respiration, which, in short, is the life of the body, must necessarily 
cause great disturbances of the body when it becomes in any way abnormally 
changed. The blood consists of corpuscles and serum. The corpuscles are of 
two kinds — red, and colorless or white. The serum contains water, fibrin, 
albumen, salts, fatty substances and extractive matters. 

Any of these constituents may be abnormally increased, decreased, or 
altered, causing an abnormal condition in the quality of the blood. 

The whole mass of the blood may be increased or decreased, causing an 
abnormal quantity. Obnoxious substances, like sugar, uric acid, oxalic acid, 
ammonia, sulphuretted hydrogen, urates, gall, pus, may be mixed with, and 
thus may impregnate, the blood, causing a poisoned state of the whole fluid. 

It is only within the last ten or twenty years that these different changes 
of the blood have been made the subject of closer examination, and much of 
it requires still closer investigation. I shall, therefore, confine myself to the 
most important facts which these researches have brought to light. 

1. Cyanosis. 

The blood-corpuscles absorb the oxygen, with which they come in con- 
tact during their course through the lungs. Any cause which prevents this 
absorption of oxygen by the blood-corpuscles hinders the transformation of 
the venous into arterial blood. This is the nature of cya7iosis. It consists in 
a. decreased absorption of oxygen by the blood-corpuscles. Its Causes are 
numerous, and may be arranged under the following heads : 

1. Imperfect respiration, in consequence of spasms, or oedema, or croupous 
inflammation of the glottis and larynx; or in consequence of obstructions 
within the trachea and bronchial tubes, caused by spasms, mucus, blood, 
foreign bodies, false membranes ; or in consequence of obstacles which pre- 
vent the air from entering the air-cells of the lungs, caused by infiltration, 

(924) 



DISSOLUTION OF THE RED BLOOD-CORPUSCLES. 925 

hepatization, exudation (emphysema, hydrothorax, pneumothorax); or in 
consequence of paralytic affections of the respiratory muscles and diseases of 
the abdomen, by which the lungs become compressed; enlargement of the 
abdominal organs, tympanites, ascites, etc. 

2. Imperfect circulation, in consequence of heart disease, obstructions 
within the pulmonary vessels, obliteration of the pulmonary tissue and blood- 
vessels, immediate transmission of the venous blood into the left ventricle, in 
consequence of the non-closure at birth of the foramen ovale. 

3. Inhalation of air, which contains too little oxygen, and is impreg- 
nated with irrespirable gases, like carbonic acid gas, etc. 

4. Inability of the blood-corpuscles to absorb oxygen. This has been ob- 
served in some severe illnesses, such as typhus, pyaemia, and in the last stage 
of pulmonary tuberculosis ; cholera. 

Symptoms. — Bluishness of the surface of the body, especially of the face 
and lips; coldness of the extremities and depression of the muscular and 
nervous system; sopor; in a still higher degree, asphyxia. 

Cyanosis is, therefore, not a disease in itself, but a mere consequence 
and symptom of other derangements ; still as a symptom it has, nevertheless, 
some therapeutic value, suggesting Aeon., Aram, carb., Arnica, Arsen., 
Camphora, Carb. veg., Conium, Cuprum, Digit., Laches., Opium, 
Pulsat, Ehus tox., Sambuc, Secale, Veratr. 

In newborn children, where the foramen ovale has not closed, Laches. 
In consequence of persistence of the ductus Botalli, Lauroc. 

2. Dissolution of the Red Blood-Corpuscles. 

Each blood-corpuscle lives a certain period of time, and after that it 
dissolves and disappears and new ones form in its place. Thus a constant 
rotation between life and death goes on in these minute bodies in order to 
sustain the life of the whole body. In disease, however, this equilibrium is 
sometimes destroyed; more corpuscles die than are generated, and this causes 
a state of the blood which is called OligOCytlitemia. It is characterized by 
weakness of the muscular system, tired feeling all over; nervousness, palpi- 
tation of the heart, bellows-sounds of the heart and large arteries; murmur 
in the jugular veins. 

In still other cases the dissolution of the blood-corpuscles goes on so 
rapidly and to such an extent that the blood-serum becomes overloaded with 
the constituents of the destroyed corpuscles, and is thus discolored. Even 
the excretions of the body assume a bloody or dark appearance; and the 
exudations are of a brownish, or still darker hue. The skin and mucous 
membranes become tinctured with hrematin (the coloring matter of the 
blood), and color it yellowish, which may be mistaken for jaundice. 



926 BLOOD. 

If such a profuse dissolution of blood-corpuscles is confined to a certain 
portion of the circulation, it constitutes an essential part iu what is called 
Local Gangrene. A general putrid dissolution through the whole system 
is General Gangrene, Septicaemia. We find such states of general disso- 
lution in some forms of typhus, scurvy, puerperal fevers, yellow fever, and 
various other forms of tropical fevers. By what it is caused, we do not know. 

Compare Alum. P. S., Arsen., Carta veg., China, Kali phos., Laches., 
Nitr. ac, Secale. 

3. Leukaemia. 

"The number of the colorless cells is so much increased that the blood 
has a whitish color," that is, under the microscope. Virchow thought, by 
finding this state of the blood in some cases, he had discovered a new disease. 
And as, according to his observations, the predominance of the white cor- 
puscles appeared in connection with enlargement of the spleen and tumors of 
the lymphatic glands, he distinguished two forms of leukaemia, the splenic and 
the lymphatic. To this has recently been added a third form, Neumann's 
myelogenous leuJccemia, which is presumed to have its starting point in the 
bony marrow. 

The patients complain, long before any increase of the white cells in the 
blood can be discovered, of prostration, dislike to work, dull pains in the 
splenic region, headache, dizziness, ringing in ears, palpitation, shortness of 
breath, enlargement of the lymphatic glands in various parts of the body, 
but especially in the cervical, jugular, axillar, and inguinal regions. How- 
ever, there are cases of considerable tumors of the spleen and lymphatic 
glands without leukaemia. 

This " new " disease of Virchow has been well known and studied in all 
its features (except the accumulation of the white blood-corpuscles), by the 
older physicians, under the name of Sycosis, who considered it as the effect 
of a contamination with gonorrhoeal poison, while Virchow and his followers 
saw the cause in the surplus of white cells — without explaining the cause of 
this accumulation, which, as stated before, is often not present until a late 
period of the disease. Thus, instead of having discovered a new disease, 
Virchow has found merely a new symptom of an old disease. Compare Von 
Grauvogl upon this subject in his great work, "Lehrbuch der Homoeopathic" 

THERAPEUTIC HINTS- Grauvogl recommends Natr. sulph. 
and Thuja as the main remedies. 

Other remedies, however, especially those of the hydrogenoid order, may 
likewise be indicated by special symptoms; such remedies are: Natr. nitr., 
Natr. carb., Natr. acet., Kali nitr., Calc. carb., Magn. carb. and phcsph., 



HYDREMIA — PLETHORA. 927 

Silic, Iodium, Brominm, Chlor., Nitr. ac, Katr. raur., Borax, Antimon., 
Alum., Carb. veg., Arnica, Aranea diad., Pulsat., Xux vom., Ipec, Arsen., 
Coniuni, Apis, Spigel., and animal food. 

4. Hydraemia 

Consists in a decrease of albumen and an increase of water in the serum san- 
guinis. In consequence of this the serum is much more prone to exudation 
than in its normal state, and we therefore find this state of the blood fre- 
quently associated with dropsical effusions. 
Its Causes may be : — 

1. Long-continued pathological secretions of clear albumen, or albuminous 
substances (mucus, milk, etc.); in consequence of albuminuria, serous diar- 
rhoea, pus-formation, exudation, loss of blood, mucous discharges, too copious 
flow of milk, too long-continued nursing. 

2. Insufficient supply of nutriment or disturbed nutrition, so that the re- 
ceived nourishment is not converted into albumen and assimilated. Hydrae- 
mia is therefore found in connection with the most different morbid processes. 
We find it in combination with diseases of the heart and lungs, especially 
tuberculosis, chronic indigestio'n, protracted intermitting fevers, Bright's 
disease, etc. 

THERAPEUTIC HINTS must be referred to the above-named mor- 
bid conditions. 

5. Plethora. 

The quantity of the blood must always be estimated as a relative mass. 
We cannot say, so much is just enough, one ounce more is too much. And 
in fact during life we have no means for such estimation. The whole ple- 
thoric theory therefore rests rather upon a weak foundation. On the other 
hand, if we observe different individuals, it seems clear enough that some are 
richer in this vital fluid than others. Aud as objective signs, which indicate 
such repletion, are stated: 1. A higher degree of redness of the body— such 
higher color, however, may be often very fallacious; it is of any account only 
when it is perpetually so; and, 2. The greater fulness and repletion of the 
circulatory vessels, arteries and veins. This is plethora of olden times. More 
recent observers have split this theory into three branches. 

They divide plethora of old into — 

1. Plethora vera, true plethora, which is said to characterize itself by 
fulness of the arteries and veins, repletion of single organs, florid complexion 
and increased temperature of the body. 



928 BLOOD. 

2. Serous plethora, an increase of blood-serum, and decrease of cor- 
puscles, which characterizes itself by fulness of the arteries and veins, pale- 
ness, or else quick change of color; and, 

3. Plethora ad Yasa, or false plethora, which is not too much blood 
in general, but too great an afflux of blood into the blood-vessels, as in 
fevers, in consequence of bodily and mental exertions, spirituous, irritatiug 
drugs, etc. 

All these distinctions are of little use for Homoeopathic practice, as the 
Homoeopathic physician will scarcely have occasion to trouble his brain with 
the question : Shall I bleed? or shall I not? 

6. Anaemia, Oligemia. 

The first denotes a ivant, the latter a poorness of the blood ; the exact 
pathological meaning is a diminution of plasmatic albuminates, of red cor- 
puscles and of water in the blood; changes in quality and quantity of other 
blood-constituents are of minor consideration. 

A sudden loss of blood by haemorrhage (internal or from wounds), al- 
though producing a state of anaemia, and in consequence thereof, j^erhaps 
general epileptiform convulsions, loss of consciousness, delirium, hiccough, 
retching, vomiting and death, does not exactly belong here. We mean to 
consider the subacute and chronic forms of anaemia, the Causes of which are 
exceedingly various. They may consist of: deficient supply of food, a want 
of light and air, too little or too much exercise, too high or too low tempera- 
ture, excessive losses of semen, too long-continued lactation, profuse menstrua- 
tion, great care or grief, or mental overwork, albuminuria, blennorrhoeas of 
the different mucous membranes, diarrhoea and dysentery, extensive suppu- 
rations, large effusions in the pericardial, pleural or peritoneal cavities, infil- 
trations into the lung tissues, malignant growths, malarial infections, mineral 
poisonings (acids, phosphorus, etc.), animal parasites, especially the anchy- 
lostomum duodenale (compare the chapter on Intestinal Worms), indigestion, 
diseases of the spleen, lymphatic glands, etc., and fever. 

The Symptoms of anaemia are : paleness of the skin and mucous mem- 
branes, dropsical effusions in consequence of the diminished albumen in the 
blood, emaciation, marasmus or general atrophy of the tissues, a tendency to 
degenerative processes and haemorrhages, and a decrease of the normal tem- 
perature down to 95° F., and lower ; muscular exhaustion, irritable weak- 
ness, anaemic murmurs over the region of the heart, and the "Nonnen- 
gerausch," or "bruit de diable," a continuous humming sound over the 
internal jugular veins, dyspnoea. 

The Duration and Prognosis of anaemia depends altogether upon the 
causes to which it owes its origin. 



PROGRESSIVE PERNICIOUS AN.EMIA. 929 

Progressive Pernicious Anaemia, 

Also known under the names of essential malignant and essential febrile 
ancemia, includes those cases of extreme anaemia which tend uninterruptedly 
towards a fatal issue, and of which no adequate cause can be discovered, 
either in the patients' circumstances or in the previous state of their constitu- 
tion. Its pathogeny and causes are shrouded in utter obscurity. It attacks 
most frequently women from the age of twenty to that of forty, and the cases 
described and classed under this new term by Biermer and Gusserow have 
principally been observed in Switzerland. Most cases were those of preg- 
nant women. 

The Symptoms begin insidiously with a gradual paling of the skin and 
mucous membrane, increasing to a degree as found in acute ansemia from 
haemorrhage. A wasting of the tissues (marasmus) is usually not observed 
until fever sets in, but other symptoms of anaemia associate early with the 
increasing paleness. Such are : palpitation of the heart ; a loud, blowing, 
systolic murmur and purring tremor over the heart, and the venous hum in the 
jugular veins, characterized by great constancy and intensity; irritable weak- 
ness and great prostration with severe fainting fits from slightest exertion ; 
dyspnoza, is hardly able to speak above her breath ; effusion into the pericar- 
dium and pleura, and puffiness of the legs; hcemorrhages from different parts 
of the body : the nose, gums, genital organs in women, and the skin in the 
form of petechia? and occasionally as large patches of ecchymosis; haemor- 
rhages in the retina and other internal parts. The fever is of an irregular 
type, with temporary exacerbations, when the temperature may run up to 
104° F. As the end approaches it is prone to fall suddenly as low as 95° or 
even 93.2° F. When occurring during pregnancy, it usually induces pre- 
mature labor, and this is the forerunner of death. 

With all these severe symptoms, Physical Examination shows no 
organic disease of the heart, nor of the kidneys (no albuminuria), nor of the 
spleen, liver or lymphatic glands, and microscopic examination reveals no 
disproportion in the relative number of red corpuscles and leucocytes, thus 
distinguishing this disease thoroughly from leukaemia. From chlorosis it 
differs by its dropsical symptoms and its hemorrhagic diathesis, and from 
otter forms of ancemia by its fever. 

The duration of the disease is seldom less than six or eight weeks, and 
seldom more than the same number of months. "Our present experience 
justifies us in regarding every case as tending inevitably to a lethal issue." 
(Immermann.) 

THERAPEUTIC HINTS.— In any case of anaemia we must, above 
all things, well weigh its cause 'or causes, which see above. As a mere 

59 



930 BLOOD. 

symptom anaemia may hint to the one or the other of the following remedies : 
Arsen., Calc. carb., Carb. veg., China, Cuprum, Ferrum, Helon., Hydrast., 
Kali carb., Natr. mur., Nux vom., Sulphur, Veratr. and many more. 

7. Chlorosis. 

According to the latest researches chlorosis seems to be characterized by 
a diminution in the amount of haemoglobin in the blood ; the change appears 
to be strictly limited to the red corpuscles. But whether this change con- 
sists in a diminution of their number, or of the proportion of coloring matter 
contained in the individual corpuscles, is not yet decided. The albuminates 
and leucocytes seem not to be affected, and this is an important pathological 
distinction between it and anaemia, in which latter there is always a decrease 
of the plasmatic albuminates. 

The disease is almost entirely limited to the female sex, between the 
fourteenth and twenty-fourth years of life ; it is especially, therefore, a dis- 
ease of the age of female puberty, seems often to grow upon a hereditary 
disposition, a peculiar constitutional habit of the body, and may be excited 
by conditions incidental to modern social life, or atmospheric and telluric 
influences, or by emotional disturbances, such as terror, anxiety, disappointed 
love, homesickness and the like. 

Its Symptoms are manifold : 

1. Color of the skin. A conspicuous paleness, sometimes clear, some- 
times yellowish, greenish, waxy. Even the lips and other mucous mem- 
branes appear pale; dark rings around the eyes. In some cases there is 
oedema of the feet, face and eyelids ; temperature decreased ; breath cool ; 
lips, nose, ears, hands and feet cold. The patient is sensitive to cold, seeks 
a warm room. 

2. Circulation. The pulse is usually small and compressible, varying 
in frequency, easily excited by any trifling cause. The heart's impulse varies 
likewise in frequency and intensity, amounting often to strong palpitations. 
Sometimes the palpitation of the heart becomes habitual, and is one of the 
most prominent, and, at the same time, most annoying symptoms. Physical 
signs are those of anaemia: systolic murmurs over the apex of the heart, and 
humming sounds over the jugular veins. The latter are the most constant. 

3. Respiration is frequently dyspnoeic, especially after any exertion ; the 
patients sigh and cough occasionally. 

4. Muscular system. Great weakness ; easily tired and exhausted. 

5. Nervous system. Dizziness; headache; noise in the ears, especially 
in the right ear ; pains in different parts of the body, especially in the stomach 
and back; even hysterical spasms; sadness; want of energy; frightful 



CHLOROSIS. 931 

dreams; nightmare; melancholy, and even mania, and inclination to self- 
destruction. 

6. Digestion. Want of appetite ; digestion slow ; sour and foul eructa- 
tions ; desire for sour things ; morbid desire for chalk, paper, ashes, coals, 
even excrements. Often the most indigestible things — pork, beans, pastry, 
etc. — suit better than light soups, meat, etc. However, these digestive symp- 
toms are, in some chlorotic persons, entirely wanting. 

7. Genital sphere. There is generally amenorrhcea or irregular men- 
struation with pain ; thin, watery leucorrhoea in place of the menses, or in 
some cases menorrhagia. 

Chlorosis is often combined with hysteria and choreic paroxysms ; also 
Basedow's or Graves' disease stands in undoubted connection with it ; and 
other neuroses, such as cardialgia, headache, toothache, backache, etc., are 
found as frequently in chlorosis as in anaemia. 

Its Duration is variable ; under proper treatment it may yield in a 
comparatively short time ; otherwise it may last for years. Marriage some- 
times relieves at once. Complications, such as acute febrile disease, phthisis, 
endocarditis, gastric ulcer, etc., of course, change its favorable prognosis. 

THERAPEUTIC HINTS.— Ant. crud., menses commence at an 
early period, are profuse and cease afterwards; great deal of headache; 
peevishness; loss of appetite; irregular stool; excessive laziness and weak- 
ness ; must lie down for hours ; deep and unrefreshing sleep at night. 

Arsen., trembling; frequent fainting; excessive debility; pernicious 
anaemia. 

Bellad., laziness and indisposition to work or stir, great general de- 
bility, with weariness and a desire to sleep in the afternoon ; shortness of 
breath; extreme paleness of the face changes instantaneously to redness, 
with cold cheeks and hot forehead. 

Bryon., all the symptoms worse from the slightest motion. 

Calc. carb., scrofulous diathesis; disposition to colds and diarrhoea; 
great weakness or curvature of the spine ; vertigo, especially on going up 
stairs ; disgust for meat ; craving for sour and even indigestible things (chalk, 
coal, etc.) ; after eating, swelling of the stomach and palpitation of the heart ; 
menses sometimes too often and too profuse, or wanting; leucorrhoea; great 
weakness of breath ; great weakness of the muscles ; walking wearies and 
makes the heart palpitate; sitting causes severe backache and headache; 
therefore constant inclination to lie dow T n; hands and feet are cold; the 
fingers sometimes appear dead. The mind is generally full of concern about 
imaginary things that might happen to her. 

Carb. veg., when complicated with itch and fluor albus; the gums 



932 BLOOD. 

are swollen, scorbutic and receding from the teeth ; the teeth are loose ; feels 
wretched all over; can scarcely walk. 

China, in such cases as result from loss of vital fluids, menstrual or 
vicarious bleeding, suppurations, etc.; or which set in after severe and pro- 
tracted illness, such as intermittent fevers, typhus, cholera, etc. ; showing in 
either case a tendency to dropsical effusions and (edematous swellings. Be- 
sides we observe sour belching, poor digestion, bloated abdomen. 

Cina, on drinking wine she shudders as though it were vinegar; spas- 
modic yawning; headache, pain in the chest and back, caused by fixing the 
eyes steadily upon some object, as, for example, when sewing; all these pains 
are aggravated by external pressure; spells of intermittent fever every after- 
noon at four o'clock, with thirst and coldness of the hands and feet ; colic 
and vomiting of ingesta; afterwards heat and sweat, followed by deep sleep. 

Conium, menses wanting; genitals very sensitive; constant dry heat 
all over, without thirst ; stitching pain in the region of the liver, and heavi- 
ness in the limbs; weeping mood; restlessness; great concern about any 
little thing that may happen ; anxious dreams. 

Cuprum, disposition to laryngeal and tracheal affections, to vomiting 
and purging; sweating of feet; torpid cases. (Von Grauvogl.) 

Cy clam., suppressed menses; or scanty, painful menstruation; head- 
ache; vertigo; swollen eyelids; pale face, lips and gums; loss of appetite; 
no thirst; constipation; palpitation of the heart; constant chilliness; dread 
of fresh air; disinclination to move and to work; constant drowsiness ; wants 
to be alone, and weeping does her good. Is very similar to Pulsat., differing, 
however, from it, by its dread and disinclination for fresh air. 

Ferrum, anaemia, characterized by great paleness of all the mucous 
membranes, especially that of the cavity of the mouth, by the bellows-sound 
of the heart and anaemic murmur of the arteries and veins ; by great paleness 
of the face, which, however, is very apt to suddenly become fiery red, with 
vertigo; ringing in the ears; great palpitation of the heart and. dyspnoea; 
thus showing a disposition to congestion and fluxion of the blood to these 
parts of the body. All the muscles are feeble and easily exhausted from 
slight exertion ; there is frequent vomiting of ingesta, especially after eating 
and from motion; cardialgia; the menses are either suppressed or watery; 
we observe general emaciation ; oedematous swelling of the body ; cool skin ; 
constant chilliness and evening fever, simulating very closely hectic fever. — 
Florid cases, with disposition to phthisis, haemoptysis, menorrhoea, scrofulous 
inflammation of eyes, diarrhoea, ascarides, etc. (von Grauvogl.) 

Graphit., scanty, pale, delaying menses, or they do not appear at all ; 
cool vagina; aversion to coitus; oedema of the eyelids, external genital or- 
gans and abdominal parietes, leaving on pressure the imprint of the finger; 
face pale and yellowish. 



CHLOROSIS. 933 

Ignat., sensitive, nervous, hysteric women, who are inclined to spas- 
modic and intermitting complaints, and where the trouble is induced by mental 
emotions, such as fright, grief, disappointed love, etc. 

Ipec, headache, as though the brain were mashed, with nausea and 
vomiting ; miliary eruptions on the forehead and cheeks by spells ; pale face 
and pale mucous membranes; weak pulse; cold hands; morose, enjoys 
nothing. 

Natr. mur., in chronic cases and cachectic individuals, with dead, 
dirty, withered skin ; frequent palpitation and fluttering of the heart ; sup- 
pressed menstruation ; leucorrhoea ; diminished sexual desire ; oppression and 
anxiety of the chest ; sadness. 

Nux vom., especially in those cases in which the functions of the 
stomach, intestines and liver are principally affected, and we may observe a 
train of symptoms like the following: irritable, angry disposition; great 
anxious concern about little things ; headache, with bilious or sour vomiting, 
worse in the morning ; pale, earthy face ; feeling badly after eating bread or 
sour things; sour taste in the mouth; craving for chalk; nausea and vomit- 
ing in the morning or after eating ; cardialgia, with wind in the stomach ; 
better from drinking something hot; obstinate constipation; running of the 
nose through the day, and stoppage of it at night; sore feeling all over in bed 
in the morning; dreads motion and fresh air; gets awake early in the morn- 
ing, then dozes again and wakes up finally, feeling much worse than at any 
other time. 

Phosphor., in deep-seated, chronic cases, with tubercular diathesis; 
brought on by depressing mental influences, such as grief, worriment, disap- 
pointed love, or by exhasting bodily causes, such as night-watching, loss of 
blood, diarrhoea, night-sweats, onanism, etc. We observe, in such cases, 
puffiness around the eyes, dry, hacking cough, great weakness in the sexual 
organs, consequent upon previous irritation of these parts; leucorrhoea of a 
whitish, watery slime, especially profuse during the time of the menses, some- 
times acrid and corroding; a total loss of energy in all the organic functions 
of the body. 

Plumbum, want of breath and great oppression of the chest from 
motion; palpitation of the heart; obstinate constipation; oedema of the feet 
and anasarca; great muscular weakness. 

Puis at., great weakness and sluggishness in the circulation, manifest- 
ing itself in constant chilliness, coldness and paleness of the skin and face, 
with hot flashes and transitory redness of cheeks; soft, irregular pulse and 
palpitation of the heart, oppression of the chest and shortness of breath; 
disinclination to move and a sad and tearful disposition; the appetite is 
generally absent, and there is no thirst ; the whole digestion is disturbed, 
and consequently the assimilation of nutriments for the blood does not take 



934 



BLOOD. 



place properly. We observe, therefore, signs of anaemia, such as dizziness, 
especially when rising, and amenorrhea, or scanty, slimy menses, which 
appear too late; in general the patient feels better in the open air. This 
distinguishes Pulsat. from Cyclam. It is frequently indicated after Calc. 
carb., Ignat., Sepia or Sulphur, and is followed well by Ferrum. Disposition 
to intermittents, melancholia, hysteria, heart and kidney diseases, discharge 
from ears, (von Grauvogl.) 

Sabina, amenorrhea; frontal headache, pressing down upon eyes, 
worse in morning on rising, better in fresh air; blue rings around eyes; 
nausea and qualmishness when in a crowd; burning in pit of stomach, with 
twisting and gurgling in bowels ; bearing down ; drawing pain in extremities, 
worse at night; lassitude and sleepiness. (Watzke.) 

Sepia, bearing down as if everything would issue out of the genitals; 
prolapsus uteri and vagina ; brown-reddish color of the vagina ; diphtheritic 
ulcers in the vagina and on the labia; leucorrhoea, yellowish and passing 
away in starts ; swelling of the external genital organs, with itching, burning 
and soreness ; stitching pains in the ovarian region ; palpitation of the heart ; 
intermitting pulsation; occasionally a hard thump of the heart; frequent 
sickness at the stomach ; brought on even by the smell of cooking. Uneasi- 
ness in the presence of strangers ; sudden flushes, starting at trifles ; tongue 
coated, most at root, clearing off in patches, leaving red surface; no 
menstruation. 

Sulphur, heat of the head with cold feet ; inclination to religious reve- 
ries; inflammation of the eyelids; frequent, unsuccessful desire for stool; 
leucorrhoea ; oppression of the chest with palpitation of the heart ; exhaustion 
even from talking; feels worse while standing; cutaneous eruptions; sleepy 
in the daytime, restless at night ; perspires easily ; feels faint before dinner. 
Is often necessary as a foundation for the better action of other remedies. 

Besides compare: Alet. far., Alum., Helon., Senecio aur. 



Digest to Chlorosis. 



Inclination to religious reveries: Sul- 
phur. 

Wants to be alone : Cyclam. 

Inclination to lie down : Calc. carb. 

Indisposition to work or stir: Bellad., 
Calc. carb. 

to move: Pulsat. 

, and general debility : Bellad. 

Laziness : Ant. crud., Bellad. 

Uneasy in the presence of strangers: 
Sepia. 



Anxious about little things: Conium, 
Nux vom. 

imaginary things : Calc. carb. 

Sadness : Natr. mur. 

Sad, tearful disposition : Pulsat. 

Weeping mood and restlessness: Co- 
nium. 

Melancholy, hysterics: Pulsat. 

Irritable, angry: Nux vom. 

Morose, enjoys nothing : Ipec. 

Peevish : Ant. crud. 



DIGEST TO CHLOROSIS. 



935 



Starting at trifles : Sepia, 



Vertigo: Cyclam. 

when rising: Pulsat. 

on going up stairs : Chic. carb. 

, with sudden redness of face : Ferrum. 

Headache : Ant. crud., Cyclam. 

, as though the brain were mashed, 

with nausea and vomiting : Ipec. 

, with bilious or'sour vomiting, worse 

in the morning : Nux vom. 

, frontal, pressing down upon the eyes, 

worse in morning on rising, better in 
fresh air: Sabina. 

and pain in chest and back, caused 

by fixing the eyes steadily upon some 
object, when sewing ; worse from exter- 
nal pressure : Cina. 

and backache from sitting : Cede. carb. 

Heat of head, with cold feet : Sulphur. 



Eyelids inflamed : Sulphur. 

swollen : Cyclam. 

oedematously: Graphit. 

Around the eyes, puffiness: Phosphor. 

, blue rings: Sabina. 

Ears, ringing in : Ferrum. 
, discharge from : Pulsat. 



Nose, running through day, stoppage at 
night : Nux vom. 

Face pale and earthy : Nvx vom. 

and yellowish : Graphit. 

, and pale lips and gums: Cy- 
clam. 

, and pale mucous membranes: 

I]KC. 

, changing suddenly to fiery red, 

with vertigo: Ferrum. 
, , with cold cheeks and 

hot forehead : Bellad. 
, miliary eruptions on forehead and 

cheeks by spells: Ipec. 



Mucous membrane of mouth pale: 

Ferrum. 
Teeth loose, gums swollen, scorbutic and 

receding from teeth : Carb. veg. 
Tongue coated at root, clearing off in 

patches, leaving red surface : Sepia. 



Before dinner, feels faint : Sulphur. 
After eating, swelling of stomach and 

palpitation of heart : Cede. carb. 
bread or sour things feels badly : 

Nux vom. 
On drinking wine she shudders as though 

it were vinegar : Cina. 
No appetite : Ant. crud., Cyclam., Pulsat. 
Craving for chalk : Nux vom. 
for sour things and indigestible 

things (chalk, coal, etc.) : Calc. carb. 
Disgust for meat: Calc. carb. 
No thirst : Cyclam., Pulsat. 



Belching: China. 

Nausea when in a crowd : Sabina. 

from the smell of cooking : Sepm. 

and vomiting after eating and from 

motion: Ferrum. 

, and in the morning : Nux 

vom. 

Vomiting of ingesta and colic: Cina. 

Burning in pit of stomach, with twisting 
and gurgling in bowels : Sabina. 

Cardialgia, with wind in stomach, worse 
from drinking something hot : Nux vom. 

Indigestion: Pulsat. 

and bloated abdomen : China. 

Stitching pain in liver region: Carb. 
veg. 

Constipation : Cyclam., Nux vom., Plum- 
bum. 

Irregular stool : Ant. crud. 

Frequent, unsuccessful urging : Sulphur. 

GBdema of abdominal parietes: Graphit. 

Ovarian region, stitching pain in the: 
Sepia. 

Prolapsus uteri and vaginae: Sepia. 

Bearing down : Sabina, Sepia. 

Sexual desire diminished : Natr. mur. 

Aversion to coitus : Graphit. 

Weakness of sexual organs after pre- 
vious irritation : Phosphor. 

Menses too early and too profuse: Calc. 
carb. 

commence at an early period, pro- 
fuse, but cease afterwards : Ant. crud. 

wanting or suppressed: Ant. crud., 

Calc carb., Coniurn, Cyclam., Ferrum, 



936 



BLOOD. 



Graphit., Natr. mur., Pulsat., Sabina, 
Sepia, 

Menses scanty, painful: Cyclam. 

, pale, delaying : Graphit. 

, slimy, too late : Puhat. 

watery : Ferrum. 

Instead of the menses, whitish, watery, 
slimy, profuse, sometimes acrid and cor- 
roding leucorrhoea : Phosphor. 

Leucorrhcea: Calc. carb., Carb. veg., Natr. 
mur., Sulphur. 

yellowish and passing away in starts : 

Sepia. 

Vagina cool : Graphit. 

of a brown-reddish color : Sepia. 

, diphtheritic ulcers in : Sepia. 

External organs oedematously swollen: 
Graphit. 

, with itching, burning and sore- 
ness: Sepia. 

Genitals very sensitive; Conium. 



Dry, hacking cough : Phosphor. 

Oppression of chest and shortness of 
breath : Bellad., Calc. carb., Pulsat. 

and want of breath from motion: 

Plumbum. 

and anxiety of chest : Natr. mur. 

and palpitation of heart: Ferrum, 

Sulphur. 

Palpitation of heart: Cyclam., Plum- 
bum, Pulsat, Sepia. 

and fluttering: Natr. mur. 

from walking : Calc. carb. 

Hard thump of heart, occasionally, and 
intermitting pulsation : Sepia, 

Bellows-sound in heart and ansemic 
murmurs in arteries and veins: Ferrum. 

Soft, irregular pulse : Pulsat. 

Weak pulse : Ipec. 



Curvature of spine : Calc^carb. 



Spasmodic yawning : Cina. 
Constant drowsiness : Cyclam. 
Sleepy and lassitude: Sabina. 

and weary in afternoon : Bellad. 

in daytime, restless at night : Sulphur. 



Deep and unrefreshing sleep at night: 

Ant. crud. 
Wakes early in the morning, dozes again 

and feels worse afterwards : Nux vom. 
Anxious dreams: Conium. 



Cold hands : Ipec. 

, fingers sometimes appear dead : Calc. 

carb. 

and feet; feet damp: Calc. carb. 

Cool skin : Ipec. 

Constant chilliness : Cyclam. 

and evening fever, similar to hectic 

fever: Ferrum. 
Intermittent fever at 4 p.m., with thirst 

and coldness of hands and feet: Cina. 
Chilliness, coldness and paleness of skin 

and face, with hot flashes and transitory 

redness of cheeks : Pulsat. 
Sudden flushes : Sepia. 
Heat and sweat, followed by deep sleep : 

Cina. 
Dry heat all over, without thirst: Co- 
nium. 
Perspires easily : Sulphur. 



Drawing pain in extremities, worse at 
night: Sabina. 

Heaviness in limbs : Conium. 

Wretched all over, can scarcely walk: 
Carb. veg. 

Must lie down for hours : Ant. crud. 

Muscular weakness : Calc. carb., Plum- 
bum. 

, easily exhausted from slight exer- 
tion: Ferrum. 

Debility, trembling, fainting: Arsen. 

Exhausted from talking: Sulphur. 



Cutaneous eruptions : Sulphur. 
Dropsical effusions and (Edematous 

swellings: China. 
CEJdematous swelling of body: Ferrum. 
of feet and anasarca : Plumbum. 



Better in open air : Pulsat. 
from weeping: Cyclam. 



SCURVY, SCORBUTUS. 



937 



Worse from motion : Bryon. 

while standing: Sulphur. 

Dreads fresh air: Cyclam. 
and motion : Nux com. 



Caused by mental emotions, fright, grief, 
disappointed love : Ignat., Phosphor. 

loss of vital fluids: China. 

, night -watching : Phosphor. 

protracted illness: China. 

COMPLICATED WITH: 

A disposition to heart and kidney dis- 
eases: Pulmt. 

stomach, liver and intestinal affec- 
tions: Xuz vom. 

laryngeal, tracheal and intestinal af- 
fections: Cuprum. 

phthisis, haemoptysis, menorrhcea, 



scrofulous inflammation of eyes, diar- 
rhoea, ascarides, etc.: Ferrum. 

A disposition to tubercular diathesis: 
Phosphor. 

cold and diarrhoea : Calc. carb. 

itch and fluor albus : Garb. veg. 

intermittent affections : Ignat., Pulsed. 

dead, dirty, withered skin : Xatr.mur. 

sweating of feet : Cuprum. 

Total loss of energy in all the functions 
of the body : Phosphor. 

Pernicious anaemia : Arsen. 



Cyclam. is similar to Pulsat., but distin- 
guished by its dread to fresh air. 

Pulsat. is frequently indicated after Calc. 
carb., Ignat., Sepia, or Sulphur, and is 
followed well by Ferrum. 

Sulphur is often necessary as a foundation 
for the better action of other remedies. 



8. Scurvy, Scorbutus. 

This disease belongs to the general disorders of nutrition, and is charac- 
terized by an intense general cachexia in connection with various local erup- 
tions, and disorders of a hemorrhagic and hsemorrhagico-inflarnrnatory char- 
acter, most constantly observed in the gums. 

The occurrence of scurvy so extraordinarily frequent in the middle ages, 
has become much less frequent in our times; but it is still occasionally ob- 
served on the land in times of famine, in places undergoing siege, in poorly 
ventilated dwellings, and in cold and damp regions and seasons ; on the sea 
during long voyages upon sailing vessels, and especially when a gloomy and 
anxious state of mind and poor food enter this combination of circumstances. 
As regards food there is no doubt, that a deficiency of fresh meat and vege- 
tables, especially potatoes and greens, induces the disease in many cases. 
And because these articles of diet contain a greater percentage of potash, 
than salt meat, dried beans and the like, some authors have unreservedly laid 
the cause of scurvy in a deficiency of potash in the food. This, however, is 
obviously wrong, since many outbreaks of scurvy are recorded where there 
was no lack of these articles. Hence, it can also be seen that a mere dietetic 
treatment will not always suffice for a cure, But there are still other con- 
ditions mentioned under which scurvy has been seen to develop, namely : 
convalescence from typhus and acute exanthemata, surgical diseases, especi- 
ally in military hospitals, and the dwelling together of old people in beneficiary 
hospitals. Its onset is usually insidious and its course lingering. We ob- 



938 BLOOD. 

serve at first a general debility, lassitude, sleepiness and depression of spirits ; 
a sad-looking, pale, cachectic face, with blue rings around the eyes ; loss of 
appetite, except perhaps in some cases a craving for fresh, green or sour 
things ; the stool is slow, the urine scanty and the skin dry. With all this 
there are aching pains, especially -in the popliteal space, with circumscribed 
hardness and a light bluish color. After a few days the gums become 
swollen, spongy and bluish; they bleed at the slightest touch. There is a 
bad taste in the mouth and a fetid breath. The general debility increases ; 
ecchymosed spots appear on the skin; first on the legs, later all over the 
body, from the size of a lentil to that of a half dollar and larger, at first 
looking purple, in severe cases black, later changing into all the different 
hues which extravasated blood undergoes; frequent nosebleed. All these 
symptoms may reach a still higher degree ; the weakness may augment to 
prostration, so that even the slightest exertion or motion causes fainting; the 
gums may issue a fetid, ichorous, bloody fluid; the ecchymosed spots may 
change into blisters, filled with ichorous fluid and forming ulcers. 

The pain in the extremities may grow still severer, and the joints and 
bones may swell ; effusions of fibrin beneath the skin may harden the legs 
like boards. The hard stools may change into a thin, ichorous and bloody 
diarrhoea, with colicky pains. The spleen is usually enlarged. Epistaxis in- 
creases, and there are even bloody secretions from the conjunctiva, respira- 
tory organs, stomach (by vomiting), and from the urinary organs, in the form 
of bloody urine. 

If to all these symptoms be added extravasation of bloody serum into 
the pleura, the pericardium, the lungs, the brain or its membranes, the pa- 
tient generally dies, either suddenly or gradually in consequence of increasing 
prostration and hectic fever. Of course, all cases do not terminate thus. Its 
duration, however, is long, lasting months, and convalescence is very slow, if 
left to nature. 

THERAPEUTIC HINTS.— Special cases which have been brought 
on by a deficiency of certain articles of food should certainly be supplied with 
these articles, as a matter of course, where it can be done. In other cases 
which owe their origin to other causes, the mere feeding with greens and 
acids will certainly be of no avail. We shall have to look again for help to 
the law of similars. 

Agave Americana, countenance pale and dejected; gums swollen and 
bleeding ; left leg, from ankle to groin, covered with dark purple blotches ; 
leg swollen, painful and of stony hardness ; pulse small and feeble ; appetite 
poor; bowels constipated. 

Amm. carb., hectic fever, profuse haemorrhages from the intestines, 
nose and gums ; falling out of the teeth ; muscles soft and flabby ; emaciatiou. 



SCURVY, SCORBUTUS. 939 

Arsen., the gums bleed readily; fetid smell from the mouth; violent 
thirst, which obliges him to drink frequently, although but little at a time ; 
offensive diarrhoea ; excessive debility ; stiffness and immobility of the knees 
and feet, with violent tearing pains, worse about midnight, better from ex- 
ternal warm applications ; great despondency and restlessness. 

Canthar., pains in the gums; coagulated blood in the mouth; early 
in the morning, in bed ; bloody urine. 

Carb. veg., swelling, receding, and bleeding of the gums; nosebleed; 
readily bleeding ulcers; general physical depression; attacks of sudden 
weakness, like fainting; after too much salty food. 

China, inertia; excessive debility ; haemorrhage from the mouth, nose 
and intestines ; great desire for sour things ; diarrhoea. 

Hydrast., physical prostration; fainty, weak feeling; ulcers on the 
legs. 

Kali phosph., easily bleeding gums; putrid decomposition; prostration. 

Mercur., spongy, bleeding gums, of a sickly appearance; they look 
white along the upper border and recede from the teeth ; bluish color of the 
inner cheeks ; fetid smell from the mouth. Sinking with an indescribable 
malaise of body and soul, obliging him to lie down ; fetid ulcers on the legs, 
which speedily become putrid; spongy, bluish, readily bleeding ulcers. 

Mur. ac, swelling of the gums; scorbutic gums. 

Natr. mur., scorbutic, putrid inflammation of the gums; bloody saliva; 
difficulty of talking, as if the organs of speech were weak. 

Nitr. ac, swelling and bleeding of the gums; the teeth are loose; 
bloody saliva ; putrid smell from the mouth ; after abuse of mercury. 

Nux vom., putrid bleeding; swelling of the gums; putrid ulcers in 
the mouth; cadaverous smell from the mouth; bloody saliva; spitting of 
blackish, coagulated blood, and blowing blood from the nose; pain in the 
limbs ; great weariness and languor. 

Phosphor., the gums bleed easily and stand off from the teeth; sore, 
excoriated spots on the skin ; ecchymosed spots. 

Staphis., the gums are painful to touch and bleed easily on being 
touched ; scorbutic ulcers. 

Sulphur, swelling of the gums, with throbbing pain in them; bleeding; 
fetid smell from the mouth ; sleeplessness at night ; desire for brandy. 

Besides, compare Cistus can., Crotal., Hepar, Kreos,, Sepia, Sulph. ac, 
Terebinth. 



940 BLOOD. 



9. Purpura Hemorrhagica, Morbus Maculosus Werlhofli. 

This is a transitory hemorrhagic diathesis of sporadic occurrence and a 
relatively brief duration, the etiology of which is entirely unknown; its de- 
velopment appears spontaneous. 

In this apparent spontaneity of its occurrence, without regard to age, 
previous health, or inherited predisposition of the individual attacked, it dif- 
fers from haemophilia, scurvy and symptomatic tendency to bleeding, which is 
frequently observed as a consecutive or accompanying symptom of certain 
severe and acute or chronic diseases, such as variola, typhus exanthematicus, 
phosphorus-poisoning, leukaemia, pernicious anaemia, protracted icterus, etc. 

It often begins suddenly, without prodromal warnings, with petechias 
upon the skin or epistaxis ; at other times its outbreak is preceded, for sev- 
eral days, by languor, headache, loss of appetite and even moderate fever. In 
still other cases it commences with rheumatic pains in the lower extremities 
especially the knees and ankles, when it has been called Purpura rheu- 
matica or Peliosis rheumatica. (Schoenlein.) 

The hemorrhagic exanthem may extend over the entire body, and the 
individual spots vary greatly in size, from that of a pinhead to that of a len- 
til, a pea or a bean. The larger ecchymoses are rare, and assume every pos- 
sible shape. These maculae are often interspersed with more or less numerous 
vesicles, which are evidently produced by circumscribed haemorrhages into 
the rete Malpighi from capillary loops of the papillae of the skin. The color 
of the maculae, when fresh, is dark bluish-red ; later it changes successively 
to greenish-blue, brown and yellow. Pressure does not alter the appearance. 
It is exceedingly common for fresh crops to appear at varying intervals dur- 
ing the disease, which brings about the various colors of the different ages of 
these maculae. 

As long as the disease manifests itself as a mere cutaneous eruption, it 
is called Purpura simplex ; when, however, it is attended by haemorrhages 
in other parts, it is called Purpura ha&morrhagica. Such haemorrhages 
may take place from the mucous membrane of the nose, mouth, stomach, 
intestines, urinary passages, genitals in women, and bronchi; they are much 
more common in morbus maculosus than even in severe cases of scurvy ; but 
the bluish-red discoloration, the softening, swelling and spongy character of 
the gums, and the excessive sensitiveness of these parts, which is character- 
istic of scurvy, are entirely wanting. Haemorrhages occur exceptionally also 
within the serous cavities, in the meninges and in the substance of the brain. 
Simple cases pass over in a week or two ; repeated and profuse haemorrhages 
may induce anaemic pallor, dropsical swellings, extreme weakness, fainting 
fits, etc. 



HEMOPHILIA, HEMORRHOPHILIA. 941 

THERAPEUTIC HINTS.— Compare, as the most important reme- 
dies, Crotal., Phosphor., Ledum, Bryon., Hamam., Secale, Arnica, 
Arsen.. Ferr. phosph., Laches., Sulph. ac. ; and incases of Epistaxis, Haem- 
atemesis, or Hematuria, the corresponding chapters. 

10. Haemophilia, Haemorrhophilia. 

By this name is meant a congenital hemorrhagic diathesis, in conse- 
quence of which even the slightest wounds, no matter where, always bleed, 
very profusely. The cause is unexplainable ; we only know that this ten- 
dency to bleed exists in certain families, and is propagated to three or four 
generations; sometimes leaping over one link and appearing again in the 
following. The female members of such families are generally, although not 
always, exempt, but they are very apt to propagate this tendency to their 
male children. 

There are no objective signs by which this diathesis could be recognized 
before the bleeding sets in. Such persons, however, are described as having 
blonde or reddish hair, a very fair skin, with the blood-vessels shining 
through, and blue eyes. In some cases it shows itself immediately after 
birth, as an uncontrollable bleeding of the navel ; oftener during the first or 
second dentition, and in other cases still later. Then the blood oozes unin- 
terruptedly from the slightest wound, as out of a sponge, until the patient 
becomes exhausted from loss of blood. Mere bruises cause large effusions of 
blood into the cutaneous and subcutaneous tissues. Spontaneous bleedings 
from the nose, which are by far the most frequent, or from the lungs, stomach, 
intestines, or kidneys, do not take place until after several bleedings from 
external wounds. Such spontaneous internal haemorrhages are mostly pre- 
ceded by palpitation of the heart, oppression, congestion to the head, pain 
in the limbs, and, in some cases, by painful swellings of the knee and ankle- 
joints. Bleeders seldom reach an old age; in some cases, however, this ten- 
dency to bleed gradually diminishes with the advancing years, and ceases 
entirely at last. 

THERAPEITIC HINTS —It seems that Phosphor, must be the 
main remedy. Compare likewise Secale, and for internal bleedings those 
chapters which treat of the corresponding haemorrhages. Eriger. is said to 
be very efficacious; also: Natr. sulph., Crocus, China, Arsen., 
Hamam. 



942 BLOOD. 

U. Scrofulosis. 

We understand by this term a cachexia which manifests itself as a 
nutritive disturbance in the external skin, the mucous membranes, joints, 
bones, organs of sense, and, above all, in the lymphatic glands, in such a 
manner, that individuals thus affected betray the internal disorder by a 
peculiar habitus. According as the faulty nutrition leads either to an ac- 
cumulation of fatty deposits in certain parts of the body, or to a deficiency 
in fat on account of too rapid growth, scrofulosis has been divided into a 
torpid and an erethic form. The habitus of the first Canstatt portraits in the 
following manner : " uncommonly large head ; coarse features ; thick, swollen 
nose and upper lip; broad cheek-bones; large belly; swollen glands on the 
neck ; soft, flabby muscles." The erethic form he characterizes as follows : 
" conspicuous white skin, which reddens easily, and through which the blood- 
vessels shine forth; red lips and cheeks; bluish color of the sclerotica, which 
gives to the eyes an expression of languor ; the muscles of such individuals 
are thin and flabby ; the weight of the body does not correspond with their 
size, showing a want of solidity of the bones ; their teeth are fair, bluish, 
glistening, long and narrow, and their hair is soft." The majority of cases, 
however, lies between these two extremes, or represent a mixture of the 
characters of both, as it happens with all such classifications. 

The special changes in the skin are eruptions, which usually have their 
seat in the face and on the scalp, and they consist of a superficial dermatitis, 
with exudation of lymph upon the free surface, constituting eczema or im- 
petigo, or, as they are likewise called, tinea or porrigo, etc. Destructive 
processes, like forms of lupus, do not take place until sometimes at a much 
later period. 

The scrofulous affections of the mucous membranes involve most generally 
by their secretion the adjacent parts of the external skin ; thus we find that 
a scrofulous conjunctivitis, otitis or coryza is generally attended by an eczema 
either on the cheeks or about the entrance to the ear or on the upper lip. 
Bronchial and intestinal catarrhs, or catarrhal affections of the urinary or 
sexual organs of scrofulous individuals are generally of an obstinate 
character. 

The scrofulous affections of the joints manifest themselves either as 
dropsical effusions, or as the so-called white swellings, or even as suppurating 
processes, constituting caries of the bone-ends and destruction of the capsular 
ligaments, as found in coxitis, gonarthrocace, etc. 

The bones themselves are attacked by inflammation of their texture or 
lining, constituting either osteitis or periostitis, or caries or necrosis, or all 
combined. 

Scrofulous affections of the organs of sense manifest themselves in the 



SCROFULOSIS. 943 

eyes, either as inflammation of the Meibomian glands, or as conjunctivitis or 
corneitis, which latter not unfrequently leaves behind spots and cicatrices 
upon that organ; in the hose, as obstinate eoryza, or, although only in quite 
rare cases, as lupus ; in the ears, as otitis, which may terminate even in de- 
struction of the petrous portion of the temporal bone. 

The greatest nutritive disturbances are sustained by the lymphatic glands 
of scrofulous individuals. Everywhere, where there is an inflammatory pro- 
cess of the skin or in the mucous membranes, we find the adjacent lymphatic 
vessels and glands participate in that process. The glands swell and inflame, 
and the inflammation spreads from the parenchyma of the glands to the 
surrounding cellular tissue, causing suppuration and abscesses, which are of 
slow growth and great obstinacy, leaving on healing almost always ugly 
cicatrices. We find these glandular abscesses most frequently in the cervical 
region. But the lymphatic glands of scrofulous individuals swell also with- 
out any inflammation of neighboring organs. 

This is almost a pathognomonic sign of scrofulosis. We sometimes find 
whole convolutes of these glands enormously enlarged. The microscope 
shows no foreign elements in them ; their enlargement consists therefore in a 
pure hypertrophy of their own cells. When they inflame and suppurate, 
they form, as above stated, abscesses, which break ; in other cases, the puri- 
form matter becomes desiccated into a cheesy mass, and may be finally trans-, 
formed into a chalky substance, when it appears under the skin as a hard, 
uneven protuberance. Such chalky masses not unfrequently irritate the 
adjacent parts, and give rise to troublesome inflammation and suppuration 
of the glands. The main seat of these glandular swellings is the cervical 
region, especially behind the ears and under the lower jaws, extending some- 
times as far down as the shoulders. But the bronchial and mesenteric glands 
also are not unfrequently the seat of this nutritive derangement. 

Scrofulosis is inherited as well as acquired. Inherited from scrofulous 
parents ; also from parents suffering with tuberculosis, carcinoma or tertiary 
syphilis ; or from parents of advanced age ; or, finally, from parents who are 
too near relatives. Still, it must be observed, that quite a number of chil- 
dren of parents, as described above, are found entirely free of any scrofulous 
taint, whilst on the other hand congenital scrofulosis is met with in children 
whose parents belong to none of the above specified descriptions. Acquired 
it may be by poor or faulty diet, or by the want of exercise and fresh air ; 
frequently by the joint action of different unhealthy influences. 

Its course is always chronic; sometimes periodically improving, and 
then growing worse again. Its worst feature is its tendency to make children 
prone to the worst forms of illness of childhood, such as croup, hydrocephalus 
and tuberculosis, with which they combine and which they aggravate. 



944 BLOOD. 

Statistics show that most of the victims of these diseases are scrofulous chil- 
dren. 

THERAPEUTIC HINTS.— Compare in general, as the most import- 
ant remedies, Aim rub., Asaf., Aurum, Badiaga, Baryt. carb., Bellad., Calc. 
carb., Calc. phosph., Cistus, Conium, Hepar, Iodium, Lycop., Mercur., Natr. 
mur., Rhus tox., Sepia, Silic, Sulphur, Theridion, "I always interpolate, 
when the best chosen remedies fail, and allow it to act for at least eight 
days." (Baruch.) 

For special hints, reference is made to the special ailments under their 
respective heads, and to Goullon's Scrofulous Affections, translated by E. 
Tietze, M.D. 



FEVER. 



Fever is characterized by these two points : an increase of temperature 
of the body and a rapid consumption of bodily substance. 

Without an increase in the natural heat of the body, there is no fever. It 
is necessary, therefore, to know something about — 

Clinical Thermometry. 

The normal temperature in the axilla of a healthy person ranges between 
97.25° and 99.5° F. ; the mean is 98.6° F. This temperature is nearly the 
same in all climates, and keeps its standard alike in summer and winter. Its 
daily oscillations are most marked after meal-times, when there is a slight 
rise. The mean temperature we find a short time before the main meal, its 
maximum about four hours after the main meal, and its minimum in the 
night hours. 

In order to ascertain the degree of temperature of a person, it is sufficient 
that the bulb of the instrument be held for five or ten minutes firmly in the 
hand, or, what is much more preferable with patients, to insert the bulb into 
the axilla, taking care that it be entirely surrounded by the adjacent parts. 
This is easily secured by slightly pressing the upper arm against the chest. 

In this way the instrument is kept in a firm position, and after the lapse 
of five or ten minutes the quicksilver partakes of the same degree of warmth 
as the surrounding parts, and its expansion can easily be read on the scale of 
the instrument. 

"A normal temperature does not necessarily indicate health; but all 
those whose temperature either exceeds or falls short of the normal range, 
are unhealthy." 

"The range of temperature in severe diseases is between 95° F. and 
108.5° F., and very seldom falls below 91.4° F., or rises to 109.4° F., though 
in rare cases it has reached 112.55° F." "Alterations of temperatuae may 
be confined to special regions, whilst the rest of the body remains almost 
normal ; they seldom exceed 1.8° to 2° F." "A rapid increase in the heat 
60 (945) 



946 FEVEE. 

of the body, and decrease of the heat of the extremities, is associated with 
'cold shivers, rigors, fever-frost.'" 

"A protracted temperature of 101.3° F., or more, is usually accompanied 
with heat, lassitude, thirst, headache, frequency of pulse ; if persisting, with 
diminution of body- weight, ' pyrexia,' fever, fever-heat." "Any considerable 
diminution of warmth in the extremities, with very high, or very low central 
temperature, is expressed by a small pulse, sunken features, weakness, nausea, 
cold sweating, collapse." 

"Temperatures much below 96.8° F. are 'collapse' temperatures. Below 
92.13° F. deep, fatal algide collapse. 

92.3° to 95° F. algide collapse with great danger, still with possibility 
of recovery. 

95° to 96.8° F., moderate collapse, in itself without danger. 
99.5° to 100.4° F., sub-febrile temperature. 
100.4° to 101.12° F., slight febrile action. 

101.3° to 102.2° F. in morning, rising to 103.1° F. in evening, moderate 
fever. 

103.1° F., in morning and about 104° F. in evening, considerable fever. 
103.1° F. in morning and above 104.09° F. in evening, high fever. 
107.6° F. and above indicates a fatal termination, except in relapsing 
fever ; hyperpyretic temperatures." 

" There is often a contrast between the temperature and the frequency of 
the pulse; though as a rule, slight febrile heat coincides with a pulse of 80 
to 90; moderate fever with 90 to 108; considerable fever with 108 to 120; 
extreme heat with 120 and upward per minute." 

"A pulse rather slow in proportion to the temperature is favorable as in- 
dicating a tranquil nervous system. A low pulse with high temperature in- 
vites us to look for spinal cause, as pressure on the brain, depressing action 
of drugs, etc." 

"A low temperature and frequent pulse points to local complications in 
the thorax or pelvis. Not forgetting, however, that moving accelerates the 
pulse." 

" The number of respirations per minute does not correspond so closely 
to the temperature as the frequency of the pulse. In collapse there is often 
(not always) a frequency of respiration, and in slight fever of childhood also ; 
in moderate fever the respirations amount to 20 or so per minute ; in children 
to 40 or 50. In considerable or extreme degrees of fever they are higher 
yet, 60 in many cases; movement also increases their frequency. In other 
cases a quickened respiration indicates local causes." {Medical Thermometry 
and Human Temperature, by Wunderlich and Seguin.) 

The temperature in special diseases is stated in the corresponding 
chapters. 



CRISIS AND CRITICAL DAYS. 947 

Crisis and Critical Days. 

Already Hippocrates, in the twenty-fourth aphorism of the second book, 
teaches in regard to critical days as follows : " Of seven days, it is the fourth 
that is indicative. With the eighth day begins the second week. The 
eleventh again must be observed, because it is the fourth day of the second 
week. So also must be noticed the seventeenth day, as it is the fourth from 
the fourteenth and the seventh day from the eleventh." And in aphorism 
thirty-six, in the fourth book, he says : " Such sweats, which occur in fever- 
patients on the 3d, 5th, 7th, 9th, 11th, 14th, 17th, 21st, 27th, 31st or 34th 
day, are salutary, because they bring on a favorable turn in the disease. If 
sweats, however, occur on other days, they denote exhaustion, obstinacy and 
relapse of the disease." 

These remarks are no doubt the result of a large amount of observation 
on fever-patients, which, having been left to nature, afforded a clear basis 
for observation. As such, they have been verified up to this day. As the 
most important of these critical days are acknowledged, according to von 
Grauvogl, the 3d, 5th, 7th, 13th and 21st. Why is it that these days should 
have more importance in the course of a disease than others? Is there any 
natural connection between these odd numbers and the diseased states of -the 
body? The old school has acknowledged the Hippocratic facts, but has 
never succeeded in solving the perplexed question. Just as many other 
things, which belong to the interior vital workings, could not be solved until 
the higher light of Homoeopathy had been made to shine upon the organism, 
so also had this problem to wait until Dr. von Grauvogl caught the seemingly 
loose and unconnected threads between odd days and certain developments 
in disease, and showed their legitimate connection by nature's own laws. I 
shall try to condense his views on this subject as he has set them forth elab- 
orately in his Lehrbuch der Homozopatkie. 

According to physiological experiments it appears that a living organis- 
mus, when it is subjected to a starving process, does not loose its bodily sub- 
stance evenly, but rather periodically, so that its greatest losses always fall 
upon the 5th, 8th and 13th day. Thu3 the operations in a living organism 
differ essentially from mere mechanical or chemical operation. If you, for 
example, expose a vessel with water to an equally dry atmosphere, it will 
lose its contents by evaporation evenly, just so much an hour. The living 
organism does not. It regulates its expenditures, or its losses, according to 
its own laws, which allow its receipts and expenditures to oscillate between 
a certain bondary, and make its operations to go on in regular periods. 
These periodical fluctuations are, therefore, the law of normal life, part and 
portion of all its evolutions in health and disease, and are not peculiar to 
states of disease. When, therefore, in diseases on the 3d, 5th, 7th, 13th, 21st 



948 FEVER. 

and 35th day, a greater amount of losses sets in in the form of excretions, 
such as sweat, flow of urine, diarrhoea, etc., which is called the crisis, it is 
nothing more nor less than the same periodic oscillation which is going on 
continually in the living organism, and which becomes only more conspicuous 
in disease, because it is frequently followed by a decided improvement or 
death. 

It necessarily must become more conspicuous, because this periodical 
loss is added to the extra consumption, which is a condition of the acute dis- 
ease. If the physical state of the patient be such as to endure both, he, of 
course, must feel better the next day, when the periodical acme ceases; and 
he dies, if his physical power cannot endure the united action of both. 

Thus the critical days of the disease are nothing more nor less than the 
normal, periodical fluctuations of the living organism, with which they cor- 
respond ; and the crisis is that critical day with its normally increased ex- 
cretions, which falls together with the height of the disease. These observa- 
tions are corroborated by the following facts : that the so-called crisis does 
not appear when, during the course of a disease, the organism is weakened by 
improper medication, because then the natural periodic fluctuation is dis- 
turbed and destroyed ; and it does not appear when, by the application of the 
proper remedy, health is restored ; because the periodic fluctuation alone is 
not conspicuous enough to be observed. 

It is, however, never wanting when the disease runs an undisturbed 
course; and, in so far, it is an important means to distinguish between a 
successful and an unsuccessful treatment. This is the theory of Grauvogl. 

It may be proper to add some further conclusions as to the importance 
of watching the critical days during homoeopathic treatment. 

1. The right remedy cures a disease without a crisis; and thus we have 
an indisputable proof that the selected remedy was the remedy. 

2. Aggravations after a remedy, when they occur on critical days, need 
not be the result of the remedy, as the conjoined action of the disease and 
the periodical oscillation alone will cause them naturally. 

3. When, after the administration of a homoeopathic remedy, a crisis 
takes place notwithstanding, we may be sure that we did not "hit" the case, 
and that the patient got well without our aid. 

4. When no crisis appears, and the patient gets worse and worse, it is 
clear that we did not find the right remedy, and we may even have spoiled 
the case by WTong means. 

Lastly, it seems to explain the observation that in most chronic cases 
the well selected remedy develops its action visibly not before the eighth day, 
and that we then ought not to disturb its action either by repetition or 
change, before the thirty-fifth day. 



INTERMITTENT FEVER, FEVER AND AGUE. 9-49 



Intermittent Fever, Fever and Ague. 

This fever is caused by a poison, which, under certain conditions, origi- 
nates in marshy lands, swamps, in low regions near rivers, in newly settled 
places which just came under the hand of cultivation; in the neighborhood 
of canals when first dug; in regions which seemingly lie dry, but contain a 
great deal of underground water; the dryer the surface the greater the 
effluvia from underneath the porous and cracked crust. This poison is called 
swamp-miasma, or malaria. Its nature is entirely unknown, but differs totally 
from typhus, small-pox, scarlatina and measles virus, as it never is propa- 
gated or carried from one person or place to another. Although swamps, 
damp, low regions, etc., are necessary for its development, yet they seem not 
the only conditions under which malaria is generated. Neither does the 
heat of the sun, the decay of vegetable substances, explain fully its presence 
here and its absence there ; because there are large tracts of land where all 
these conditions exist without any sign of miasma; whilst, on' the other hand, 
we find small, confined districts in which ague prevails every spring and 
summer. Another peculiarity of the poison is, that it seems to spread hori- 
zontally, so that it is often prevented from spreading further by a wall, a 
hedge, unless carried over these obstacles by a blast of wind. In those places 
where the miasma develops itself, ague prevails endemic; but how widely 
spread epidemics of intermittent fever originate is wholly unexplainable. 
So, also, have great ague epidemics been the forerunner of the Asiatic cholera ; 
in hot climates both are often found together, and still more frequently go 
hand-in-hand, typhus fever, dysentery, influenza and ague ; all which facts 
we cannot explain. Quite inexplicable is also the occurrence of sporadic 
cases in places where the miasma never prevails, and the attacked person 
had never been in a malarial region. 

Besides this malarial theory of origin we have a neurotic, a cryptogamic 
and also a splenic theory as to the cause of intermittent fever. 

The liability to invasion by the miasma is a very general one; no age 
or sex being exempted. Unlike small-pox, scarlatina, etc., the liability to 
repeated attacks increase after the first invasion. Persons thoroughly satu- 
rated with the poison may not suffer any more with acute outbreaks of 
chills and fever, but are more subject to a chronic enlargement of the spleen 
and a malaria cachexia. 

The time of incubation is not known with certainty; in some cases the 
poison seems to develop its consequences at once, and in others it seems to 
linger in the system from six to twenty days, in still others three, six and 
even nine months. Before, however, it produces its own characteristic type 
of paroxysms of chills and fever, with intervals of immunity — apyrexia — it 



950 FEVER. 

often manifests itself for a while only as a general indisposition — a general 
malaise and disturbance of different functions. 

The real paroxysm of an intermittent fever consists of three stages — the 
chill, the heat and the sweat. 

The cMlly stage may last from a few minutes to full three hours. During 
this stage the appearance of the patient is remarkably altered; his whole 
volume seems to shrink; his face appears sunken, his nose pinched, and the 
rings on his fingers (if he wears any) become quite loose. The arterial blood 
is prevented from reaching the surface, while the venous blood is stagnated 
in the capillaries; this makes the skin pale and the lips and nails blue. The 
whole surface is cold, and covered with the well-known appearance of 
goose-skin (cutis anserina). The internal temperature, however, increases 
rapidly from two to three, even to five and seven degrees above the normal 
standard. The attending symptoms of this stage are numerous and various — 
headache, thirst, colic, cough, oppression, backache, etc., etc.; either one, or 
all, or still others, may exist in a lighter or graver degree or not at all at 
that stage. 

The stage of heat creeps on slowly, still intermingled with chilly sensa- 
tions. Finally, the whole body is in a perfect blaze; the temperature rises 
still higher and remains so until near the end of this stage. There have been 
cases observed where the thermometer rose to 108.5° and 109.4° F. Physical 
examinations may also detect a swelling of the spleen, which, having com- 
menced during the chill, reaches its height during this stage. The heat 
generally lasts from a few to eight, or even twelve hours. Here, too, as in 
the chilly stage, the attending symptoms vary in number and character in 
each individual case. 

The third stage, that of sweat, finally closes the paroxysms, and, in most 
cases, greatly relieves the sufferings of the patient. The temperature sinks 
step by step till at last the patient feels more or less completely well again. 
There are, however, enough cases in which this last stage is likewise attended 
by a number of various symptoms, which, indeed, are important, like those 
of the first and second stage, in regard to the selection of the remedy, but 
have no particular bearing on the diagnosis of the case. 

The apyrexia which now follows is very seldom entirely free of all mor- 
bid manifestations, and these are likewise numerous and various, and for the 
observant homoeopathic physician of the highest importance. Just these 
manifestations may present to him the hints which will lead him to the dis- 
covery of the required remedy for the case. 

When an intermittent fever develops its paroxysms in these three stages, 
and in this order, it is called intermittens completa; when, however, one or 
the other of the stages is wanting, it is called intermittens incompleta; and 
when the order of its stages is reversed, so that, for example, the paroxysm 



INTERMITTENT FEVER, FEVER AND AGUE. 951 

commences with sweat and ends with the chill, it is called intermittens 
inversa. 

The apyrexia is, in different cases, of variable duration. It may last 
only six, eight, or twelve hours, so that the new paroxysm sets in after 
twenty-four hours from the ene preceding, then it is called a daily or quo- 
tidian fever; if twice twenty-four hours elapse between the paroxysms, it is 
called a tertian fever; and if three times twenty-four hours intervene, it is 
called a quartan fever. Sometimes it recurs only every seventh day — inter- 
mittens septiana. 

The most frequent forms are the quotidian and tertian. Sometimes it 
happens that the paroxysms keep no regular times ; they either set in each 
time earlier (anticipating), or later (postponing). In such cases it may come 
to pass that the original type is altogether changed into another; for ex- 
ample, a quotidian by postponing into a tertian, or a tertian by anteponing 
into a quotidian. When a fever-paroxysm lasts so long that its end reaches 
to the beginning of a new paroxysm, it is called a febris intermittens sub- 
intrans. When, however, the intervals of a quotidian, tertian, or quartan 
fever are again interrupted by another paroxysm, then it is called a febris 
intermittens duplicata. The double quotidian consists of two paroxysms 
within twenty-four hours, the intervening being generally lighter than the 
original. The double tertian has one paroxysm every day, mostly at differ- 
ent hours, and again the intervening lighter than the original ; while the 
double quartan has two paroxysms in three days, and in this way, that two 
successive days are fever days, and the third day is free. 

Masked intermittents show themselves usually as typical neuralgias, in 
the course of one or another nerve-trunk, which, however, cannot be dis- 
tinguished from other neuralgias, except by their typical recurrence; they 
manifest themselves also in the form of intermittent hyperemia, haemorrhage, 
oedema, coryza, bronchial catarrh, etc., as typical skin affections, such as 
erysipelas, purpura, urticaria, pemphigus, and in many other typical forms 
of diseases. 

A long- continued, oftentimes suppressed intermittent fever frequently 
terminates in dropsy in consequence of existing functional disturbances of 
the spleen, which gradually become an organic lesion, or in chronic paren- 
chymatous nephritis, or scorbutic affections and general ague cachexia. 

THERAPEUTIC HINTS.—- Aeon., in recent cases of young individ- 
uals of a full habit; all the stages must be sharply marked, with a prominent 
congested state of the head and chest. The pulse is full, hard and frequent. 
During the chill internal heat, with great anxiety, sensitiveness and restless- 
ness; the pupils are contracted. The heat is confined mostly to the head and 
face; great thirst for cold water and inclination to uncover. The sweat is 



952 FEVER. 

most prominent on the parts covered, and is attended with earache and pro- 
fuse micturition. 

Ant. crud., predominant gastric symptoms : thick-coated tongue; bitter 
taste; nausea; belching; vomiting; loss of appetite ; little or no thirst; pain 
in the bowels, diarrhoea or constipation. Sweat breaks out after the chill 
with the heat but soon disappears, dry heat continuing. 

Apis, according to Wolf, is one of the most important remedies in all 
kinds of intermittent fevers, and indeed has been used everywhere with great 
success. Chill with thirst about three or four o'clock p.m.; worse in a warm 
room or near the stove ; renewed chilliness from slightest motion, with heat 
of the face and hands. Heat, especially in the chest, pit of the stomach, 
bowels, female organs and hands, with muttering and unconsciousness; 
diarrhoea; shortness of breath; drowsiness or sleeplessness; rarely thirst. 
Sweat alternates with dryness of the skin; no thirst. Nettle-rash during 
sweat or apyrexia. During the apyrexia, pain under the short ribs, worse on 
the left side; great soreness of all the limbs and joints; great debility; en- 
largement of the abdomen ; swollen feet and scanty urine. Apis is therefore 
indicated not only in recent but also in protracted and badly-treated cases 
After it Natr. mur. follows well. 

Arnica, before and during the chill great thirst; drinks a great deal, 
and vomits afterwards; yawning and stretching; pain in all the bones; bed 
and sofa feel too hard ; the chill is felt worst in the pit of the stomach ; cold 
hands and feet, with heat in the head and face, and reduess of one cheek ; 
heat, with indifference, stupor ; drinks less; the sweat smells sour; during the 
apyrexia stitching pain in the region of the spleen ; soreness of the spleen on 
pressure; aching in all the limbs as though beaten. 

Arsen., intermittens incompleta. Before the attack: vertigo; head- 
ache; yawning; stretching; general discomfort; weakness; pain in the pit 
of the stomach and empty eructations; cutting pain in the bowels. The chill 
is frequently intermixed with heat; or heat and chilliness follow each other 
in rapid succession ; or the patient feels cold inside and burning hot outside. 
During the chill: generally no thirst; if there be any, drinking increases 
the chill and causes vomiting; oppression and spasms in the chest, with hack- 
ing cough ; bloatiug of the pit of the stomach ; pain in the pit of the stomach ; 
anxiety, restlessness ; blue nails. The heat is either wanting, or mixed up 
with the chill, or is very great, with delirium, unconsciousness and headache; 
restlessness ; anxiety ; pulsation through the whole body ; tension and press- 
ure in the left hypochondrium ; burning in the stomach; generally great 
thirst, but drinking little at a time ; also drinking a great deal at a time ; 
oppression and short breathing ; palpitation of the heart. The sweat sets in 
some time after the heat, or does not appear at all ; during the sweat the 
thirst is often the greatest, and the patient drinks large quantities of water; 



INTERMITTENT FEVER, FEVER AND AGUE. 953 

the symptoms of the former stages become ameliorated. The apyrexia is 
never clear. The face is pale, sunken, earthy, sallow, bloated ; the lips are 
pale, cracked, swollen and crusty; the tongue is white and dry, or coated 
yellowish ; the taste is gone, without bad taste, only after eating, bitter taste ; 
the appetite is sometimes increased for a while, satisfying it causes heat and 
nausea, and not satisfying it causes an unpleasant sensation of discomfort ; 
the hypochondriac regions are swollen, especially the left, the abdomen is 
bloated ; the stools are diarrhoeic, fetid; the urine is rather scanty and turbid, 
the feet are oedematous; the skin is pale, often covered with cold perspiration; 
there is sleeplessness, especially the night before a new paroxysm, and great 
sinking of general strength. 

Bellad., the heat predominates, with vertigo, hallucinations, delirium, 
restlessness, anxiety ; drowsiness with inability to go to sleep, or sopor ; head- 
ache, throbbing in right temple, injected eyes, and sensitiveness to light ; red 
cheeks ; throbbing of the carotid arteries ; choking sensation in the throat ; 
great thirst and dryness of the mouth and throat; palpitation of the heart; 
painful swelling of the spleen; constipation; great irritability of temper, or 
else tearful mood. 

Bryon., the chill predominates, only exceptionally the heat; great 
thirst during the chill, still greater during the heat; the sweat lasts long. 
There are, as the most important leading symptoms: stitching pains in the 
sides of the chest, with hard cough; stitching pain in the hypochondriac 
regions and in the abdomen ; rheumatic pains in the limbs ; all worse from 
motion. 

Cact. grand., regular paroxysms at 11 o'clock, a.m. or p.m.; first 
chill, then burning heat, with headache, coma, stupefaction, insensibility; 
thirst, shortness of breath, inability to remain lying. The sweat is profuse 
and attended with inextinguishable thirst. The apyrexia is complete. 

Calc. carb., chronic cases; chill commences in pit of stomach ; thirst 
during the chill. General indications ; hardness of hearing ; pot-belliedness ; 
hard, bloated stomach; enlarged spleen; diarrhcea white, undigested; 
monthly period too early and too profuse; glandular swellings about the 
neck ; altogether scrofulous diathesis. 

Capsic, chill, mostly with thirst, and worse after drinking; the chill 
commences in the back and spreads all over, and is relieved by hot irons or 
jugs of hot water; after the chill sweat; or heat, with sweat and thirst at the 
same time. During the chill: giddiness and excruciating, tearing pains in 
the back and limbs, extorting cries and causing the patient to bend together 
like a hedgehog. During the heat: cutting pain in the bowels, and slimy, 
burning stools, with much pressing and bearing down ; headache. 

Carb. veg., irregular paroxysms, sometimes commencing with sweat, 
followed by chill. Before the attack toothache, headache and pain in the 



954 FEVER. 

limbs. During the chill great thirst. Heat and sweat frequently mixed 
together, with evening hoarseness, dizziness, red face, nausea, but no thirst. 
The sweat is sour and sometimes very profuse. Afterwards long-continued 
headache; heat and burning in the eyes; yellow complexion ; liver-spots in 
the face; belching; bad smell from the mouth; stomach bloated; spleen 
swollen and painful; abuse of quinine. 

Cedron, chill at 3 a.m. or 3 p.m., is preceded by mental depression, or 
excitement; during chill no thirst; chill predominates; during heat thirst 
for warm drinks ; numb, dead feeling in legs ; sweat profuse, with thirst and 
tearing pains in extremities. During apyrexia general malaise and great 
debility. 

Chamom., heat and sweat predominate, and are often together; red 
face, or only one cheek red and the other pale; sweat especially about the 
head, and mostly hot. The tongue is red in the middle and white on the 
sides, or white in the middle and red on the edges ; bitter taste ; bitter vom- 
iting ; great oppression about the heart ; diarrhoea. The patient is very irri- 
table, excited, complaining, with great restlessness and anxiety. 

China, the paroxysms come mostly at irregular hours, with thirst before 
(not during) chill or heat and during the sweat ; they are mostly preceded 
by palpitation of the heart with anxiety ; sneezing ; nausea ; hunger ; pressure 
in the stomach; pain in the bowels and jerking, tearing headache; pain in 
the limbs and great debility. During the fever the veins appear greatly en- 
larged, and there is great congestion to the head, with redness and heat of 
the face, even with chilliness and coldness of other parts of the body. The 
sweat is sometimes only partial and cold, for example, on the forehead ; at 
other times it is profuse, and almost always attended with thirst. In general 
the patient sweats easily, especially at night, during sleep; there is swelling 
of the liver and spleen, painful to motion and pressure; a characteristic 
weakness, exhaustion and cachectic appearance, a sallow yellowishness of the 
skin, not only in the face but also on the chest and region of the stomach, and 
different ansemic and dropsical symptoms. The urine is scanty and turbid, 
with a thick yellowish or brick-dust sediment, or a sediment of little crystals. 
The presence of swamp miasma is another indication. 

Chin, sulph., regular paroxysms at the same hour, and clear intermis- 
sions; real thirst mostly only during the sweat. During the paroxysm pain 
in the dorsal vertebrce on pressure; pain in the region of the liver and spleen 
on bending, taking a deep breath, coughing ; the urine gives a voluminous, 
brick-dust-like or fatty sediment, or contains crystals of urates; ringing in 
the ears, with dizziness and enlarged feeling of the head. 

Cimex., before the chill thirst and heaviness in the legs. The chill 
commences with clenching of the hands and violent raging; it is attended with 
pains in all the joints; sensation as if the tendons were too short; the knee- 



INTERMITTENT FEVER, FEVER AND AGUE. 955 

joints are usually contracted, so that the legs cannot be stretched; the chest 
feels oppressed, obliging one to frequently take a long breath ; irresistible 
sleepiness; it ends with a tired feeling in the legs, obliging one to change po- 
sition constantly; with thirst; drinking, however, causes violent headache; 
continuous dry cough ; oppression of breathing ; heaviness in the middle of 
the chest; anxiety. Abstaining from drinking ameliorates all this. The 
heat is attended with gagging ; the oesophagus feels constricted, and the water 
drank goes down only at intervals ; no thirst. The sweat is mostly on the head 
and chest, accompanied by hunger. 

Cina, thirst only during the chill, or only during the heat. Nausea, 
vomiting, diarrhoea, pain in the stomach and abdomen may set in at any 
time, and soon be followed by a clean tongue and ravenous appetite. The 
face is puffed and pale even during the heat, or glowing red; the pupils are 
much enlarged, and the child picks often at the nose. 

Diadema, paroxysms every day or every other day at precisely the 
same hour ; chill predominating ; constant chilly feeling ; always worse on 
rainy, cold days; menses too early and too profuse; enlargement of the 
spleen. 

Eupat. perf., long before the chill great thirst, which continues 
through chill and heat; after drinking, vomiting ; the paroxysms usually 
occur in the morning, about seven or nine o'clock; they are attended with 
intense itching in the back and limbs, as if the bones were broken, and with 
a number of gastric or so-called bilious symptoms; the sweat is generally not 
very prominent, or even wanting, but sometimes drenching, and the inter- 
mission is sometimes marked by a loose cough. 

Eupat. purp., the paroxysm comes at different times in the day, every 
other day ; chill commences in the small of the bach and then spreads over the 
body ; violent shaking, with comparatively little coldness ; thirst during chill 
and heat ; vomiting between chill and heat; violent bone-pains during chill 
and heat. 

Ferrum, similar to Arsen. and China, it will frequently be of service 
in protracted and badly-treated cases by quinine, which are characterized by 
anaemia and total prostration of the reproductive sphere of the system. AVe 
observe great paleness of the face, which, however, may flush up from any 
excitement to a fiery redness of short duration; paleness, whiteness of the 
inner surface of the mouth ; vomiting of everything that is eaten without 
being digested; swelling and hardness in the hypochondriac regions; great 
weakness and emaciation; dropsical swelling of the feet; frequent congestion 
of the lungs; continued shortness of breath; nun's murmur in the veins. 

Gelsem., chill in afternoon or evening, commencing in hands and feet, 
or running up back from sacrum to occiput, without thirst; or only fever at 
10 a.m., without chill and without thirst. The heat is attended with red face 



9o6 FEVER* 

and sleep, or with nervous restlessness, delirium, mental anxiety or agitation, 
vertigo; a curious sensation of falling, sensitiveness to light and sound, par- 
tial blindness or deafness. Where there is a want of distinctness in its several 
stages, the whole presents an adynamic condition of the system. 

Hepar, bitter taste in the mouth; bilous vomiting; diarrhoea; itching, 
stinging, nettle-rash before and during the chill; fever-blisters around the 
mouth ; tettery eruption on the chest ; previous abuse of mercury. During 
the sweat keeps himself closely covered. 

Ignat., thirst only during the chill, or in short spells, independent of 
any stage. The chilliness is relieved by the external application of warm 
things; external heat, or heat in some, and coldness of other parts of the 
body ; sometimes with pain in the bowels ; afterwards sleep and sweat. The 
paroxysms are sometimes accompanied with spasmodic symptoms; heaviness 
of the head; aching pain in the occiput; vomiting and pressive pain in the 
pit of the stomach ; urticaria over the whole body. The paroxysms are apt 
to postpone or antepone. 

Ipec, predominance of gastric symptoms during the paroxysm as well 
as during the apyrexia. It begins chiefly with yawning, stretching and a 
collection of saliva in the mouth ; then follows the chill, aggravated by ex- 
ternal warmth, w T ith or without nausea, vomiting, diarrhoea, or great oppres- 
sion of the chest, with heaving. The three stages may be very strongly 
marked or very light ; the thirst is generally quite inconsiderable in all of 
them. The apyrexia has the same gastric symptoms, especially a marked 
sensation of relaxation of the stomach, as though it were hanging down ; entire 
loss of appetite. The spleen is little, if any, swollen. Miasma; after the 
abuse of quinine and arsenicum ; after faults in diet. 

Laches., one of the most important remedies after the abuse of quinine. 
The paroxysms are mostly in the afternoon, with pain in the small of the 
back and limbs; restlessness; oppression of the chest; jerking; headache; 
red face; talkativeness. During the chill wants to lie near the lire, or be 
held tightly to relieve the pain in head and chest, and prevent shaking. 

Lycop., where there are other chronic symptoms — cough, with thick, 
yellow, salty expectoration; oppression of the chest; pain in the left side; 
palpitation of the heart; pale face, often with circumscribed redness of the 
cheeks; sour vomiting between chill and fever; bloatedness of the stomach; 
rumbling in the bowels; great debility; the sweat is often sour and profuse, 
sometimes following immediately upon the chill, and at other times not until 
some time after the heat; after the sweat, thirst. Fever paroxysms often 
from 4 to 8 p.m. 

Mangan., incomplete intermittent, consisting of only heat and sweat, 
with moderate thirst. 

Menyanth., irregular time and type; chill predominating without 



957 

thirst ; especially coldness of fingers, toes and legs, not relieved by external 
warmth, of abdomen. 

Mezer., incomplete intermittent, consisting of chill with thirst, and 
sweat with sleep. 

Natr. mur., one of the most important of all in recent as well as in 
inveterate and badly treated cases. Hard chill very often at 10 or 11 o'clock 
A.M., with great thirst which continues through all stages. The heat is 
characterized by the most violent headache, relieved by perspfration. There 
soon appears an eruption of hydroa or fever-blisters, which cover the upper 
and lower lip like pearls. During the apyrexia sallow complexion, dry, 
white coated tongue ; bitter taste ; water tastes bad ; loss of appetite ; after 
eating, sour belching and vomiting ; pressure in the stomach ; swollen stom- 
ach; pain in the region of the kidneys; cutting pain in the urethra after 
micturition. 

Nux vom. is characterized by great prostration and paralytic weak- 
ness from the beginning. Hard chill with bluish face and blue nails; stitch- 
ing pain in the abdomen ; spasmodic drawing and stiffness of the lower ex- 
tremities; great thirst; the heat is great, aud notwithstanding this the patient 
covers himself all over, because uncovering or the slightest motion makes 
him feel chilly; headache; great thirst, especially for beer. Both chill and 
heat are accompanied with gastric and bilious symptoms. During the sweat 
the painful symptoms gradually subside. During the apyrexia, headache; 
yellowish complexion ; belching; loss of appetite ; nausea; vomiting; consti- 
pation; liver and spleen swollen ; cough; debility; soreness of the spine. 

Opium, sleep during chill, heat and sweat; during sweat he still feels 
burning hot ; children and old people. 

Podoph., chill at 7 a.m., without thirst; heat with thirst; loquacity 
during chill and heat; sweat with sleep; besides, pain or uncomfortable 
feeling in region of liver which makes him rub and stroke this part; diar- 
rhoea during forenoon, frequently changing in color. 

Pulsat., the several stages are in general not very violent, and mostly 
unattended by thirst ; or thirst only during the heat; or the several stages 
are mixed up; one-sided sweat. The paroxysms set in frequently (though 
not always) in the evening, and last through the night. Characteristic feat- 
ures: tearful and peevish; headache during the intermission; face pale or 
greenish-yellow; tongue moist, coated, with bad taste; loss of appetite and 
thirst; nausea; vomiting of slime and bile; spleen enlarged; stools diarrhoeic, 
slimy, watery, at night; profuse, watery urine; suppressed or scanty menses; 
pain in the chest and cough, with pain in the head and pit of the stomach ; 
frequent palpitation of the heart; murmur in the jugular veins; constant 
chilliness and drowsiness; chlorotic state of the system. 

Rhus tox., before the chill: stretching of the limbs; yawning with a 



958 FEVER. 

feeling in the maxillary joint as if sprained; thirst; dry, teasing cough, with 
sweetish, foul expectoration. Chill in some parts, and in others heat; or 
hard chill, with aching in the small of the back, drawing in the limbs and 
formication in the fingers; with restlessness and constant change of position. 
The heat is sometimes before and sometimes after the chill, and often at- 
tended with nettle-rash ; pain in the bowels and diarrhoea. The following 
sweat if often profuse and sour. The paroxysms set in most frequently in 
the evening and last through the night; they generally return every day, 
but seem altered every other day. 

Sabad., intermittens incompleta, consisting of chills only; or intermit- 
tents with predominating chill, and thirst between chill and heat; the 
paroxysms occur precisely at the same hour; sometimes they are accom- 
panied with morbid hunger in alternation with loathing of food ; during the 
apyrexia there is constant chilliness ; sometimes cough with heavy breathing 
and pain in the chest. 

Sambuc, profuse, debilitating sweat, lasts through the apyrexia, com- 
mences in the face, is worse while the patient is awake, disappears and 
changes to a dry heat when he is falling asleep. 

Sepia, chronic cases, with one or the other of the following symptoms: 
frequent flushes of heat ; paralytic sinking down of one of the upper eyelids ; 
yellowishness of the white of the eyes; brownish-yellow saddle across the 
bridge of the nose ; yellowishness around the mouth ; loathing of meat and 
milk; diarrhoea after drinking milk; pain in the liver on moving; bearing 
down towards the genitals ; palpitation of the heart ; tettery eruptions ; the 
coldness begins in the feet and rises upwards. 

Silic, in scrofulous subjects. 

Stramon., chill, with icy-cold skin, covered with cold sweat; hands 
and feet livid, head and face hot; vertigo; delirium; epileptiform convul- 
sions. Wants to be covered during all stages. 

Sulphur, like Sepia, in chronic cases; especially when rooting in the 
soil of suppressed itch or other cutaneous eruptions, with one or the other of 
the following symptoms : heat on the top of the head with cold extremities ; 
red lips ; red tip of the tongue ; worse always after eating ; sudden attacks of 
faintness, with hunger in the forenoon; costiveness, or else looseness of the 
bowels early in the morning, driving out of bed ; hemorrhoidal complaints ; 
leucorrhoea ; cough when lying down in the evening ; feverishness through 
the night; complete sleeplessness; itchiness of the skin. 

Tart, emet., thirstlessness during chill and fever; shuddering with 
sleepiness; heat with sopor; sweat with sleepiness; fainting; anxiety; and 
pain in the lower extremities. 

Thuja, according to Wolf, if Apis is not sufficient, and the complaint 
originates in a chronic gonorrhoea! contamination of the system; only the 



DIGEST TO INTERMITTENT FEVER. 



959 



uncovered portions of the body perspire; those which are covered are dry 
and hot. 

Veratr., chill at 6 a.m.; chill and coldness predominate, with sticky, 
cold perspiration and thirst ; heat not so marked ; the sweat profuse, often 
cold and long-continuing. Attending symptoms: great exhaustion; sinking 
of strength; nausea; vomiting; diarrhoea, or obstinate constipation ; cramps 
in the limbs. It is indicated, therefore, in the most pernicious kinds of in- 
termittent fevers, and those which occur during the prevalence of cholera. 

For still further particulars, I refer to H. C. Allen's and T. P. Wilson's 
Treatises on Intermittent Fever, and Win. A. Allen's Repertory. 



Digest to Intermittent Fever. 



BEFORE CHILL. 

Mental depression or excitement: Ce- 
dron. 
Vertigo : Arsen. 

Headache : Arsen.; Carb. veg., China. 
Toothache and pain in limbs: Carb. veg. 
Bitter taste, bilious vomiting, diarrhoea: 

Hepar. 
Thirst, drinks a great deal and vomits 

afterwards : Arnica, Eup. perf. 
■ , palpitation with anxiety, sneezing, 

nausea; hunger, pressure in stomach, 

pain in bowels, pain in limbs, and great 

debility: China. 
, dry, teasing cough, with sweetish, 

foul expectoration : Rhus tox. 

, and heaviness in legs : Cimex. 

Yawning and stretching, pain in pit of 

stomach and eructations; cutting pain 

in bowels: Arsen. 
, pain in bones; bed or sofa feel j 

too hard: Arnica. 

, maxillary joint feels as if I 

sprained : Rhus tox. 

, general discomfort, weakness : i 

Arsen. 

Itching, stinging nettle-rash: Hepar. 

Sleeplessness the night before, and j 
great sinking of general strength: Ar- 
sen. 

CHILL BEGINS "WITH: 

Yawning, stretching and a collection of 
saliva: Ipec. 



Clenching of hands and violent raging : 
Cimex. 

TIME OF OCCURRENCE. 

Midnight, after: Arsen. 

3 o'clock A.M. or P.M.: Cedron. 

6 o'clock A.M.: Veratr. 

7 o'clock A.M.: Podoph. 
7-9 o'clock A.M.: Eup. perf . 

10 o'clock A.M.: Stannum. 

10-11 o'clock A.M.: Natr. mur., Sulphur. 

11 o'clock A.M.: Nux vom. 

or p.m.: Cact. grand. 

Noon, about: Nux vom., Sulphur. 
1-2 P.M.: Arsen. 

2-3 P.M.: Laches. 
3 P.M.: Apis, Bellad. 
Afternoon and evening: Gelsem. 
Evening : Nux vom., Pulsat., Rhus tox. 
Any time : Arsen., China, Eup. perf., 

Eup. purp., Ipec., Natr. mur., ■ Nux vom., 

Pulsat., Sulphur. 
Irregular time : China, Menyanth., Sepia. 
At precisely the same hour: Cedron, 

Diad., Sabina. 
Postponing : China, Cina, Ignal, Ipec. 
Anticipating: Arsen., Bryon., China, 

Ignat., Natr. mur., Nux vom. 
Quotidian : Arsen., Carb. veg., China, 

Cina, iJiad., Gelsem , Ignat., Ipec, Natr. 

mur., Nux vom., Pulsat., Rhus tax., Sul- 
phur. 
, double: Ant. crud., Apis, Bellad., 

China, Elater., Siramon,, Sulplvur. 



960 



FEVER. 



Tertian: Arsen., Bellad., Bryon., Carl, 
veg., China, Cina, Diad., Eup. per/., Ig- 
nat, Ipec, Natr. mur., Nux vom., Pulsat, 
Rhus tox. 

, double: Arsen., China, Eup. pur p., 

Lycop., Rhus tox. 

Quartan : Arsen., Carb veg., China, Men- 
yanth., Natr. mur., Nux vom., Pulsat, 
Rhus tox , Sabina, Veratr. 

, double: Arsen., China, Eup. purp ^ 

Rhus tox. 

LOCATION AND DIRECTION. 

Pit of stomach, commences in: Cdlc. 
caib. 

, is felt most in: Arnica. 

Back, between shoulders, commences in, 
and spreads all over, worse by external 
heat: Bryon., Capsic. 

Small of back, commences in, and 
spreads all over : Eup. purp. 

Hands and feet, commences in, or run- 
ning up back from sacrum to occiput : 
Gelstm. 

, coldness of, with heat in head 

and face, and redness of one cheek: 
Arnica. 

Feet, begins in, and rises upwards : La- 
ches., Sepia. 

Fingers, toes and legs, abdomen, cold- 
ness of, not relieved by external warmth: 
Menyanth. 

In some parts, in. others heat: Rhus tox. 

Left hand cold, right one warm: China. 

Icy-cold skin, covered with cold sweat: 
Stramon. 

ACCOMPANIED BY: 
Delirium : Stramon. 
Loquacity : Podoph. 
Anxiety, sensitiveness and restlessness: 

Aeon., Arsen. 
Vertigo : Capsic, Stramon. 
Pupils contracted: Aeon. 
Face bluish and nails bluish : Nux vom. 
and head hot: Stramon. 



Thirst during chill only : Apis, Calc. 



carb., Capsic, Carb. veg., Cimzx, Cina, 
Ignat., Mezer., Nux vom., Veratr. 

Thirst during chill and during heat: 
Eup. perf., Eup. purp. 

and more during heat: Bryon. 

between chill and heat: Sabad. 

during chill and all stages: Natr. 

mur. 

, or in short spells, independent 

of any stage : Ignat. 

, or only during heat: Cina. 

, chill worse after drinking: Arsen., 

Capsic. 
, chill with; but drinking causes 

headache, dry cough, oppression of 

breathing, heaviness in middle of chest, 

anxiety: Cimex. 
, without: Arsen., Cedron, Gelsem., 

Menyanth., Podoph. 
, , during chill and fever: Tart. 

emet. 
Morbid hunger or loathing of food : So- 
bad. 
Gastric and bilious symptoms : Eup. perf., 

Nux vom. 
With or without nausea, vomiting and 

diarrhoea: Ipec. 
Vomiting after drinking : Arsen. 

between chill and heat: Eup. purp. 

Bloating and pain in pit of stomach: 

Arsen. 
Stitching pain in abdomen : Nux vom. 

and hypochondriac regions: 

Bryon. 



Chest, oppression of, and heaving : Ipec. 

, , must take long breaths: Cimex. 

, , and spasms in chest, with 

hacking cough : Arsen. 
, stitching pain in sides of, with hard 

cough : 



Aching in back and limbs, as if the bones 

were broken : Eup. perf. 
in small of back, drawing in limbs, 

formication in fingers, with restlessness : 

Rhus tox. 
Tearing pains in back and limbs, ex- 



DIGEST TO INTERMITTENT FEVER. 



961 



torting cries and causing the patient to 
bend together like a hedgehog : Capsic 

Drawing and stifThess of lower extremi- 
ties : 2fux vom. 

Pains in all the joints, as if the tendons 
were too short; knee-joints contracted: 
Ciraex. 

Rheumatic pains in the limbs, worse 
from motion: Bryan. 

Pain in all the bones, couch feels too hard : 
Arnica. 

Violent bone-pains : Eup. per/., Eup. 
purp. 

Livid feet and hands: Stramon, 

Blue nails : Arsen. 

Chill ends with a tired feeling in legs, 
must change position : Cimex. 



Sleepiness : Cimex. 

, with shuddering: Tart. emet 

Sleep during chill, heat and sweat : 
Opium. 

Itching, stinging nettle-rash: Hepar. 
Sticky, cold perspiration: Ver. alb. 

CHILL IS AGGRAVATED: 

After drinking: Gapsie. 

In a warm room or near the stove, and 

motion: Apis. 
By external warmth : Ipec. 

CHILL IS RELIEVED: 
By external warmth : Ignat. 

and being held tightly : Laches. 

Wants to be covered during all stages: 
Stramon. 



Chill predominates: Bryon., Cedron, 
Diad., Jlenyanth., So.bad., Ver. alb. 

, only exceptionally the heat 

predominates: Bryan. 



Chill and internal heat : Aeon. 

intermixed with heat, or cold inside 

and burning hot outside : Arsen. 

AFTER CHILL: 

Vomiting : Eup. purp. 
61 



Vomiting, sour: Lycop. 
Sweat : Capsic. 

and heat ; sweat soon disappears, dry 

heat continues: Ant. crud. 

HEAT. 

At 10 A.M., without chill or thirst: 
Gelsem. 

From 4-8 P.M.: Lycop. 

Sometimes before the chill: JRhus tax. 

Mixed up with chilliness: Aeon,, Apis, 
Arnica, Arsen., Bellad., Chamom., China, 
Eup. purp., Gelsem., Laches., Xux vom., 
Podoph., Pulsat., Rhus tox., Sulphur. 

with sweat : Capsic, Carb. veg., Eup. 

per/., Ipec, Opium, Podoph., Pulsat, Rhus 
tox., Sabad., Sepia, Stramon,, Veratr. 

External heat; or heat in some, and 
coldness of other parts : Ignat. 

ACCOMPANIED BY: 

Coma, stupefaction, insensibility: Caci. 
grand. 

Unconsciousness : Arsen,, Xatr. mur. 

, with muttering : Apis. 

Delirium: Arnica, Arsen., Bellad., Chin, 
sulph,, Gelsem., Ignat., Laches., Xatr. 
mur., Xux vom., Opium, Podoph., .Stra- 
mon. 

Loquacity: Podoph. 

Indifference, stupor: Arnica. 

Anxiety, or agitation: Arsen., Bellad., 
Gelsem. 

Vertigo : Arsen., Bellad., Br yon., Carb. 
veg., Gelsem., Ignat, Ipec, Xatr. mur., 
Xux vorn., Pulsat., Sepia, Stramon., Ve- 
ratr. 

, curious sensation of falling: Gelsem. 



Headache : Aeon., Arnica, Arsen,, Bellad,, 
Bryon., Capsic, Carb. veg., China, Eup. 
per/., Ignat., Laches., Xatr. mur., Xux vom., 
Opium, Podoph., Pulsat., Rhus tox., Sa- 
bo.d, Seprn, Sulphur. 

I , relieved during sweat: Natr. mur. 

'■ Sensitiveness to light and sound, or 
partial blindness and deafness : QeUt m. 
Eyes injected : Bellad. 

| Pupils enlarged : Cina. 



9G2 



FEVER. 



Ears cold : Ipec. 
Nose cold: Ignat. 
Picks at nose : Cina. 

Face cold: Ipec, Pulsat 

. pale : Arsen., Bryon., Capsic, Cina, 

Ipec, Rhus tox., Sepia. 

and red alternately: A con., Bel- 
lad., Capsic, Ipec, Nux vom., Opium, Pul- 
sat. 

One cheek pale, the other red: Chamom. 

Cheeks puffed : Cina. 

Lips, burning of: China. 

, dryness of: Rhus tox. 

, fever-blisters on: Hepar, Ignat., 

Natr. mur., Nux vom. 

Tongue red in middle and white on 
edges, or white in middle and red on 
edges: Chamom. 

Mouth and throat dry ; choking sensa- 
tion in throat : Bellad, 

CEsophagus constricted : Cimex, 

Thirst : Aeon., Arsen., Bellad., Bryon., 
Cact. grand., Capsic, Chamom., China, 
Chin, sulph., Eup. purp., Hepar, Ipec, 
Laches., Natr. mur., Nux vom., Podoph., 
Palsat., Rhus tox., Sulphur. 

for beer: Nux vom. 

, drinks but small quantities at a 

time: Arsen., China, Pulsat. 

, drinks large quantities: Aeon., Ar- 
sen., Bryon., Natr. mur. 

, drinks less during fever : Arnica. 

, only during heat : Cina, Pulsat. 

for warm drinks: Cedron. 

for cold water : Aeon. 

'When drinking, the water goes down 
only at intervals : Cimex. 

No thirst : Ant. tart , Apis, Calc carb., 
Camphora, Capsic, Carb. veg., China, Ci- 
mex, Ignat, Pulsat., Sepia. 

Hunger : China, Cina, Phosphor. 

Nausea: Ant. tart, Arsen., Bryon,, Carb. 
veg., Eup. perf., Ipec, Natr. mur., Nux 
vom. 

Gagging : Cimex. 

Vomiting of bile: 
perf., Natr. mur. 

after drinking: 



Chamom., Cina, Eup. 



after cold drinks: Lycop. 



Vomiting of ingesta: Cina, Eup. perf., 

Ferrum, Ignat., Nux vom. 

, sour: Lycop. 

Gastric and bilious symptoms: Nuxvovu 
Stomach, burning in: Arsen. 

, heat in: Apis, Laches. 

, pain in: Arsen., Cirb. veg., Cina, 

Rhus tox., Sepia. 
Hypochondrium, left, tension and press- 
ure: Ai^sen. 

, stitching pain : Bryon. 

Bowels, pain in: Arsen., Carb. veg., Cina, 

Ignat, Nux vom., Rhus tox. 

, cutting pain in: Capsic 

, stitching pain in: Bryon. 

, heat in: Apis, Cact grand,, China, 

Laches. 
Diarrhoea: Cina, Pulsat., Rhus tox. 
, slimy, burning, with much pressing 

and bearing down: Capsic. 
Female organs, heat in : Apis. 
Hoarseness in evening: Cxrb. veg. 
Chest, heat in: Apis. 

, stitching pain in sides of: Bryon. 

, oppression and short breathing: 

Apis, Arsen., Cact. grand., Carb. veg., Ci- 
mex, Ipec. 
Palpitation of heart : Aeon., Arsen., 

Bellad., Calc carb., Sepia, Sulphur. 
Pulsation through whole body: Arsen. 
Limbs, pain in: Arsen., Bryon,, Calc. 

carb., Capsic, Carb. veg., China, Eup. 

perf., Eup. purp., Laches., Pulsat, Rhus 

tox., Sepia, Sulphur. 

numb, dead feeling in legs: Cedron. 

Veins distended: Bellad., Camphora, 

China, Pulsat 
Nettle-rash : Apis, Ignat., Rhus tox. 



Sleep : Apis, Oelsem., Ignat., Natr. mur., 

Opium. 
Sopor: Ant. tart, Bellad., Opium. 
Sleeplessness: Aeon., Arsen., Nux vom.., 

Pulsat, 

, with sleepiness : Bellad. 

Restlessness : Aeon., Arsen,, Bellad., 

Capsic, Chamom., Gelsem., Pulsat., Rhus 

tox. 
Inability to remain lying : Cact grand. 



DIGEST TO INTERMITTENT FEVER. 



963 



Wants to uncover: Aeon., Arnica, Arsen., 

China, Eup. per/., Laches., Natr. mur., 

Pvdsai. 
Averse to uncover: Apis, Bellad., Hepar, 

Ignai., Nv/x vom., Rhus tox., Stramon. 
Feels chilly when uncovering: Arnica, 

China, Nux vom., Pulsat. 

SWEAT. 

Profuse : Bryan., Cact. grand., Carb. veg., 
Cedron, Hepar, 3Iercur. r Natr. mur., Rhus 
tox., Sambuc, Veratr. 

and sour: Bryon., Carb. veg., Chamom., 

Hepar, Ipec, Lycop., Rhus tox., Sepia, 
Sulphur. 

Drenching, sometimes, generally not 
prominent, even wanting : Eup. perf. 

Cold : Arsen., Camphora, China, Cina, 
Ipec, Lycop., Sepia, Stramon., Veratr. 

Hot : Chamom., Opium. 

Long-continuing : Bryon., Ferrum, Ve- 
ratr. 

, lasts through apyrexia, worse during 

waking ; dry heat during sleep : Sambuc. 

About head: Chamom., Eup. purp., 
Opium. 

On forehead : China, Cina, Stramon., 
Veratr. 

On head and chest: Cimex. 

On one side only: Aeon., Bryon., Cha- 
mom., China, Lycop., Nux vom., Pulsat, 
Rhus tox., Sulphur. 

On covered parts : Aeon. 

On uncovered parts, except face: Thvja. 

Sets in some time after the heat : Arsen. 

, or immediately after the 

chill: Lycop. 

Sweat alternates with dryness of skin: 
Apia. 

ACCOMPANIED BY: 

Thirst: Arsen., Cact. grand., Capsic, 
Cedxon, China, Chin, sulph., Natr. mur. 

after the sweat : Lycop. 

No thirst: Apis, Cole, carb., Cimex, Cina, 
Ignai., Nux vom., Sambuc, Veratr. 

Hunger: Cimex, Cina. 

Tearing pains in extremities : Cedron. 



Nettle-rash : Apis, Rhus tox. 

Sleep : Arnica, A^sen., Ignat, Mezer., 
Opium, Podoph., Pulsat, Rhm tox., Sul- 
phur. 

Wants to uncover: Aeon., Calc carb., 
Eup. perf., Ferrum, Natr. mur., Opium, 
Veratr. 

Covers tightly : Hepar. 

Uncovering causes pain: Stramon. 



Headache is better: Natr. mur. 
Painful symptoms gradually subside: 
Arsen., Nux vom. 

AFTER THE SWEAT: 

Long-continued headache : Carb. veg. 
Thirst: Bellad., Lycop., Nux vom., Sa- 

bina. 
Hunger: Cina. 
Diarrhoea : Puhat. 
Cough : Eup. perf. 
Weakness : Arsen. 
Chill: Carb. veg. 

PAROXYSMS IN GENERAL. 

Regular at the same hour with clear in- 
termissions, though not always: Chin. 



All stages strongly marked, or very 
light ; no great thirst : Ipec 

in general not very violent, and 

mostly unattended by thirst : Pulsat. 

Return every day, but seem altered every 
other day : Rhus tox. 

Incomplete: Arsen., Mangan., Mezer., 
Sabad. 

(Compare: no chill, or no heat, or no 
sweat.) 

Irregular, commencing with sweat, fol- 
lowed by chill : Carb. veg. 

, sweat after chill : Lycop. 

, several stages mixed up: Pulsat. 

Chill predominating : Bryon., Cam- 
phora, Cedron, Dixid., Menyanth., Sabad., 
Ver. alb. 

Heat predominating : Bellad., Bryon., 
Cact grand., Chamom., Hepar, Ipec, Rhm 
tox. 



964 



FEVER. 



Sweat wanting: Apis, Arsen., Bellad., 
Diad., Eup. per/., Gelsem., Lycop., Pulsat, 
Rhus tox., Sulphur. 



Gastric symptoms : Ipec. 

Bitter taste and vomiting; oppression 
about the heart; diarrhoea; irritable, 
excited, complaining, restless, anxious: 
Chamom. 

During afternoon, talkative, headache, 
red face, oppression of chest, pain in 
small of back and limbs, restless: La- 
ches. 

Pain in dorsal vertebrae on pressure, in 
liver and spleen on bending, breathing 
and coughing; brick-dust or fatty sedi- 
ment in urine ; ringing in ears with diz- 
ziness, and enlarged feeling of head: 
Chin, sulph. 

Spasmodic symptoms ; heaviness of 
head; aching in occiput; vomiting and 
pressive pain in pit of stomach ; urticaria 
over whole body: Ignat. 

Anaemia, and total prostration of the re- 
productive sphere of system: Arsen., 
China, Ferrum. 

Recent cases of young individuals of a 
full habit : Aeon. 

Children and old people: Opium. 

Chronic cases: Calc. carb., Carb. veg., 
Sepia, Sulphur. 

After abuse of quinine: Arsen., Ferrum, 
Ipec., Laches., Natr. mur., Nux vom., Pul- 
sat. 

Swamp miasma: Cedron, China, Ipec., 
Nux vom., Natr. mur. 

DURING APYREXIA. 
Tearful : Bellad., Cina, Nux vom., Pulsat 

and peevish : Pulsat. 

Irritable: Aeon., Bellad., Bryon., Cha- 
mom., Nux vom., Pulsat. 
Anxiety : Aeon., Camphora, Tart. emet. 
Fear of being left alone: Lycop. 
Wants to be alone : China. 



Headache : Arnica, Arsen., Bellad., Bry- 
on., China, Gelsem., Ignat., Nafr. mur., 



Nux vom., Opium, Pulsat., Rhus tox., 
Sepia. 

Heat on top of head, with cold extremi- 
ties: Sulphur. 

and burning in eyes : Carb. veg. 

Yellowishness of white of eyes: Sepia. 

Swelling of lids: Apis. 

Sinking down of one of upper lids: 
Sepia. 

Hardness of hearing: Calc. carb. 

Ringing in ears: China. 

Face bloated : Arsen., Ferrum. 

pale: Arsen., Camphora, Carb. veg., 

China, Ferrum, Ignat., Lycop., Nux vom., 
Pulsat., Sulphur. 

, and flushing up easily from 

any excitement: Ferrum. 

, with circumscribed redness of 

cheeks : Lycop. 

, sunken, earthy, sallow: Arsen. 

yellow : Arnica, Arsen., China, Eup. 

per/., Ferrum, Natr. mur., Nux vom., Rhus 

tox., Sepia. 
, and also chest and region of 

stomach: China. 

greenish-yellow : Pulsat. 

, brownish-yellow saddle across bridge 

of nose : Sepia. 

yellowish around mouth : Nux vom., 

Sepia. 

Around mouth and corners of mouth, 
fever-blisters and eruption at: Hepar, 
Ignat, Natr. mur., Rhus tox. 

Lips pale, cracked, swollen and crusty: 
Arsen. 

red : Sulphur. 

About neck, glandular swellings: Calc. 
carb. 

Pain in back of neck: Ferrum. 

Mouth, bad smell from : Carb. veg. 

, taste bad : Pulsat. 

, of water : Natr. mur. 

, bitter: Ant. crud., Arnica, Ar- 
sen., Bryon., Chamom., China, Nux vom., 
Pulsat., Rhus tox., Sulphur. 

, lost : Arsen., Pulsat 

, foul: Arnica, Bellad., Ferrum, 

Natr. mur., Nux vom., Podoph., Pulsat, 
Rhus tox. 



DIGEST TO INTERMITTENT FEVER. 



965 



Mouth, taste sour: Lycop., Xux vom., 

Sepia. 
Tongue blistered: Xatr. mur. 

broad and indented: Podoph., Rhus 

tox. 

, brown streak down the middle: Ar- 
nica, Eup. purp., Laches. 

dry: Arsen., Bellad., Xatr. mur., Pul- 
sat., Stramon. 

on tip : Rhus tox., Sulphur. 

pale: Eup. per/., Ferrum, Ipec. 

, red papillae: Aeon., Apis, Bellad., 

Xux vom., Stramon. 

red: Apis, Bellad., Lycop., Sulphur, 

Tart. emet. 

on tip: Arsen., Laches., Xux 

vom., Rhus tox., Yeratr. 

white : Ant. crud., Arsen., Xatr. mur., 

Xux vom., Pulsat., Sulphur. 

yellow: Arsen., Bryon., China, Eup. 

perf, Ipec., Xux vom., Podoph., Pulsat, 
Sulphur. 

Inner mouth pale : Ferrum. 

Appetite, loss of: Ant. crud., Arnica, Ar- 
sen., Bryon., Garb, veg., China, Ignat., 
Ipec, Xatr. mur., Xux vom., Podoph., Pul- 
sat., Rhus tox. 

for beer : Xux vom., Pulsat. 

sometimes increased, with heat and 

nausea when satisfied : Arsen. 

Loathing of milk and meat: Sepia. 

Hunger : Ant. crud., Arnica, Carb. veg., 
China, Cina, Jlenyanth., Xux vom., Rhus 
tox., Sepia, Sulphur, Veratr. 

, with faintness in forenoon : Sulphur. 

Thirst: China, Cimex, Sulphur, Veratr. 

, loss of: Pulsat. 

, little or no thirst : Ant. crud. 

Belching : Ant. crud., Carb. veg., Nux 
vom. 

, sour, after eating : Xatr. mur. 

Nausea : Ant. crud., Arnica, Arsen., Cina, 
Eup. perf., Ipec., Xux vom., Pulsat., Rhus 
tox., Tart, emet'., Veratr. 

Vomiting : Ant. crud., China, Cina, Eup. 
perf., Ferrum, Ipec., Lycop., Xux vom., 
Sepia, Veratr. 

of bile: Arsen., Eup. perf ., Ipec, Xux 

vom., Pulsat., Veratr. 



Vomiting after eating: Xatr. mur. 

of ingesta: Arsen., Eup. perf, Ferrum, 

Ipec, Xux vom., Pulsat. 

of slime : Xux vom., Pulsat. 

, followed by a clean tongue and 

ravenous appetite: Cina. 
Stomach bloated: Calc. carb., Carb. veg., 

Lycop., Xatr. mur., Xux vom. 
, pressure in : Ant. crud., Xatr. mur., 

Rhus tox. 
, sense of relaxation, as though it 

were hanging down : Ipec 
Bowels bloated : Apis, Arsen., Cdlc. carb., 

China, Xatr. mur. 
, pain in: Ant. crud., Cina, Sulphur. 

Tart. emet. 

, rumbling in : Lycop. 

Constipation : Ant. crud., Bellad., Bryon., 

Xatr. mur., Opium, Sulphur, Veratr. 

or diarrhoea: Ant. crud., Sulphur, 

Veratr. 

Diarrhoea : Ant. crud., Arsen., Calc. carb., 

Gelsem., Podoph., Pulsat., Rhus tox., Sepia, 

Sulphur, Veratr. 

after drinking milk : Sejria. 

Haemorrhoidal complaints : Sulphur. 
Liver, pain in: Arsen., Bellad., Bryon., 

China, Lycop., Xatr. mur., Xux vom., 

Pulsat. 
, , with inclination to rub and 

stroke this part: Podoph. 
, , worse on moving: Bryon., 

China, Sepia. 

, , and spleen: China, Xux vom. 

, swollen: China, Xux vom. 

Spleen enlarged: Arsen., Bellad., Calc. 

carb., Carb. veg., China, Diad., Ferrum, 

Pulsat. 
, pain in : Apis, Arnica, Arsen., Bel- 
lad., Carb. veg., China, Ferrum, Xatr. 

mur., Xux vom. 
Hypochondriac regions, worse left, 

pain in : Apis. 

, right side: Eup. perf, Xux 

vom. 

, swollen: Arsen. 

, and hard : Ferrum. 



Kidney region painful : Xatr. mur. 



966 



FEVER. 



Urine scanty : Apis, Arsen., Bryon., China, 

Natr. mur. 
turbid : Arsen., China, Cina, Lycop., 

Natr. mur. 

profuse : Eup. per/., Pulsat. 

Micturition, cutting in urethra after: 

Natr. mur. 



Menses suppressed: Arsen., Calc. carb., 
Ferrum, Lycop., Nux vom., Pulsat, Sepia, 
Sulphur. 

scanty: Lycop., Natr. mur., Pulsat., 

Sulphur. 

profuse : Calc. carb., Diad., Nux vom. 

Leucorrhcea : Sulphur. 



Cough : Apis, Arsen., Bellad., Bryon., 

China, Cina, Eup. per/., Ipec, Nux vom., 

Pulsat., Sulphur. 

in evening on lying down : Sulphur. 

, loose : Eup. per/. 

, thick, yellow, salty expectoration: 

Lycop. 
, with heavy breathing and pain in 

chest: Sabad. 
, with oppression ; pain in left side : 

Lycop. 
, with pain in chest, head and pit of 

stomach: Pulsat. 
Congestion of lungs; shortness of breath : 

Ferrum. 
Palpitation of heart : Aeon., China, Ig- 

not., Laches., Lycop., Natr. mur., Pulsat., 

Sepia, Sulphur. 
Nun's murmur in veins: Ferrum, Pul- 
sat. 



Spine, soreness of: Nux vom. 

, , between shoulder-blades : Chin. 



Limbs, aching as though beaten : Arnica. 
, cramps in : Veratr. 



Limbs, soreness in : Apis. 
Pain in lower extremities : Tart. emet. 
Feet swollen : Apis, Arsen., Bryon., Cldna, 
Ferrum, Nux vom., Pulsat., Sepia. 



Skin pale, covered with cold sweat: Ar- 
sen. 

itchy : Hepar, Ignat., Rhus tox., Sul- 
phur. 

, tettery eruptions : Sepia, Sulphur. 

, on chest: Hepar. 

, nettle-rash : Apis. 



Debility, prostration : Apis, Arsen., China, 
Ferrum, Gelsem., Lycop., Natr. mur., Nux 
vom., Sulphur, Veratr. 

Fainting : Tart. emet. 



Sleepy, drowsy: Bellad., Bryon., Calc. 

carb., Opium, Pulsat., Tart. emet. 
Sleepless: Arsen., Bellad., China, Cina, 

Ipec., Natr. mur., Rhus tox., Sulphur. 



Chilliness: Arsen., Bryon., Hepar, Pul- 
sat., Sabad., Veratr. 
Feverish through the night: Sulphur. 
Flushes of heat : Sepia. 
Sweating : China, Sambuc, Veratr. 
, one side : Pulsat. 



Diathesis, scrofulous: Calc. carb., Silic, 

Sulphur. 
, psoric: Calc. carb., Carb. veg., Cina, 

Sepia, Sulphur. 

, gonorrhceic: Thuja. 

Arsenic poison : Hepar, Ipec, Nux vom. 

Mercury poison : Hepar. 

Quinine poison : Arnica, Arsen., Bellad., 

Carb. veg., Ferrum, Ignat., Laches., Natr. 

mur., Nux vom., Pulsat., Sulphur, Veratr. 



Apis follows well after Natr. mur., Thuja. 



INTERMITTENT AND REMITTENT FEVERS. 967 

Pernicious Intermittent; Remittent and Continuous Mala- 
rial Fevers; Congestive Fevers. 

1. Pernicious fevers are characterized by special dangerous, local affec- 
tions of important organs ; they often appear in the form of an epidemic ; 
their paroxysms are usually of the same duration as those of a simple inter- 
mittent ; sometimes they last longer ; their separate stages may be distinct or 
ill-defined, with complete or incomplete intermittance of various types. When 
there are severe disturbances of the nervous system, one of the most common 
forms is the comatose, or the intermittens apoplectica, with unconsciousness, 
stertorous breathing, etc. ; the eclamptic form, mostly found among children 
and puerperal women, with convulsions and unconsciousness; the tetanic form, 
the severest of all pernicious forms, with tetanic spasms; the hydrophobic 
form, with symptoms of hydrophobia. When the alimentary canal is espe- 
cially affected, we have the choloraic form, especially found in hot climates, 
which may increase to an algid intermittent; the cardialgic form, with great 
pains in the region of the stomach ; the dysenteric form, with all the symp- 
toms of dysentery; the hemorrhagic form, with haemorrhages from the 
stomach or bowels. The pneumonic and pleuritic forms show serious affec- 
tions of the lungs and pleura, and the icteric form especially attacks the liver. 

2. Remittent and continuous malarial fevers are frequently met 
with in the south and southwest of the United States, and in the tropical 
countries. They are all of a malarial origin, which is proved by the fact 
that they occur exclusively in regions where ague prevails, in regions, therefore, 
which, by their conformation of soil and climate, constitute the necessary 
conditions for the development of the miasma ; and it is further proved by 
the fact, that remittent fevers, when improving y gradually change into the inter- 
mittent type. Hence remittent fevers are only graver forms of the effects oi 
the same unknown virus, called miasma, that causes the ague, and this cor- 
responds again with the fact, that we find remittent fevers oftener in such 
regions in which the common intermittent cases are likewise much more severe 

o 

than in other regions. 

Remittent fever has no apyrexia, but in place of it there is merely a 
slacking off of the fever, which is again succeeded by another exacerbation. 
If it be a continued fever there is not even such a remission of its violence. 
These remittent fevers may be divided into three forms: 

1. The bilious or gastric remittent, characterized by commencing with a 
chill, which is followed by a violent fever and many gastric symptoms; the 
spleen is swollen; there is slight icterus; irregular and whitish stools; herpes 
labialis; headache; pain in the limbs; dizziness; ringing in the ears; epis- 
taxis; bronchial irritation; great debility. It might be confounded with 
the beginning of typhus if it were not for the fever blisters around the mouth 



968 FEVER. 

and the exacerbations, recurring a"t first irregularly, but later, regularly, as- 
suming a regular intermittent type. It may last from several days to three 
weeks, and corresponds to the febris intermittens subintrans. 

2. The typhoid form gradually loses the remissions and becomes con- 
tinuous. The patient is delirious or lies in a stupor; his tongue is dry and 
his spleen swollen. In addition to all this there may be icterus, or symp- 
toms of pneumonia, dysentery, etc. This form lasts from eight to fourteen 
days, and, if getting better, works over into an intermittent type; if fatal, 
the patient dies in a comatose condition, corresponding thus to the comatose 
form of a pernicious intermittent. 

3. The gravest form is characterized by a high degree of adynamia and 
a tendency to rapid collapse. Such patients are deeply apathic from the 
very beginning, and exhibit functional disturbances in almost all organs. 
Many patients are icteric ; others bleed from the nose, stomach or kidneys ; 
others show albuminuria, or suppressio urinse ; and still others have cholera- 
like or dysenteric discharges from the bowels. Liver and spleen are swollen, 
terminating sometimes in inflammation and suppuration. The serous mem- 
branes show exudates, and the external skin is covered with petechias, or 
destroyed by decubitus and gangrene. 

Congestive fever, malignant bilious fever, typho-malarial fever, etc., are 
only other names for the above-described different forms of remittent mala- 
rial fevers. 

THERAPEUTIC HINTS —Compare Intermittent Fever. 

The comatose form requires principally Bellad., Hyosc, Laches., Opium, 
Stramon., Tart. emet. 

The adynamic form especially Arnica, Arsen., Bryon., Camphora, Carb. 
veg., Chin, sulph., Ferrum, Hydr. ac, Laches., Phosph. ac, Rhus tox., 
Veratr. 

Yellow Fever. 

The following is from the special report of the Homoeopathic Yellow 
Fever Commission : 

"Yellow fever is a specific disease, entirely independent of malaria, oc- 
curring rarely a second time in the same person, infectious and capable of 
transmission to any distance by means of fomites or infected material. 

" The yellow fever germs, for we accept provisionally the germ-theory 
of the disease, are indigenous to the West Indies and perhaps to the west coast 
of Africa, and have been thoroughly naturalized in many localities in the 
southern portion of the United States. They were imported into "New 
Orleans during the last quarter of the eighteenth century, and have existed 



YELLOW FEVER. 969 

in the soil or atmosphere of that place ever since, either in a latent or an 
active condition. They may lie dormant for many years consecutively, and 
they require a concurrence of causes to develop them into a state of disease- 
producing activity. 

" Some of the factors which seem to be favorable to the excitation of the 
yellow fever germ are the following : 

" Low, swampy ground near the level of a tropical sea. Long contin- 
uance of a very high temperature, following heavy rains. Long continuance 
of south and east winds. Aggregations of human beings with the excreta of 
their bodies in small spaces. A crowded and dirty ship may be a nidus for 
yellow fever, as well as a crowded and dirty city. Long continuance of 
calm weather, unbroken by thunder-storms. Exposure of decaying vegetable 
and animal matter to a burning sun. Inefficient drainage and the general 
accumulation of filth, especially the city garbage. Deficiency of ozone in 
the atmosphere. Pestilential exhalations from an upturned soil. 

"When the yellow fever germ has been waked into activity by these 
causes, it may be transported to places where none of them exist. It seems 
that a certain concurrence of several of the above factors is necessary to the 
generation of yellow fever. There is probably one combination in one epi- 
demic, and a somewhat different combination in the next epidemic. An 
epidemic may be mild or severe, according to the number and force of the 
concurring causes. There may also be other unknown but discoverable 
factors, which may be necessary at one time to produce an epidemic, and 
not necessary at another. No one of the above suggested causes could ex- 
cite an epidemic by itself, and it is not probable that they all ever concurred 
equally to the formation of the disease. The most extensive collections and 
comparison of facts are necessary to illumine the very great darkness which 
lies upon these complex questions. 

" The naturalized yellow fever germs may receive so slight a stimulus as 
to produce only a few sporadic cases. Or they may be vitalized in certain 
localities to such a degree as to occasion quite an outbreak in those localities, 
not easily communicated to other quarters. Or thirdly, the disseminated 
germs may be vivified in all directions, and a general epidemic excited. Or 
lastly the naturalized germs may lie entirely quiescent, until fresh and active 
germs are brought in from foreign ports, which then act as sparks to ignite 
the inflammable material already existing. We thus have four shades or 
degrees of yellow fever visitation: sporadic cases; local and limited out- 
bursts ; epidemics from naturalized germs, and epidemics from importation. 

In sporadic cases and limited outbreaks the specific nature of the fever 
is not clearly brought to light, and it is sometimes difficult to diagnose it 
from the dominant malarial or bilious diseases. The imported epidemic, 
whether from Havana to New Orleans or from New Orleans to Memphis, 



970 FEVER. 

etc., etc., is always a more quick-spreading and malignant disease than that 
arising from our naturalized germs. The comparative mildness of the late 
epidemic in New Orleans, is one out of several reasons for believing that the 
disease was of local origin. 

"The yellow fever of domestic origin can only be prevented by local 
sanitary measures. So long as the public authorities ignore the crying evils 
at home, and watch only for the enemy at the seaside, we shall continue to 
be scourged with repeated epidemics of yellow fever. Quarantine may or 
may not keep out the tropical foe, but our utmost energies should be con- 
centrated against the enemy which has been domiciliated in our households 
for nearly a century." 

The incubation is short, frequently not longer than a day or two ; in 
some cases fourteen days. 

Its course is an acute one, lasting from three to ten days, and consists 
of three distinct stages. 

1. The febrile Stage. — "Very high fever, preceded or not by a chill, 
w T ith extremely severe pains in the head (occipital region predominantly), 
back and limbs. Temperature from 103° to 107° F. ; great restlessness and 
malaise, accompanied sometimes with mental anxiety and fear of death; 
vomiting of ingested bile ; red, watery eyes ; suffused countenance ; sleepless- 
ness or stupor with intense heat; delirium, sometimes violent, sometimes 
muttering; skin very hot and dry, but very easily excited to perspiration." 

2. The stage of exhaustion. — " Passing in most cases by insensible 
gradations from a state of great apparent, but of really little danger, the 
patient enters the second stage of yellow fever, in which he may seem to be 
doing very well to an inexperienced eye, while in fact he may be in an 
alarming and even hopeless condition. The pulse becomes natural again, or 
w r eak and irregular, or in some cases very slow, forty or even thirty to the 
minute. The patient expresses himself as well, wants to eat or drink, would 
commit great imprudence in diet, or talking, or throwing off cover, or get- 
ting out of bed, if permitted ; apathy, indifference, no realization of danger ; 
at night sleeplessness, sometimes a terrible pervigilium, restlessness, great 
nervousness ; sour or acid eructations ; epigastric pains ; tenderness on press- 
ure over the liver and spleen ; vomiting of ingesta, of a claret-colored water, 
of mucous substances specked with blood, of pure blood, of floating shreds 
like bees' wings, of brown vomit, of genuine coffee-grounds, black vomit; 
excessive irritability of stomach ; black stools; hiccough. Sudden and un- 
accountable changes of color ; alternate flushings and paleness ; yellow tint 
of the sclerotica ; increasing yellowness of the surface, even in some cases to 
the deepest jaundice, and hemorrhages ; oozing of dark blood from gums, 
nose, eyes, ears ; hemorrhage from the uterus, bowels, or kidneys ; petechia? ; 



YELLOW FEVER. 971 

decided albuminuria ; scanty or suppressed urine, followed by coma or con- 
vulsions ; secondary fever, from local congestions or inflammations." 

3. The Stage Of collapse. — " Skin of a dirty yellow or almost bronze 
color; large petechial spots; slow oozing of blood from every orifice of the 
body; black vomit; bloody, black, or totally suppressed urine; extreme 
jactitation; total apathy or muttering delirium ; hiccough; cold extremities ; 
feeble and flickering pulse; convulsions; involuntary discharges of black 
matter, and utter prostration, sometimes with precordial anguish and undy- 
ing irritability of the stomach." {Report of Homoeopathic Yellow Fever Com- 
mission.} 

THERAPEUTIC HINTS— In the first stage most physicians have 
used Aeon., Bellad., Bryon. ; some have recommended Gelsem. and 
Ver. vir.; one has called attention to Eupat. perf., Cimicif., Baptis. 
In the second stage all used Arsen., many also Laches., or Crotal., and 
on failure of these remedies, Carb. veg. Phosphor, is barely mentioned 
by two physicians. In the third stage the choice lay between Arsen., Cro- 
tal., Carb. veg., Hydr. ac., Secale and Tincture of Aeon. 

SPECIAL HINTS. — Aeon., first stage; burning heat and dry skiu ; 
full, hard, quick pulse ; desire to be uncovered ; great restlessness and anxiety ; 
fear of death; dizziness on rising; pain in the forehead and temples; face 
dark red; eyes injected, sometimes sensitive to light; lips and mouth dry ; 
great thirst; nausea, vomiting; heat in the stomach; short, anxious respira- 
tion ; distress in cardiac region ; pain in the back and extremities. Useful 
only for a short time; is followed well by Bellad. (Taft, Hardenstein.) 

Apis, pain in forehead and temples, relieved by pressure; burning, 
stinging heat in face with purple color ; dry, swollen and inflamed tongue 
with difficulty of swallowing; strangury, or urine scanty and high colored; 
sleep disturbed by many dreams ; restlessness and delirium. (Angell.) 

Arg. nitr., second stage; vomiting of a brownish mass, mixed with 
coffee-ground-like flakes. (Holcombe.) Meningeal symptoms. (Harden- 
stein.) 

Arsen., second and third stage; dull, heavy or throbbing pain in the 
head; face yellowish and livid, or deep, dull red ; eyes dull and sunken, with 
dark rings around and yellow sclerotica ; nose pointed ; nosebleed ; lips and 
tongue brown or black; vomiting, especially after drinking; black vomit; 
burning or stitching pain in the epigastrium and region of the liver ; great 
pressure in the pit of the stomach; cramp-pains in the bowels; diarrhoea, 
with tenesmus, or painless and involuntary ; bloody discharges ; retention of 
urine ; bloody urine ; oppression of the chest, with short, anxious breathing ; 
pulse irregular, frequent, small, trembling; internal heat and external cold- 



972 FEVER. 

ness of the body, and cold, sticky perspiration ; stiffness and lameness of the 
limbs ; rapid sinking of strength ; anxiety and restlessness ; wants to go from 
one bed to another ; delirium with desire to escape. (Taft, Holcombe.) 

Baptis., stupid stare and bewildered look; cannot collect himself; face 
dull red, listless, besotted ; dry, red tongue, or with a dark yellow coating ; 
difficulty of protruding the tongue; fetid breath; urine scanty and high 
colored; all symptoms worse from evening till one o'clock a.m. (Angell.) 

Bellad., first and second stage; dry, burning heat, with changing pulse ; 
sharp, stitching, shooting and throbbing pains in the head and ears ; face 
scarlet red, shining and swollen ; eyes red, glistening, staring, dilated and os- 
cillating pupils; carotid arteries pulsating; dry, hot tongue and throat; 
nausea and violent vomiting; cramp-like pain in the stomach; burning and 
throbbing in the pit of the stomach ; urine red or brown ; painful heaviness 
and cramp-like pain in the back, loins and legs; head and body hot, feet 
cold ; delirium, afraid of creeping things. (Hardenstein, Taft.) 

Bryon. , first and second stage ; headache in back of head down to neck 
and shoulders, worse from motion ; pain in the eyes when moving them ; the 
eyes are red or dull and glassy, or glistening and watery ; tongue dry and 
coated white, or dirty-yellowish, or brownish ; burning thirst ; vomiting worse 
after drinking; fulness and oppression in the pit of the stomach and bowels; 
pleuritic pains in the chest with or without cough ; pain in the back and 
limbs ; yellow skin ; anxiety and fear about the future ; loss of memory ; de- 
lirium. (Taft, Hardenstein, Angell.) 

Cadm. sulph., when nausea is not relieved by Ipec. or Arsen., in first 
stage. Taste like pitch in the mouth; salty, rancid belching; nausea in 
mouth, chest and abdomen, often with pain and cold sweat in face ; pain in 
abdomen ; vomiting of sour, yellow and black matter ; burning and cutting 
in stomach ; vertigo, room and bed seem to spin around. (Hardenstein.) 

Camphora, when there is a severe and long-lasting chill at the com- 
mencement. (Holcombe.) Trembling of the internal parts; coldness of 
limbs. (Hardenstein.) 

Canthar., second and third stage; complete insensibility; cramps in 
the abdominal muscles and legs ; suppression or retention of urine ; haemor- 
rhages from the stomach and intestines-; cold sweat on the hands and feet. 
(Taft.) Strangury. (Holcombe.) 

Chamom., suitable especially for women and children with gastric 
irritations. (Holcombe.) An intercurrent remedy for colic. (Hardeustein.) 

Carb. veg., like sulphur in cholera, so is, according to Hering, Carb. 
veg., that medicine which, more than any other, corresponds in the totality 
of its action, to yellow fever. Taft recommends it, especially for the third 
stage, and Howard gives the following indications : haemorrhages with great 
paleness of the face, violent headache, great heaviness in the limbs and trem- 



YELLOW FEVER. 973 

bling of the body. — The report of the Yellow Fever Commission gives the 
following indications: pupils do not respond to the light; haemorrhage from 
the eyes ; repeated nosebleed, with small, intermittent pulse ; hippocratic face ; 
grayish-yellow ; red cheeks, covered with cold sweat ; bloody saliva ; rancid 
eructations ; enormous flatulence ; burning in the stomach, with vomiting of 
blood ; all discharges fetid and offensive ; menorrhagia ; capillary stagnation ; 
cyanosis; thread-like pulse; sleepless, intensely restless, from suffocating sen- 
sations ; icy coldness of the body ; ecchymoses. 

Cepa is said to have cured a case of yellow fever when raging in Phila- 
delphia ; there are a good many symptoms in its pathogenesis which might 
suggest its further application. 

Cimicif., delirium with excessive restlessness; subsultus tendinum; 
waking from sleep with a start; dreams and delirium about negroes, devils, 
etc. (Angell.) Violent pains in small of back ; stiff neck ; soreness of all 
muscles ; pains like electric shocks here and there ; sharp pains from neck to 
vertex. Melancholy, indifferent, taciturn. (Report of H. Y. F. Commis- 
sion.) 

Coloc, for colic and colicky pains. 

Crotal., is indicated especially by the haemorrhages from the eyes, nose, 
mouth, stomach and intestines. (Bute.) The report of the Commission, and 
Hardenstein, give the following indications: delirium with open eyes; utter 
apathy; confused speech; disconnected answers, with coldness of the skin 
and rapid pulse; terrible headache, with red, puffed face; face yellow, or 
sometimes of a leaden color; blood flows from the eyes, ears and nose, indeed 
from all the orifices of the body, even bloody sweat; thirst; sour, acrid eruc- 
tations; scraping, rancid sensation down the oesophagus to the stomach; 
extreme nausea and vomiting on least exertion ; vomiting of bile, of blood ; 
swelling of the whole abdomen ; enlargement of the inguinal glands ; bloody 
stools, sometime involuntary ; haemorrhage from the urethra ; painful reten- 
tion of urine; menses anticipate; hoarse, weak, rough voice; pains in chest; 
pulse slower than natural (sixty beats), or intermitting and scarcely per- 
ceptible ; pains in bones ; deep yellow color of the whole body ; purple spots ; 
extreme depression of the vital powers; spasms; death by syncope; acts 
more on right side. 

Crot. tigl., recommended by Hackett, an allopath; he saw from his 
doses aggravations, but afterwards rapid improvement. 

Cuprum, when Arsen. does not relieve the vomiting of blood. 
(Kiistner.) 

Eupat. perf., valuable in first stage as an intercurrent remedy in 
cases where the bones ache as if broken, with headache and backache, thirst 
and vomiting. (Angell.) 

Gels em., unconnected ideas, cannot follow any idea for any length of 



974 FEVER. 

time ; if he attempts to think consecutively, he is attacked by a painful 
vacant feeling of the mind; giddiness with loss of sight; indistinctness of 
vision, or double vision; fulness of head, with heat in face, and cold feet; 
pain in back of neck; heavy, dull expression of countenance and yellow 
face, or nausea and paleness. Sticky feeling in mouth ; fetid breath ; tongue 
coated whitish or yellowish ; dryness and burning in throat ; sour eructa- 
tions ; pulse frequent, full, but soft. As soon as he goes to sleep, he is de- 
lirious. (Angell.) 

Ipec, in the first stage: dizziness, chilliness, pain in the back and 
limbs, uncomfortable feeling in the epigastrium, with nausea, vomiting and 
great weakness. (Taft.) To be followed by Cadmium sulph. if relief is not 
soon attained. (Hardenstein.) 

Laches., quite important in any of the stages. Kiistner gave it also 
after previous abuse of mercury or quinine. The report of the Commission, 
and Hardenstein, give the following indications : delirium at night ; loqua- 
cious, disposed to quarrel ; slow, difficult speech ; drowsy ; rush of blood to 
the head; red face; yellow conjunctiva; yellow or purplish tint of skin; 
blood dark, non-coagulable ; small wounds bleed much; perspiration stains 
yellow; lips dry, cracked and bleeding; tongue heavy, trembling, dry and 
red, cracked at tip ; tip red, centre brown ; difficult speech ; sour eructations ; 
heartburn; nausea after drinking; vomiting, with palpitation; dyspnoea; 
anxiety about the heart ; cannot lie on left side ; irregular, weak pulse ; 
urine almost black; persistent sleeplessness; fainting; trembling all over; 
sudden flushes of heat; sensitiveness about the neck and pit of stomach 
against any pressure; worse when waking; better after nourishment. Acts 
more on left side. 

Mercur., yellow skin; red, injected eyes, sensitive to light; paralysis 
of the one or the other limb ; tongue moist, coated, thick and white, or dry 
with brown slime; pulse irregular, quick, strong and intermitting, or soft 
and trembling. Drowsy or sleepless from nervous irritation; tired and 
weak; rapid sinking of strength; dizziness and violent headache; violent 
convulsive vomiting of slime and bilious matter; burning pain and sensitive- 
ness of the stomach; constipation or diarrhoea of slime, bile or blood; cold- 
ness of the extremities with cramps. Great irritability of all the organs ; 
anxiety and restlessness ; weak memory ; fears ; discouragement ; crossness. 
(Taft.) 

Nux vom., after allopathic drugging, or in persons accustomed to 
drinking strong liquors. According to Taft : yellow skin, pale or yellowish 
face, especially around the nose and mouth ; eyes injected, yellow and watery ; 
dark rings around the eyes; tongue slimy or dry, cracked and red on the 
edges ; thirst for beer or stimulating drinks ; burning in the stomach ; press- 
ure or cramp-pain in the stomach ; vomiting of sour, bilious, or slimy sub- 



YELLOW FEVER. 975 

stances; hiccough; dizziness or headache; trembling of the limbs; cramps 
in different parts of the body; contractions of the abdominal muscles; thin, 
slimy, bilious or bloody stools ; burning pain in the neck of the bladder, with 
difficult urination; coldness, lameness and cramps in the legs; cold feet. 
Excessive anxiety ; fear of death; despondency or loss of consciousness and 
delirium, with moaning and groaning. 

Phosphor., hemorrhagic form, with petechial spots, or with menin- 
gitis, or especially pleuritic pains after Bryon. (Hardenstein.) "Its power 
of producing acute yellow atrophy of the liver, fatty degeneration, malignant 
jaundice, albuminous urine, the hemorrhagic diathesis, and many of the 
symptoms of Arsen. and Crotal., shows that it is a remedy of great hompao- 
pathic applicability to yellow fever." (Report of Commission.) 

Rhus tox., according to Tail: dirty yellow color of the body; glassy, 
sunken eyes; dry, black tongue; talkative delirium, or coma with rattling 
respiration ; constant groaning ; torturing pain and burning in the stomach ; 
nausea ; vomiting ; paralysis of the lower extremities ; cramps in the abdomen ; 
colic; diarrhoea; difficulty in swallowing; constant restlessness and tossing 
about. According to Angell : bright redness of face (in first stage), or pale 
and sunken face, with pointed nose; epistaxis; dryness of mouth and throat; 
dry cough and red tongue, or dark brown (mahogany) or black ; cracked 
tongue, unable to protrude it; eructation and rumbling in abdomen, causing 
great distress ; diminished urine ; sleeplessness. 

Sulphur, melancholic; fearful; undecided; sad; absent-minded; dizzi- 
ness; headache; face pale or yellowish; eyes red or yellowish; itching and 
burning in the eyes; noises in the ears; tongue dry, red, or with white or 
brown coating ; aphthse in the mouth ; nausea with trembling and weakness ; 
vomiting of sour, or bilious, or bloody and black masses; pressure in the 
stomach; pain in the back and loins. (Tafl.) 

Tart, emet., continuous nausea with vomiting, or vomiturition with 
perspiration on forehead; shuddering; attacks of fainting and trembling; 
great prostration. (Angell.) 

Verbena Jam. The juice of the leaves of this plant, the species of 
which is not properly given, is said to have cured a number of the most des- 
perate cases. 

Veratr., according to Taft: yellowish or bluish face, cold and covered 
with a cold perspiration; eyes dull, yellowish, watery; deafness; lips and 
tongue dry, brown, cracked; difficult swallowing; hiccough; great thirst; 
vomiting of bile or blood ; burning in the stomach ; coldness of the hands and 
feet ; trembling and cramps of the hands, feet, legs and abdomen ; diarrhoea, 
thin, blackish or yellowish ; pulse small, scarcely perceptible, intermitting. 
Great exhaustion; vertigo; fear; despondency; restlessness; loss of con- 
sciousness; coma or delirium. According to Angell: after purging from 



976 



FEVER. 



castor oil; vomiting of slime and diarrhoea, sometimes involuntary stools; 
hopelessness of life. According to Hardenstein : in first stage trembling and 
jerking of external parts; coldness all over the body. 

Ver. vir., intense fever with occipital pains, and vascular and nervous 
erethism, threatening convulsions, especially in children; developments of 
local inflammations; precordial distress; vomiting with cold sweat on the 
face ; great and sudden changes in the pulse. (Report of Commission.) 

Aside from these remedies we find recommended : 

For nausea: Apomorph., Kreos., Hydr. ac, Lobel. infl. 

For nervousness and sleeplessness: Coffea or Bellad., Opium, Daphne ind., 
Sepia. 

For hcemorrhages : Plumb, ac, jfc of a grain (Angell), Sulph. ac, Tereb., 
Millef., Eriger., Lycop., Arnica, Sabina, Secale, Hamam., Thlaspi bursa 
pastoris. 

For albuminuria: Euonymin, Helon., Cuprum, Merc corr. 

For retention of urine, with delirium and convulsions: Hyosc, Opium, 
Stramon., Plumbum. 

For difficult urination and tenesmus: Lycop., Tereb., Chimaph., Apis, 
Apocyn., Prunus spinosa, Cann. ind., Sulphur, Citric ac. 

For cerebrospinal symptoms : Glonoin., Corall., Cicuta, Zincum. 

During convalescence: Calc carb., China, Hepar. (Report of Commis- 
sion, Hardenstein.) 



Digest to Yellow Fever. 



Consciousness, loss of: Nux vom., Ver. 
alb. 

Insensibility: Canihar. 

Memory, weak: Mercur. 

, loss of: Bryon. 

Absent-minded : Sulphur. 

Cannot collect himself: Baptis. 

Unconnected ideas ; cannot follow any 
idea for any length of time; if he at- 
tempts it, he is attacked by a painful 
vacant feeling of the mind : Gelsem. 

Disconnected answers, with coldness 
of skin and rapid pulse : Crotal. 

Confused speech : Crotal. 

Stupid stare and bewildered look: Bap* 
tis. 

Delirium : Bryon. 

— — with open eyes : Crotal. 

at night : Laches. 

as soon as he goes to sleep : Gelsem. 



Delirium and coma : Rhus tox., Ver. alb. 

about negroes, devils, etc. : Cimic. 

, afraid of creeping things : Bellad. 

, talkative : Rhus tox. 

, with moaning and groaning: Nux 

vom. 
— — , with desire to escape : Arsen. 
, restlessness: Apis, Cimic. 



Loquacious : Laches. 

Moaning and groaning : Nux vom., Rhus 

tox. 
Taciturn : Cimic. 



Indifferent: Cimic. 

Apathy : Crotal. 

Fears : Mercur., Sulphur, Ver. alb. 

about the future : Bryon. 

of death : Aeon., Nux vom. 

Anxiety : Arsen., Bryon., Nux vom. 



DIGEST TO YELLOW FEVER. 



977 



Anxiety and restlessness : Aeon., Arsen,, 

Jlercur. 
Sad : Sulphur. 

Melancholy : Cimic, Sulphur. 
Despondency : Nux vom., Ver. alb. 
Hopelessness : Ver. alb. 
Discouragement : Jlercur. 
Undecided : Sulphur. 
Crossness : Jlercur. 
Quarrel, disposed to: Laches. 



Vertigo : Sulphur, Ver. alb. 

, room and bed seem to spin around : 

Cadm. sulph. 

on rising : Aeon. 

and headache : Jlercur. 

or headache: Nux vom. 

, with loss of sight : Gelsem. 

and chilliness : Ipec. 

Headache : Carb. veg., Sulphur. 

, dull, heavy, throbbing pain : Arsen. 

, with red, puffed face: Crotal. 

Pain, forehead and temples: Aeon. 

, , relieved by pressure: 

Apis. 
, back of head down to neck and 

shoulders, worse from motion : Bryon. 

, sharp, from neck to vertex : Cimic. 

, , stitching and throbbing in head 

and ears: Bellad. 
in occiput, with intense fever: Ver. 

vir. 
Head and body hot, feet cold : Bellad. 

, rush of blood to the: Laches. 

, fulness of, with heat in face and cold 

feet: Gelsem. 
Meningeal symptoms: Arg.nitr., Phos- 
phor. 



Eyes itching and burning: Sulphur. 

painful when moving them : Bryon. 

red, injected: Aeon., Bellad., Bryon., 

Jlercur., Nux vom., Sulphur. 
, , sensitive to light: Aeon., 

Jlercur. 

glistening, staring : Bellad., Bryon. 

glassy, sunken: Bhus tox. 

, dull and watery : Bryon. 

62 



Eyes dull and sunken : Arsen., Carb. veg. 

and Avatery : Ver. alb. 

yellowish : Laches., Sulphur, Ver. alb. 

and watery ; dark rings around 

eyes: Arsen., Nux vom. 

Pupils dilated and oscillating : Bellad. 

do not respond to the light: Carb. 

veg. 

Sight indistinct, or double vision: Gel- 
sem. 

Haemorrhage from eyes: Carb. veg. 

and all orifices of bodv : Crotal. 



Ears, noises in : Sulphur. 

, deafness: Ver. alb. 

, haemorrhage from: Crotal. 



Nosebleed : Arsen., Crotal., Bhus tox. 
, with small, intermittent pulse : Carb. 

veg. 
Nose pointed: Arsen., Carb. veg., Rhus 

tox., Ver. alb. 



Face, dull, heavy expression: Gelsem. 

, listless, besotted expression : Baptis. 

pale, with nausea : Gelsem. 

, with haemorrhages : Carb. veg. 

and sunken, with pointed nose : 

Bhus tox. 
or yellowish: Nux vom., Sulphur, 

red : Laches. 

bright red : Bhus tox. 

dark red: Aeon. 

dull red : Arsen., Baptis. 

scarlet red, shining and swollen : Bel- 
lad. 

purplish, with burning, stinging heat : 

Apis. 

yellowish or bluish, with cold sweat: 

Ver. alb. 

yellowish, grayish, hippocratic: Carb. 

veg. 

, or of a leaden color: Crotal. 

and 1 ivid : Arsen. 

, especially around nose and 

mouth : Nux vom. 

, cold sweat on : Carb. veg. 

, , during vomiting: Ver. 

vir. 



978 



FEVER. 



Face, cold sweat on forehead during per- 
spiration : Tart. emet. 



Lips dry, cracked and bleeding : Laches. 

and mouth dry: Aeon. 

and tongue dry, brown, cracked : Ver. 

alb. 

brown or black : Arsen. 

Tongue dry and cracked: Laches., Nux 
vom., Rhus tox., Ver. alb. 

, black : Rhus tox. 

, brown : Ver. alb. 

, red at tip: Laches. 

, on edges: Nux vom. 

and red: Baptis., Laches., Sul- 
phur. 

and hot, and throat : Rellad. 

and brown: Ver. alb. 

and black : Rhus tox. 

and brown or black : Arsen. 

or red : Rhus tox. 

and coated white, or dirty-yel- 
lowish, or brownish : Bryon. 

dark yellow : Baptis. 

white or brown : Sulphur. 

with brown slime : Mercur. 

, swollen and inflamed, with dif- 
ficulty of swallowing : Apis. 

, tip red and centre brown : Laches. 

, red streak in centre : Ver. vir. 

moist and coated thick and white : 

Mercur. 

coated whitish or yellowish : Gelsem. 

— — heavy, trembling : Laches. 

difficult of protruding: Baptis., La- 
ches., Rhus tox. 

Mouth and throat dry : Rhus tox. 

• , aphthae in : Sulphur. 

, haemorrhage from : Crotal. 

, bloody saliva: Carb. veg. 

■ , sticky feeling in : Gelsem. 

- , taste like pitch : Cadm. sulph. 

, fetid breath : Baptis., Gelsem. 

Thirst: Aeon., Arsen., Bryon., Crotal, 
Eup. per/., Ver. alb. 

for beer or stimulating drinks : Nux 

vom. 

Swallowing difficult: Rhus tox., Ver. 
alb. 



Speech slow, difficult: Ladies. 
Throat dry and burning: Gelsem. 

, scraping, rancid sensation to stomach : 

Crotal. 



Eructations, rancid: Cadm. sulph., Curb. 

veg. 

, salty : Cadm. sulph. 

, sour: Crotal., Gelsem., Laches. 

and distressing rumblings in bowels: 

Rhus tox. 
Heartburn : Laches. 
Hiccough : Nux vom., Ver. alb. 
Nausea in mouth, chest and abdomen, 

with pain, and cold sweat in face : Cadm. 

sulph. 
and paleness : Gelsem. 

and trembling and weakness: Sul- 
phur. 

after drinking : Laches. 

and vomiting: Aeon , Bellad., Nux 

vom., Tart. emet. 

, with great weakness: Ipec. 

Vomiting, with sweat on forehead : Tart, 
emet. 

, with cold sweat on face : Ver. vir. 

, with burning in the stomach : Carb. 

veg. 

, with palpitation: Laches. 

, with thirst: Eup. per/. 

after drinking: Arsen., Bryon. 

, when the water gets warm in 

the stomach : Phosphor. 

of black stuff: Arsen., Cadm. sulph., 

Sulphur. 

of a brownish mass, mixed with cof- 
fee-ground-like flakes: Arg. nitr. 

of blood: Arsen., Carb. veg., Crotal., 

Cuprum, Sulphur, Ver. alb. 

sour, bilious: Cadm. sulph., Crotal, 

Mercur., Nux vom., Sulphur, Ver. alb. 

slime : Mercur., Nux vom., Ver. alb. 

and diarrhoea, sometimes involuntary : 

Ver. alb. 
Gastric irritations : Chamom. 
Stomach, burning in: Carb. veg., Ver. 

alb. 

, and cramp-pain in : Nux vom. 

, and cutting in : Cadm. sulph. 



DIGEST TO YELLOW FEVER. 



979 



Stomach, burning and sensitiveness in : 

Mercur. 

• , and throbbing in : Bellad. 

, and torturing pain in: Bhus 

tox. 
, in, and coldness of hands and 

feet: Ver. alb. 
=*-, or stitching pain in, and region 

of liver: Arsen. 

, heat in : Aeon. 

, pressure in: Arsen., Sulphur. 

, fulness and oppression in: Bryon. 

, sensitive to pressure in, and about 

the neck: Laches. 

, distress in : Ver. vir. 

, cramp-like pain in: Bellad. 

, haemorrhage from, and bowels : Can^ 

thar., Crotal. 



Abdomen, flatulence: Curb. veg. 

, swelling: Crotal. 

, cramps in : Arsen., Rhus tox. 

, , and in extremities : Ver. alb. 

, in abdominal muscles and legs : 

Canthar. 

, contraction of abdominal muscles: 

Nux vom. 

, colic in: Cadm. sulph., Coloc, BJius 

tox. 

Enlargement of inguinal glands : Crotal. 

Diarrhoea : Bhus tox. 

, sometimes involuntary : Ver. alb. 

, bilious, slimy : Mercur., Nux vom. 

, thin, blackish, or yellowish: Ver. 

alb. 

, bloody: Canthar., Crotal., Mercur., 

Nux vom. 

, , sometimes involuntary: Crotal. 

, with tenesmus, or painless and in- 
voluntary: Arsen. 

or constipation : Mercur. 



Neck of bladder, pain in, with difficult 

urination : Nux vom. 
Strangury : Apis, Canthar. 
Retention of urine: Arsen., Canthar., 

Crotal. 
Urine diminished : Bhus tox. 
scanty and high colored : Apis, Baptis. 



Urine red or brown : Bellad. 

almost black : Laches. 

bloody: Arsen., Crotal. 



Menses anticipate: Crotal. 
Menorrhagia: Carb.veg. 



Voice hoarse and weak : Crotal. 

Chest, pain in : Crotal. 

, pleuritic pains in : Phosphor. 

r , with or without cough : 

Bryon. 

Respiration rattling, with coma: Bhus 
tox. 

Oppression, with short, anxious breath- 
ing : Acon. T Arsen. 

, anxiety about the heart: Laches. 

Distress in cardiac region: Aeon. 

Palpitation, with vomiting: Laches. 

Pulse frequent, full, but soft: Gelsem. 

, small, trembling: Arsen. 

full, hard, quick : Aeon. 

intermitting : Carb. veg., Crotal., Mer- 
cur., Ver. alb. 

irregular, quick and strong: Mercur. 

, great and sudden changes: Ver. 

vir. 

and weak : Laches. 

slower than normal: Crotal. 

small, scarcely perceptible: Carb. 

veg., Crotal., Ver. alb. 

soft and trembling: Mercur. 

thread-like: Carb. veg. 

Carotid arteries pulsating : Bellad. • 



Neck, pain in back of: Gehem. 

, stiff, and soreness of all muscles: 

Cimic. 
Back, small of, pains in: Cimic. 
and loins, pain in: Sulphur. 

and limbs, pain in: Aeon., Bryon. 

Ipec. 

, loins and legs, heaviness and cramp- 
like pain in: Bellad. 

and headache, and as if all the bones 

were broken : Eup. per/. 

Bones, pain in: Crotal. 
Different parts of body, cramps in: Nux 
vom. 



980 



FEVER. 



Limbs, stiffness and lameness of: Arsen. 
, paralysis of one or the other of the : 

Mercur. 

, heaviness of: Carb. veg. 

, coldness of: Camphora, Ver. alb. 

, , with cramps of: Mercur. 

Legs, coldness, lameness and cramps in : 

Nux vom. 
Feet cold : Nux vom. 



Blood dark, non-coagulable : Laches. 

flows from all orifices: Orotal. 

, discharges of: Arsen., Carb. veg. 

, capillary stagnation; cyanosis; all 

discharges fetid and offensive : Carb. veg. 
Small wounds bleed much: Laches., 

Phosphor. 



Trembling all over : Carb. veg., Laches. 

of internal parts : Camphora. 

of the limbs : Nux vom. 

and attacks of fainting : Tart. emet. 

and jerking of external parts : Ver. 

alb. 
Subsultus tendinum : Cimic. 
Spasms : Crotal. 
Paralysis of left side : Laches. 

of lower extremities: Rhus tox. 

Pains like electric shocks here and there : 

Cimic. 
Irritability of all organs : Mercur. 
, vascular and nervous, threatening 

convulsions, especially in children : Ver. 



Coldness all over : Ver. alb. 

, icy, all over : Camphora, Carb. veg. 

, external, with internal heat : Arsen. 

Chill, severe and long-lasting, at the com- 
mencement: Camphora. 

Shuddering : Tart. emet. 

Heat, dry, burning : Aeon. 

, , , with changing pulse: 

Bellad. 

, sudden flushes of: Laches. 

, internal, with external coldness, and 

cold, sticky perspiration: Arsen. 

Fever, intense, with occipital pains : Ver. 



Local inflammations : Ver. vir. 
Sweat bloody : Crotal. 

cold, sticky : Arsen. 

, on face : Carb. veg. 

, on hands and feet : Canthar. 

stains yellow : Laches. 



Rhus 



Coma, with rattling respiration: 
tox. 

Drowsy: Laches. 

or sleepless from nervous irritation : 

Mercur. 

Sleeplessness : Laches., Rhus tox. 

and restlessness from suffocating sen- 
sations : Carb. veg. 

Sleep disturbed by many dreams : Apis. 

Waking with a start from sleep : Cimic. 

Restlessness : Ver. alb. 

— — and tossing : Rhus tox. 

, wants to go from one bed to another : 

Arsen. 



Sinking of strength : Arsen., Mercur, 
Exhaustion : Ver. alb. 
Prostration : Tart. emet. 
Depression of vital powers : Crotal. 
Fainting: Laches. 
Death by syncope : Crotal. 

Skin yellow: Bryon., Mercur. 

or purplish : Laches. 

— — deep yellow : Crotal. 

- dirty yellow : Rhus tox. 

, purplish spots : Crotal. 

, ecchymoses: arb. Cveg. 

, petechial spots : Phosphor. 



Worse on right side : Crotal. 

on left side : Laches. 

lying on left side : Laches. 

from evening till 1 o'clock a.m. : Bcip- 

tis. 

when waking : Laches. 

Desire to be uncovered : Aeon. 
Better after nourishment : Laches. 



Aeon, is followed well by Bellad. 
Cadm. sulph., when nausea is not relieved 
by Arsen. or Ipec. 



DENGUE, OR BREAK-BONE FEVER. 



981 



Carb. veg. is, according to Hering, the 
fundamental remedy in yellow fever, 
like Sulphur in cholera. 

Cepa is said to have cured a case of yel- 
low fever. 

Chamom., as intercurrent remedy for 
colic in children. 

Crot. tigl., in allopathic doses, was fol- 
lowed by aggravation and final rapid 
improvement. 

Cuprum, when Arsen. does not relieve the 
vomiting of blood. 



Laches., after previous abuse of mercury 
or quinine. 

Nux vom., after allopathic drugging. 

Phosphor, is similar to Arsen. and Oro- 
tal, and produces acute yellow atrophy 
of liver, fatty degeneration, malignant 
jaundice, albuminous urine and hemor- 
rhagic diathesis. 

Ver. alb., after purging with castor oil. 

Verbena Jam. is said to have cured a 
number of the most desperate cases. 



Dengue, or Break-bone Fever. 

Dr. R. D. Arnold, of Savannah, says (Identity of Dengue and Yellow 
Fever, 1859): "The dengue is a milder type of yellow fever, consisting of 
violent pain of the head and loins, with a sort of rending of the bones of the 
extremities, of a single fever-paroxysm of variable duration, which termi- 
nates into a cutaneous eruption, similar to that of scarlet fever." Dr. War- 
ing, of Savannah, says: "At first the correspondence between yellow fever 
and dengue would be complete, and each would seem to be preceding to a 
similar conclusion, when abruptly and without perceptible cause, it appears 
to sweep the disturbances it has excited into the stomach, and ends in black 
vomit, while the other precipitates itself upon the skin and eventually in a 
fugitive inflammation." Zuelzer in Ziemssen's Encyclopedia says : " The name 
dengue is applied to an acute disease, which mostly occurs as an epidemic in 
hot climates, seldom sporadically, and the course of which, after a sudden 
onset or after slight prodromata lasting several days, consists of two par- 
oxysms accompanied by fever, either following immediately one upon the 
other, or after an intermission of one, two or three days. But the paroxysms 
are essentially different one from the other ; the first is characterized by con- 
tinuous high fever, reaching its height within the first 12 to 24 hours (tem- 
perature 106.7° and 107.6° F., and pulse from 120 to 140 per minute), and 
numerous exceedingly painful swellings of the joints, which inter/ere with 
motion, also, more rarely, by an exanthem. These symptoms subside after 
two or three days, simultaneously with the sudden outbreaks of a sweat, or 
epistaxis, or a diarrhoea, which is often critical. 

The second febrile stage, which lasts from two to three days, is marked 
by a remitting fever, and a more or less extensive blotchy or uniform, non- 
elevated, rose-red eruption and great itching of the skin, also less frequently 
by swelling of the joints. 

The subsequent recovery is gradual, and accompanied by decided des- 



982 FEVER. 

quamation. Its course is generally accompanied by great loss of appetite, 
restlessness and sleeplessness. More serious brain-symptoms are absent. 

The disease attacks all ages and both sexes; with adults it terminates in 
recovery, with children it is occasionally dangerous. It sometimes leaves be- 
hind loug continued and painful swellings of the joints, diarrhoea-, emaciation 
and great debility. Relapses also occur. It is not yet determined whether 
the disease is contagious or occasioned by miasmatic influences." 

Typhus. 

Typhus means literally, smoke, stupefaction. In the course of time this 
word has been used to signify different pathological affections, all of which, 
however, were characterized by a dry tongue, stupor, delirium and great 
prostration. -Nowadays it has become usus to call typhus only three forms of 
low fever, namely: the typhus exanthematieus, or petechial typhus, which is 
characterized by a peculiar eruption, the typhus abdominalis, or ileo-typhus, 
which is characterized by a peculiar diseased state of the small intestines, in 
this country best known under the name of typhoid fever, and the relapsing 
fever. 

Typhus Exanthematieus, Petechial Typhus. 

This form is also known under the name of Jail-fever, Ship-fever, or 

Camp-fever. Its immediate Cause is unknown; recent authors, however, 
agree that it is spread by a typhus-germ. Its contagiousness is great, and 
increases with the duration of closer contact with typhus patients, therefore 
assistants and nurses in hospitals are much more frequently attacked than 
the visiting physicians and students ; and where many persons are confined 
to a limited space, e. g., in prisons, on shipboard, in camps, etc., the pestilence 
spreads rapidly to those thus confined. The disease germ is carried by every 
article which has been in contact with diseased persons, by water, if polluted 
with excrements from patients, by air, if contaminated with diseased exhala- 
tions, etc. Famine, atmospheric and telluric conditions, damp, marshy soil, 
etc., favor its development. It attacks rich and poor of both sexes and of all 
ages, but most frequently those between the ages of 20 and 40 years. Ordi- 
narily, it occurs but once in a lifetime. Epidemics have most frequently 
raged in Ireland, but also in other parts of the globe. 

The time of incubation varies from a few days to a week and longer, and 
is attended with various disturbances, none in any way characteristic of the 
complaint. 

The stadium invasionis commences in many cases with a severe chill, or 
with several slight chills, sometimes repeated at intervals during the first 



TYPHUS EXANTHEMATICUS. 9S3 

day, which are followed by a continuous great heat, amounting already on 
the third or fourth day to 103° or 104° F. in the morning, and to 104° or 
105.8°, rarely to 107.6° F. in the evening. The patient is at once stricken 
down by a sense of great weakness and debility, and complains of heaviness 
or pain in the head, which at times is somewhat ameliorated by a spontaneous 
bleeding from the nose; of vertigo, nickering before the eyes and ringing in 
the ears. His hearing becomes impaired ; his muscles are sore and painful, 
and on motion his limbs tremble. He lies apathetic on his back, talks de- 
liriously while being awake, or mutters in his sleep. Others, however, are 
intensely excited, almost wildly, scarcely to be held in bed. With all this 
we observe various catarrhal affections of the eyes, nose, throat and chest, 
which latter is the most constantly affected part, manifesting itself by a 
harrassing, rough cough, with a scanty, tough, sometimes bloody expectora- 
tion. Auscultation reveals numerous rhonchi. The tongue looks, at this 
stage, white, with a pappy taste; there is, at times, nausea, vomiting and 
diarrhoea. This state of things lasts about half a week, when between the 
third and fifth days, scarcely later than the seventh day, the second stage, the 
stadium eruptionis et florescentice, commences. We now observe the breaking 
forth of a rash — roseola spots, greatly resembling that of measles — first on the 
trunk and gradually spreading over the entire body. During the first few 
days these spots disappear on pressure, later, when exudation of blood-cor- 
puscles or coloring matter has taken place, they fade no longer under press- 
ure; they remain till toward the end of the second week. True petechia?, 
on the contrary, are spotted extravasations of blood from the beginning; 
they remain longer and disappear more slowly, and may re-appear after the 
roseola has gone. The appearance of this eruption does not in the least 
ameliorate the situation of the patient; on the contrary, he grows worse all 
the time; his sensorium becomes more clouded; he is unable to think, gives 
slow, incoherent answers, is in constant delirium, either of a mild or raving 
nature, with constant attempts to jump out of bed and run away. After 
recovery the patient scarcely ever remembers anything of this stage. 

The difficulty of hearing increases ; the tongue grows dry and is covered 
with a brownish coating, and the respiration, although the cough has lessened 
materially, is quick and superficial, with increased rhonchi and a dull per- 
cussion sound on the dependent parts of the thorax. There is almost always 
constipation at this stage, with involuntary discharge of urine. The heat 
retains its height to the latter part of the first week, when in light cases it 
generally slackens off a little, and by the seventh day shows an appreciable 
remission for the first time. In severe cases, however, the temperature of the 
body increases during the second part of the first week, and shows no remis- 
sion on the seventh day. The spleen is considerably enlarged toward the 
end of the first week, and the eruption commences to grow more livid with 



984 FEVER. 

the commencement of the second week. Now the patient lies flat on his 
back, with his eyes half closed, and his hands on his genitals, in deep stupor, 
out of which he can scarcely be roused ; he mutters single, unintelligible 
words, draws faces according to the nature of his ever-working imagination, 
gesticulates, catches at something in the air, or picks the bedclothes, tries to 
rise or to put his feet out of bed, in fact, his mind seems to be constantly 
busy at something, although entirely disconnected with the world around 
him. He manifests no desire for drink, which, however, is taken when 
offered, though sometimes with great difficulty, as the tongue is parched and 
trembling and the swallowing difficult. The teeth and gums are covered 
with sordes, the nostrils appear blackened as by soot, and the breath exhaled 
has a terrible smell. By this time the petechial eruption is joined by the 
breaking forth of a miliary eruption; the bronchial catarrh may increase to 
pneumonia or collapse of the lungs, and a number of cases, even light ones, 
are complicated with parotitis. The fever increases in all cases with the 
beginning of the second, may there have been a remission on the seventh 
day or not. In light cases, however, this aggravation is not very severe, nor 
does it last more than a few days, while in severe cases it reaches up to 
106 8° or even 107.8° F., lasting to the end of the second week, even to the 
sixteenth and seventeenth day of the disease. 

The third stage, or the stadium critleum, commences almost always in 
the latter part of the second week, or, in severe cases, in the first days of the 
third week. The change sets in remarkably quick, often in one single night, 
in which the patient at once, after so many sleepless nights, enjoys a deep, 
quiet sleep, out of which he awakes for the first time conscious again, but 
without remembrance of what has passed. The temperature has sunk, per- 
haps, two degrees and the frequency of the pulse, perhaps, twenty to thirty 
beats per minute ; instead of the pungent heat, the body is in a gentle per- 
spiration and the roseola spots appear much paler. Now convalescence com- 
mences, which goes on, however, quite slowly. The crisis is accompanied by 
the formation of sediments in the urine, an increase in its quantity, a dis- 
appearance of the albumen, and a normal amount of urea and chlorides, 
though these changes occur slowly. Often recovery is delayed or even 
frustrated by a renewance of a slow fever, which takes away the last strength 
of the patient, or other sequelse retard its progress, among which the most 
frequent are: inflammation and suppuration of the parotid glands, pneu- 
monia, pleurisy, diphtheritic or follicular inflammation of the intestines, 
numerous furuncles, ecthyma pustules or large abscesses in the subcutaneous 
or intermuscular cellular tissue; even thrombi in the veins of the legs and 
their consequences. 

There have been observed light, abortive cases of exanthematic typhus, 
in which it did not even come to an eruption or to an enlargement of the 



TYPHOID FEVER. 985 

spleen, and where the whole morbid process was finished in two weeks. Loss 
of hair is not uncommon after an attack of typhus. 

TELEKAPELTIC HINTS.— See the following chapter. 
Typhoid Fever, Typhus Abdominalis, Ileo-Typhus. 

This form is also known under the name of enteric fever, mesenteric fever, 
enter o-mesenteric fever, abdominal nervous fever, pyihogenic (produced by pu- 
trefaction) fever. Contrary to typhus this fever is never directly transmitted 
from person to person. It is not like typhus a purely contagious disease, but 
belongs to the miasmatic-contagious diseases. According to numerous ob- 
servations its poison, though originating in the typhoid patient, is transported 
and developed in the excrements when they are left for some time to them- 
selves, as in dirty linen (fresh dejections are handled by physicians and 
nurses with impunity), or still more abundantly when they are collected in 
privies, sewers, or ground already saturated with organic substances. Thus 
it seems that the poison, in order to become active, has to go through a certain 
stage of development outside of the body, where it retains its vitality for a 
long time. From such beds of developed poison infection can be carried to 
whole communities by the inhalation of gases arising from sewers, etc., and 
by drinking water polluted with excrementitious matter, in which the specific 
poison of typhoid fever has been developed. Poisoned water can be disin- 
fected by boiling. The period of incubation seems on an average about three 
weeks, though in isolated cases it may be only two weeks, and in others last 
as long as four weeks. In large cities sporadic cases happen at any season; 
epidemics of typhoid fever occur most frequently from August to November. 

The greatest individual disposition to take the disease seems to prevail 
between the ages of fifteen and thirty years. Children less than one year old 
are very seldom attacked ; after this up to fifteen years the predisposition 
steadily increases, while after the age of thirty years it steadily decreases. 
On the whole the disease attacks by preference the strong and healthy; it 
avoids those already suffering with chronic ailments, and also pregnant and 
puerperal women, and those who are nursing infants, although exceptions 
exist. Persons who have passed through the disease once before are not al- 
ways exempt from another attack, and "real recurrences, that is a new- 
attack coming on soon after the first has run its course, and relapses before 
the completion of the disease are often seen." (Liebermeister.) 

The principal anatomical changes which typhoid fever produces, are: 
catarrh in the chest, even in the finest bronchial tubes; enlargement of the 
spleen to double and even six times its natural size; and ulceration of the 
small intestines. These last, more or less constant, anatomical changes have 



986 FEVER. 

given rise to the appellation of ileo-typhns. Rokitansky distinguishes four 
stages of this typhoid process upon the mucous membrane of the small in- 
testines. 

1. The congestive state, by 'which the whole membrane appears swollen, 
injected and covered with slime, worse so, however, on its lower portion in 
the neighborhood of valvula Bauhini. 

2. The state of infiltration, by which the general redness and swelling 
gradually disappear and become concentrated to the solitary and Peyer's 
glands in the lower part of the ilium. 

3. The state of softening, by which the swelling of the glands is absorbed, 
or the glands burst and become covered with a dry, crumbly crust, or they 
burst and discharge their contents without getting covered with a crust. 

4. The state of ulceration, by which the affected glands suppurate and 
form the typhoid ulcer. These ulcers are round when originating out of 
a solitary follicle and elliptic when originating out of Peyer's plaques ; their 
size varies from that of hemp-seed or pea to the size of half a dollar. Their 
basis is the submucous cellular tissue which lines the muscularis of the gut. 

The Symptoms and Couese of typhoid fever are the following : The 
patient has generally several days previous to the attack, a sense of general 
indisposition, weakness and debility, with headache, dizziness and soreness of 
the limbs, and sometimes repeated attacks of bleeding from the nose, or none 
at all. The attack itself begins almost always with a more or less violent 
chill, or Tepeated chilly sensations, but sometimes without a chill. It is, 
therefore, not always possible to fix accurately the time of the disease. The 
chill is followed by heat, which keeps a regular, quite characteristic, typical 
rise and fall every day for the first three or four days, "rising about 1.8° to 
2.7° F. from morning till evening, and falling from every evening till next 
morning about .9° to 1.3° F., so that on the third or fourth evening a tem- 
perature of 104° F. is reached, or a little exceeded. The formula of this 
ascent is nearly as follows : 

First day, morning: 98.6° F., evening: 101.8° F. 

Second day, " 100.21° F., " 102.56° F. 

Third day, " 101.66° F., " 103.64° F. 

Fourth day, " 102.56° F., " 104.54° F. 

This pyrogenic course in the initial stage of typhoid fever is so decisive 
a test for its diagnosis, that Wunderlich further says: "If the temperature of 
the second, third and fourth evenings is only approximately normal; if the 
temperature of the first three evenings, or of two of them, is of the same 
height ; if the temperature of two out of the first three mornings is alike ; if 
the temperature of the first two days rises to 104° F. or more; if the temper- 
ature retrogrades only once on any of the first four mornings and evenings : 



TYPHOID FEVER. 987 

in every one of these cases we may or must exclude typhoid fever from our 
diagnosis; and contrarily, said diagnosis is the more certain as the course of 
the temperature of the first four days comes nearer to the above formula." 

"Meanwhile, exceptions must not be overlooked. The rise may be com- 
pleted in two days, or protracted to five; both foreboding a severe course, the 
latter a delay in the favorable turn (crisis or lysis) till the middle of the third 
week; the temperature may return to normal the second morning, and be 
succeeded by a greater rise the second evening; the rise of the first and sec- 
ond day being less, that of the third and fourth will be much more; the 
height reached the third and fourth day is not always 104° F., but may be a 
few tenths less or more by a whole degree, 105.8° F. When the typhoid 
fever is secondary to another disease its initial is obscure, often unrecog- 
nizable." 

"In the second half of the first iveek, and the first half of the second, the 
course of the temperature is quite uniform, but cannot help the diagnosis. 
At this time the maximal height, 104° to 106.7° F., is rarely reached more 
than once between noon and evening of the fourth or fifth day; meantime 
the morning temperature is .9° to 2.7° F, lower than the evening's — one re- 
mission may be accidentally even lower." (Wunderlich's Thermometry, by 
Seguin, page 123.) 

The course of the temperature during a whole attack may be character- 
ized in this way, that in the first week it rises steadily, in the second week it 
is continuous, having the same maximum and minimum every day, in the 
third week it becomes remittent, showing greater remissions in the morning 
although the exacerbations in the evening keep still the same height, while 
in the fourth week the remissions become more marked and the exacerbations 
gradually lower. (Liebermeister.) 

With the temperature rises also the pulse, amounting generally during 
the first week from ninety to one hundred beats per minute; sitting up, 
bodily exertion, or mental excitement, is apt to accelerate it considerably, 
even to twenty or thirty beats. 

With all this the patient complains of great weakness and prostration, 
severe headache, dizziness, flickering before the eyes, and ringing in the ears; 
his sleep is restless and disturbed by tiresome dreams, sometimes of the same 
thing over and over again ; he calls out in sleep or talks incoherently. 
When awake he is fully conscious but indifferent, answering questions slowly 
and reluctantly. His thirst is great, his appetite gone, and his taste pappy, 
disagreeable. The bowels are during the first days frequently constipated, 
but change towards the end of the first week to diarrhoea. There is in many 
cases repeated bleeding from the nose, and already at this time a catarrhal 
irritation in the chest. The face is flushed, especially the cheeks look dark 
red as long as the patient lies quietly on his back, but it turns pale and 



988 FEVER. 

sunken when he sits up a while. The tongue is soft, flabby, showing the im- 
prints of the teeth, and is covered by a slight whitish fur, which gradually is 
thrown off, leaving the tongue moist, smooth and red, as though it were cov- 
ered with a fine gold-beater's skin; it soon, however, grows dry. In cases 
where the tongue is thickly coated, this covering commences to disappear 
either on the tip and edges, whereby the yellowish-white coating becomes en- 
circled by a gradually broader-growing, deep, red belt, or it disappears at 
first in the centre, and constitutes that well-known, dry, red streak in the 
middle of the tongue, which is frequently broader at the point of the tongue, 
and forms, in this way, a kind of triangle, with its base down at the tip. 

The abdomen at this time appears somewhat bloated and is sensitive to 
strong pressure. A deep pressure upon the ileo-csecal region may cause a 
gurgling noise in that region, especially if there be already diarrhoea present. 
The spleen is swollen, which can be detected by percussing the patient when 
he lies upon his right side. Finally, there appear toward the end of the first 
week, single, pale, reddish, lentil-sized roseola spots upon the epigastrium 
and adjacent parts of the chest and abdomen. 

In the second week the temperature of the body ranges between 104° F. 
and more; towards morning there is only a slight remission, and the pulse 
grows softer, weaker and more frequent, from 110 to 120 beats, revealing 
more or less weakness of the heart. The dizziness increases, the ringing in 
the ears changes to hardness of hearing, which is generally dependent upon 
a catarrhal affection of the Eustachian tubes and tympanum. The expres- 
sion of the face becomes more and more stupid, and the indifference of mind 
increases. By and by the consciousness of the patient becomes clouded and 
he sinks gradually in a state of somnolence and stupor. Although the tongue 
is as dry as " chip," yet he utters no desire for drink ; takes it, however, when 
offered, very greedily. When asked to show his tongue, he does not seem to 
comprehend at first, but finally, with great effort, he brings it forth, pointed 
and trembling. Stool and urine pass off involuntarily. The patient lies 
always on his back, and having lost consciousness of all muscular power, the 
body follows its own weight and the patient slides gradually down in bed, 
without any effort of his own to change this position. The mental operations 
are still going on ; we see it on the now and then trembling lips, as efforts to 
speak, and in the low murmuring of unintelligible words now 7 and then. 
This is febris nervosa stupida. 

Other patients, although likewise mentally disconnected with the ex- 
terior world, neither knowing nor understanding w T hat is going on about 
them, manifest a vivid, dreamful perturbation of the mind. 

They are in constant agitation, throw off the covers, try to get out of 
bed and to escape, talk loud or lisp some unintelligible words, gesticulate 
and become angry when interfered with. Their obstinacy in gaining their 



TYPHOID FEVER. 989 

imaginary ends is sometimes astonishing, when all at once it changes to some 
other object. In other cases there seems to be no intelligible connection be- 
tween the constantly-changing phantasmata, with which they seem to be 
haunted. This agitation of the mind is generally greatest during the night. 
This is febris nervosa versatilis. There are again cases where both of these 
states make a regular turn; the febris stupida prevailing through the day, 
and the febris versatilis through the night. 

During this week the bowels are almost always loose, owing to the 
catarrhal affections of the intestines; the cheeks have a brownish-red or 
bluish color; the eyelids are half closed; the conjunctiva is injected; the 
nose is thoroughly dry, and the nostrils are blackened as of soot. On the 
gums and teeth we observe sordes ; the tongue is covered with a brownish 
crust, which gradually grows black from the admixture of blood; it is stiff, 
making swallowing quite difficult. The abdomen is inflated like a drum; 
the spleen has grown still larger, and the roseola-spots have, in some cases, 
likewise increased, and are joined by numerous sudamina. On the chest, 
physical examination reveals solidification of the dependent parts of the 
lungs and far-spread catarrhal affections. There is a less full percussion 
sound, weak vesicular breathing, fine, bubbling rattles in the dependent 
parts and loud rhonchi everywhere else. 

The third week does not bring any amelioration as yet. The temperature 
of the body is still on the increase, and the morning remissions are quite 
indistinct. Only where the case turns favorably, there is in the second half 
of the third week a decided improvement in this respect. While the evening 
temperature still rises to 104° or over, the morning temperature shows 
greater remissions. 

The prostration reaches, in this week, its climax; the patient slides 
down in bed; there is a constant jerking of the tendons; somnolence and 
stupor are complete, and stools and urine are passed unconsciously, or the 
urine is retained in consequence of a paralysis of the detrusor vesicae; the 
roseola-spots commence to get paler, the sudamina increase more and more, 
and in some cases there appear petechia?. To all this associates an erythema 
in the region of the sacrum, which, by throwing off the epidermis, is soon 
converted into a bed-sore — decubitus. This is, indeed, the week when the 
mortality of typhoid patients is the greatest, while in favorable cases its 
latter part is the turning point. We observe then a gradual abatement of 
all the above-detailed symptoms. The stupor changes into a natural sleep, 
consciousness gradually returns; diarrhoea, respiration, pulse, countenance, 
all improve. 

This improvement continues in the fourth week, or in some instances 
commences then, and finally passes over into the state of convalescence. 



990 FEVER. 

During this time nearly all the patients lose their hair, which, however, is 
soon followed by a new crop. 

This is about the course which a majority of typhoid fever cases run. 
Besides this, however, there are a number of variations, of which the follow- 
ing are the most important: 

The Abortive typhoid fever is, in every respect, much lighter, and 
correspouds to the " gastric fever or nervous fever" of older writers. Although 
it shows all the symptoms of a regular typhoid fever, yet they are all much 
milder; the temperature of the body never reaches such an intensity, and 
already on the eighth or ninth day there is a considerable morning remission, 
which sinks at the end of the second or during the third week to a normal 
state, with only slight aggravations in the evening. Still the patients gain 
their usual strength quite slowly. 

The Typhus amhulatorillS is a peculiar form, corresponding to the 
"walking cases" of yellow fever, by which the patient complains only of 
general debility and exhaustion, but still attends to his business, until all of 
a sudden he sinks under the signs of perforation of the intestines or intestinal 
haemorrhage. In such cases it seems that the poison has localized exclusively 
in the intestines, without affecting the general circulation. 

The Typhus tumultuarius, on the other hand, sets in at once so vio- 
lently that the temperature of the body rises already in the first week to 
106° F. and above, and the pulse to 120 and 130; all other symptoms are 
correspondingly severe, so that the disease reaches its climax towards the 
end of the first or the beginning of the second week. Such cases are mostly 
fatal at this early period, or the symptoms grow milder again in the second 
week, and take then the usual course. 

The Pneumo-typhus and Broncho-typhus are forms in which the 
poison seems to localize principally in the chest, causing hypostasis of the 
lungs, pneumonia, or violent bronchitis, while the characteristic affections of 
the small intestines are comparatively light, or even wanting. 

Cardiac weakness, the result of degeneration of the muscular tissue of 
the heart, is responsible in part for the tendency to disintegration which is 
found in all tissues of the body, and is the most frequent immediate cause of 
death, and consequently "the observation of the pulse is of even greater sig- 
nificance than the observation of the temperature for the prognosis of some 
cases. So long as the pulse is, in a measure, strong, and its frequency only 
moderately increased, no immediate danger exists on this side, even when 
the constant elevation of temperature is very considerable." (Liebermeister.) 
This degeneration of the heart-muscle exists, to a greater or less degree, in 
all severe cases without exception. 

Parenchymatous degeneration of the liver is also found in every severe, 



TYPHOID FEVER. 991 

prolonged and fatal cases of typhoid fever, and may reach so high a grade as 
to present a distinct complication, a group of symptoms characteristic of 
icterus gravis or acute yellow atrophy of the liver. Still, jaundice occurs 
lesj frequently during typhoid fever than in pneumonia. 

Parotitis begins most frequently during the third or fourth week, is 
always confined to the most severe cases only, and is a bad prognostic sign. 

In still other cases the normal progress of the disease is interrupted by 
an intercurring perforation of the intestines, when the typhoid ulcers eat 
through the muscularis and serosa of the gut. This is always followed either 
by a partial or diffuse peritonitis, the symptoms of which compare under the 
corresponding chapter. The most reliable sign, however, of perforation, 
during typhus, is tympanites, or the sudden escape of gas into the peritoneal 
sac, which presses the liver back from off the thoracic wall, and causes, on 
percussion, in place of the dull liver sound, a clear tympanitic sound. 

Or the natural progress of the disease is interrupted by an intercurriug 
haemorrhage from the bowels. This takes place either in consequence of arro- 
sions of blood-vessels near the ulcers, or in consequence of the bursting of 
overfilled capillaries. It causes bloody stools, and, if profuse, collapse and 
a sudden sinking of the temperature, which sometimes restores consciousness 
for a while, but generally ends fatally, in consequence of the exhaustion 
which it produces. Less dangerous are the intercurring profuse haemorrhages 
from the nose, which take place sometimes in the second or third week of 
typhus, and the haemorrhages from the womb in female patients. But as both 
are the consequence of a highly debilitated state of the system, none of them 
can be considered as a favorable sign. 

Or the whole course of the disease is protracted by the sloiv healing pro- 
cess of the intestinal ulcers. In such cases we find the typhus followed by a 
low, asthenic fever for weeks afterwards, or in fact there is no cessation of the 
fever; the sensorium remains clouded; the weakness increases; the emacia- 
tion grows excessive ; the bed-sores enlarge ; any part of the body, wherever 
its own weight rests upon, shows the signs of decubitus. Many of these 
patients die about the fifth or sixth week, as such a far-spread decubitus alone 
seems to be sufficient to consume the little strength that is left. 

As Sequelae of typhus may be mentioned: neuralgia, partial paralysis, 
partial anaesthesia, mental disturbances, tabes, ansemia and hydrsemia. It is 
not unfrequent that, during the period of reconvalescence, phthisis pulmonalis 
is developed. 

THERAPEUTIC HINTS.— Agar, muse, constant delirium, at- 
tended with attempts to get out of bed, with a tremulous propulsion of the 
tongue and a general tremor of the whole body. (G. C. Hibbard.) Desire 



992 FEVER. 

for alcoholic drinks, which are easily borne. It suits well typhoid fever in 
drunkards. (A. Charge.) 

Alumen, great masses of coagulated black blood pass from the anus in 
the third week of typhus, with signs of the greatest exhaustion. (Herijjg.) 

Alumina, is often indicated when Bryon., though indicated, does not 
act deep enough. (Gosewitsch.) 

Apis, according to Wolf, in the presence of: apathic conditions, uncon- 
sciousness, stupor, with murmuring delirium, hardness of hearing, inability 
to talk and put out the tongue, which is cracked, sore, ulcerated or covered 
with vesicles ; difficulty in swallowing, great soreness and bloatedness of the 
abdomen; constipation, or frequent, painful, foul, bloody and involuntary 
discharges from the bowels ; unconscious flow of urine ; dry, burning skin, or 
partial, clammy sweats; trembling and jerking of the limbs; white miliary 
eruption on the chest and abdomen, greatest weakness and sliding down in 
bed ; frequently changing, weak and intermitting pulse. 

Arnica, stupefied condition; sits as if in thought, yet thinks of nothing, 
like a waking dream ; forgets the word while speaking ; confusion of the head ; 
loss of consciousness; delirium; great weakness, weariness and bruised sore- 
ness, which compels to lie down, and yet every position feels too hard ; unre- 
freshing sleep, with anxious dreams, talking, and loud blowing during expira- 
tions; bleeding from the nose; trembling of the lower lip; dry tongue; with 
a brown streak in the middle ; putrid smell from the mouth ; distention of the 
abdomen; involuntary discharges of feces and urine; pleuritic stitches at 
every inspiration ; great sinking of strength. 

Arsen., especially for weak or debilitated individuals, old age and 
children ; in slow, protracted cases, with mild delirium ; loss of consciousness ; 
great restlessness and anxiety, manifesting itself in constantly moving head 
and limbs, while the trunk lies still, on account of too great weakness ; pick- 
ing of the bedclothes ; sopor ; face distorted, sunken, anxious, hippocratic ; 
lower jaw hanging down; cheeks burning hot, with circumscribed redness; 
eyes staring, glistening or sunken, dull and watery, or closed with sticky 
matter ; hardness of hearing ; lips dry and cracked ; lips, gums and teeth 
covered with brown or black slime ; tongue red and dry, cracked ; stiff, like 
a piece of wood ; black tongue ; speech unintelligible, lisping, stammering, as 
though the tongue were too heavy; excessive thirst, but little drinking at a 
time ; the fluid rolls audibly down into the stomach ; vomiting and retching ; 
burning in the stomach and bowels, sensitive to pressure; meteoristic disten- 
tion of the abdomen ; constipation or looseness of the bowels ; brownish or 
watery, bloody, foul, involuntary discharges; involuntary discharge of urine 
or retention of urine ; " frequent urging to urinate, with burning and scanty 
discharge." (TV. J. Martin.) Voice weak and trembling, or hoarse, coarse 
or crowing; breathing short and anxious, oppressed, rattling; dry cough; 



TYPHOID FEVER. 993 

fetid breath. On chest and abdomen roseola spots; white miliary eruption, 
even petechia; decubitus; excessive prostration and rapid emaciation; pun- 
gent, hot, dry skin, like parchmeut; cold, clammy perspiration, pulse frequent, 
small, trembling, intermittent. A cadaverous smell scents the whole atmos- 
phere. All symptoms worse about and soon after midnight or uoon. 

Arum triph., lips and corners of mouth sore and cracked; excessive 
salivation; saliva acrid; breath very fetid ; picking the ends of the fingers 
with the nails ; picking the lips until they bleed ; boring with the fingers in 
the nose ; great restlessness, tossing over the bed, wants to escape while per- 
fectly unconscious of what he is doing, or what is said to him; urine generally 
suppressed. (Lippe.) 

Baptis., "she cannot go to sleep, because she cannot get herself to- 
gether. Her head feels as though scattered about, and she tosses about 
the bed to get the pieces together." (Dr. Bell.) Dull, stupefying headache, 
confusion of ideas; delirious stupor; heavy sleep, can scarcely be aroused 
long enough to answer a question, falling asleep in the middle of the sen- 
tence; dark red face, with a besotted expression; injected eyes; coated 
tongue, brown and dry, particularly in the centre, or dry and red ; sordes 
on the teeth; fetid breath; fetid sweat; fetid discharges from the bowels; 
fetid urine; great debility and nervous prostration; ulcerations; chilliness 
all day; heat at night; chilliness, with soreness of the whole body. Sensa- 
tion as though there were a second self beside the patient in bed. 

Bellad., during the early stage, especially of tumultuous cases, when 
there is great congestion to the brain, with great drowsiness, and an inability 
to go to sleep, and frequent starting during sleep; violent delirium, with 
attempts to run away, to strike, bite, or spit at his attendants; sparkling, 
staring eyes; throbbing of the carotid and temporal arteries, and also in the 
forehead ; deafness ; burning heat and redness of the face ; distortions of the 
mouth ; dryness of nose, mouth and throat ; tongue with red margin and 
white centre; trembling and heaviness of the tongue, with stammering as if 
drunk; sore throat and dry cough from bronchial irritation. 

Bryon., in any stage when there is delirium, especially at night, about 
the affairs of the previous day or business matters ; visions, especially when 
shutting the eyes; irritableness ; peevishness; easily offended ; hasty speech; 
headache; dull, pressive, or stitching, tearing pains, worse from motion and 
opening the eyes; eyes dull, watery; hardness of hearing; dryness of nose; 
lips dry, brown, cracked; tongue coated thick, white, or yellowish, later 
brown and dry; dry feeling in the mouth, without any thirst, or else great 
thirst, with drinking large quantities at a time; bitter taste in the mouth; 
nausea ; retching ; great soreness in the pit of the stomach to touch or motion ; 
bowels constipated ; hard cough, with stitching pain in the chest and region 
of the liver; bronchitis; great lassitude and weakness; wants to lie quiet; 
63 



994 FEVER. 

pain in all the limbs when moving ; restless sleep, with groaning and moaning, 
and frequent movements of the mouth, like chewing ; eruption of white, mil- 
iary rash, with anxiety in the region of the heart; sighing, groaning and 
moaning, and a peculiar sour smell of the body, with or without sweat. 

Calc. carb., according to Goullon, during the aggravations, which 
precede the outbreak of the miliary rash, about the fourteenth day of the 
disease : palpitation of the heart, tremulous pulse, anxiety, restlessness, red- 
ness of the face, delirium, jer kings, especially in children; short, hacking 
cough ; excessive diarrhoea. Also when a pneumonia develops, tending to 
gray hepatization with its characteristic sputa ; great soreness of the soles 
of the feet. Besides this, it may be indicated at the very onset, and then cut 
off all further progress in persons inclined to grow fat ; after great anxiety 
and worriment of mind ; utter sleeplessness from overactivity of the mind ; 
it is the same disagreeable idea whicli always rouses the patient as often as he 
falls into a light slumber; constant tickling under the middle of the sternum, 
causing a hacking cough, worse from talking or moving ; during coughing, 
painful shocks in the head ; the brain feels hot and burning. (Lippe.) Urine 
very dark, but clear. 

Camphora, in extreme cases like Carb. veg., only that the symptoms 
set in much more rapidly. Greatest weakness; cold sweat all over; quickly 
decreasing temperature, especially of the extremities; small, very frequent, 
scarcely perceptible pulse;. great nervous restlessness of body and limbs; 
collapse in face ; cold, pointed nose and cold mouth; automatic motions of 
the muscles; delirium; syncope; snatches of sleep; great thirst, with red, 
dry tongue; frequent involuntary stools, after much rolling and rumbling in 
the bowels. (Trinks.) 

Canthar., may be indicated by its characteristic urinary symptoms. 

Carb. veg., often at the brink of death a saviour, in those states of 
collapse, dissolution of blood, and paralytic conditions, which seem rapidly 
to invade the whole organism. All this is indicated by stupor, out of which 
the patient can scarcely be roused for moments; the eyes are dull, without 
lustre, and the pupils without reaction against light; the hearing is gone ; 
the face is pale, sunken, hippocratic, cold ; there are haemorrhages from mouth 
and nose; the tongue is sometimes moist and sticky; other times parched and 
cracked, heavy, scarcely movable, bluish or pale; the pit of the stomach is 
bloated ; the abdomen meteoristic, with loud rumbling and gurgling of wind 
in the intestines; there is colliquative diarrhoea, brownish, grayish, or bloody, 
of a cadaverous smell, and involuntary. The cough has ceased, and the col- 
lecting secretions cause loud, rattling breathing, a sign of beginning paralysis 
of the lungs; the circulation is without energy; the blood stagnates in the 
capillaries and causes cyanotic blueness of face, lips and tongue ; ecchymotic 
spots here and there ; decubitus; the pulse is extremely weak, frequent, small, 



TYPHOID FEVEE. 995 

scarcely perceptible; face and extremities grow cold and become covered 
with cold perspiration — all signs of beginning paralysis of the heart ; in 
short, the patient offers a picture of complete torpor of all vital functions, 
thus differing entirely from that of Arsenicum, which is always more or less 
associated with erethism of the system. 

China, especially where there is painless diarrhoea, bloatedness of the 
abdomen, haemorrhages, and slowly progressing convalescence after such 
weakening influences. 

Coccul., in such cases which are mainly characterized by a depriva- 
tion of the nervous system, showing little or no disturbance in the vegetative 
sphere of the system, except enlargement of the spleen. There is a slowness 
of comprehension ; he don't find the right expressions for his ideas; what has 
passed he cannot remember ; he talks muttering, mumbling ; it costs him a great 
deal of effort to speak the words plainly ; and then again for a short while 
he is very irritable, cannot endure either noise or contradiction, and speaks 
hastily. Most of the time, however, he sits in silence or feels an unconquera- 
ble inclination to sleep ; his eyelids are heavy, fall shut, as if paralyzed ; the 
drowsiness may increase to coma. There is dizziness in the head, especially 
when rising up in bed, with nausea, compelling to lie down again ; ringing 
in the ears ; heat in the head and chilliness in the remaining body ; pappy 
taste in the mouth; belching; nausea; distention and rumbling in the ab- 
domen; great general weakness and weariness; great heaviness in the feet; 
attacks of trembling and jerking of the eyelids, muscles of the face and limbs, 
and fits of fainting from bodily movement, with spasmodic distortion of the 
facial muscles. Especially indicated after mental and bodily overexertion. 

Colonic, according to Wells, great weakness, as if after exertion. If 
the patient be raised up the head falls constantly backwards, and the mouth 
opeus to the widest extent. Sudden sinking of the forces, so that in ten 
hours he can hardly speak or walk ; cadaverous aspect and extreme prostra- 
tion; emaciation; lying on the back; comatose; eyes half open; respiration 
audible and accelerated; hands and feet cold; trunk hot and extremities 
cold; skin dry; sweating; suppressed, cutaneous transpiration; forehead 
covered with cold sweat ; pulse small and contracted, quick and hardly per- 
ceptible, small and frequent, quick and thready; pulseless; delirium, with 
cephalalgia ; intellect beclouded, though he gives correct answers to ques- 
tions; unless questioned he says nothing of his condition, which does not 
seem to him dangerous; perception entirely lost; he is unconscious; eyes 
hollow, staring and sunken ; pupils much dilated and little sensitive to light, 
or immovable, and but slightly dilated; nostrils dry and black; face sunken 
and hippocratic; risus sardonicus; lips, teeth and tongue covered with a 
thick, brown coating; lips cracked; face covered with perspiration; griuding 
of teeth; tongue protruded with difficulty; tongue bright red; tongue heavy, 



996 FEVER. 

stiff and numb; loss of speech; inextinguishable thirst; epigastrium and 
stomach extremely sensitive to pressure; abdomen distended, tense and 
hard; surface of the abdomen hotter than the rest of the body; tympanites 
with pain in the back; watery diarrhoea; the stools are passed insensibly; 
stools fluid, offensive, with white flakes; involuntary stools; numerous, 
liquid, dark, offensive stools, with severe pain; secretion of urine suppressed; 
urine copious; involuntary urination; respiration irregular and intermittent. 

Cuprum, according to Baehr, in typhus without high fever, but with 
excessive weakness, which increases rapidly under the signs of dissolution of 
blood (nosebleed and petechia?), until under general paralytic symptoms 
death ensues. 

Fluor, ac, recommended by Hering when there is decubitus. 

Gelsem., stage of invasion with sense of extreme prostration; trem- 
bling from weakness; muscles refuse to obey the will; pulse slow, but greatly 
accelerated by lifting or turning the patient; severe pains in head, back and 
limbs; chilliness, cold hands and feet; crimson flush of face; thick, brown, 
coated tongue; occasional moisture here and there; sleeps frequently half 
waking and talking incoherently; head feels "big as a bushel;" vertigo; 
blind spells; epistaxis; iliac tenderness. (J. C. Morgan.) 

Ginseng, loud gurgling noise in the ileo-csecal tract, dry tongue, heat, 
delirium on going to sleep. (Liedbeck.) 

Hamam., haemorrhage from the bowels of fluid, dark, fetid blood; 
great soreness of the abdomen. 

Helleb. nig., facies quatrata; stupid expression, though the face is 
not collapsed; vacant look of the eyes with dilated pupils; constant som- 
nolence, out of which the patient may be roused, but does not gain full con- 
sciousness; he stares at the physician, is slow in comprehending and answer- 
ing his questions ; all perceptions by the senses grow only slowly or not at 
all conscious. The patient utters no desire; when left alone sinks in slum- 
ber; he lies upon his back with limbs drawn up; sliding down in bed. 
Mucous membranes but little or not at all affected; abdomen not bloated, 
unpainful; no diarrhoea; sometimes unconscious discharge of urine; slow 
action of the heart; pulse only 80 per minute; respiration slow; temperature 
of skin nearly normal; no miliary eruption; no sign of putrid dissolution of 
the blood; loss of flesh trifling; only the brain seems to be the invaded part 
of the body. (Trinks.) 

Hydr. ac, when the drink which is swallowed rolls audibly down the 
throat, as though it were poured into an empty barrel. (Heynel.) 

Hyosc, entire loss of consciousness, and of the functions of the organs 
of the senses ; does not recognize relatives or friends ; illusions of the imagina- 
tion and senses. Delirium which is continued while awake, and which sees 
persons who are not and have not been present. Indistinct and muttering 



TYPHOID FEVER. 997 

loquacity; muttering with picking of the bedclothes; inability to think, the 
thoughts cannot be directed or controlled; constant staring at surrounding 
objects, with apparent entire self-forgetfulness; or else great agitation; rest- 
lessness; jumping out of bed; attempts to run away, etc. Eyes red and 
sparkling, staring, rolling about in their orbits; squinting; deafness; dis- 
torted face, stupid expression; tongue red or brown, dry and cracked; para- 
lyzed; loss of speech, or indistinct speech ; cadaverous smell from the mouth ; 
involuntary or unnoticed stools in bed ; suppressed secretion or retention of 
urine; involuntary discharge of urine, leaving streaks of red sand on the 
sheet. Paralysis of sphincter ani and vesicae. Convulsive motions; grating 
of teeth; jerkings; subsultus tendinum; trembling; sleeplessness, or con- 
stant sleep with muttering; coma vigil. Roseola spots on chest and ab- 
domen ; cold extremities. 

Ignat., great impatience and despair about pains and bad feelings, 
which he cannot describe; gets easily frightened, and feels as though he were 
swung to and fro in a cradle or in a swing. Attacks of yawning, stretching, 
followed by pain in the front of the head, which does not allow opening the 
eyes; choking sensation from the stomach up into the throat, with oppression 
in the chest, better from belching ; palpitation of the heart ; sinking, weak 
feeling in the pit of the stomach; convulsive motions of the limbs; jerking 
of the tendons. Sleeplessness on account of various visions as soon as he falls 
in a doze; troublesome dreams. 

Kali carb., intermitting pulse, vomiting, headache, nervous, easily 
frightened, pale, sickly complexion. (Goullon, Jr.) 

Kreos., typhoid haemorrhages, with fetid stools, followed by great 
prostration. (Trinks.) 

Laches., fever worse in the afternoon; sweat without alleviation; sleep 
with following aggravation of all the symptoms; loss of consciousness; mut- 
tering; stupor; sunken countenance; dropping of lower jaw; dry, red or 
black tongue, cracked on the tip and bleeding; in the attempt of protruding 
it, it trembles; or the tip remains under the lower teeth, and does not come 
out; dry lips, cracked and bleeding; stools very offensive, whether formed 
or loose; haemorrhage from bowels, with flakes of decomposed blood, having 
the form and appearance of charred straw, in longer or shorter pieces, to- 
gether with portions more or less ground up; sore throat with deafness; 
nasal, indistinct speech; dyspnoea; cough, with slimy, bloody expectoration; 
after sleeping a short time, terribly restless, tossing about and throwing the 
bed-covers off. 

Lauroc, clonic spasms of the upper and lower extremities, with para- 
lytic weakness of the limbs; no loss of consciousness. (Trinks.) 

Lycop., sopor; delirium; uses wrong words for correct ideas, which he 
intends to express; fear to be left alone; restless sleep, with outcries and 



998 FEVER. 

loud laughing; when awaking, exceedingly cross, irritable, scolding, scream- 
ing, behaving disagreeably; violent jerkin gs of the limbs, shaking the whole 
body, awake or asleep; subsultus tendinum; catching at flocks; sunken face, 
yellowish, or with circumscribed redness in the afternoon ; tongue red and 
dry ; sometimes it is spasmodically thrust to and fro between the teeth ; lower 
jaw sunken; bowels much distended, with rumbling and constipation; urine 
leaves, if voided in bed, a red, sandy stain; cold hands and cold feet; one 
foot hot and the other cold ; wants to be uncovered during heat. 

Mercur., may be indicated at the beginning of the disease, when there 
is: swollen and bleeding gums; fetor from the mouth; pain in the liver; 
yellow-green stools; dark urine; bronchitis; icteroid color of the skin. 
"Obtuseness of mental operations, with great inclination to sleep; heaviness 
and muddledness of the head; thick and dirty- whitish coating of tongue ; in- 
sipid, pappy, slimy, foul taste, with desire for refreshing things; thirst; pain- 
ful sensitiveness of precordial, hepatic, umbilical and ileo-csecal region ; 
bilious, slimy or watery diarrhoea, which, however, may be absent altogether; 
prostration ; sometimes copious, debilitating perspiration ; pale and sunken 
face and eyes; also dirty-yellowish color of the face." (Trinks.) 

Moschus, in cases of impending paralysis of the lungs, where the 
cough ceases and the collected mucus cannot be expectorated ; where respira- 
tion and pulsation of the heart grow weaker and weaker; where in swallow- 
ing, the fluid rolls audibly down the throat, and stool and urine pass off in- 
voluntarily. 

Mur. ac, febris stupida; constant sliding down in bed, with groaning 
and moaning in sleep, and muttering and unconsciousness while awake; ex- 
cessive dryness of mouth and tongue ; the tongue is heavy, paralyzed ; the 
patient cannot move it at will, even if conscious; the pulse intermits every 
third beat; profuse discharge of watery urine; watery diarrhoea; stools and 
urine involuntary. "Febris nervosa versatilis after Bryon., if the disease 
still grows in intensity. Continuous delirium, hindering sleep and rest; the 
patient is all the time occupied with things past and present; he forgets time, 
place and all he has said. Vivid hallucinations; the eyes shun the light; 
the ears are sensitive to slightest noises and hear sounds — the falling of rain, 
or music — which do not exist; smell and taste very acute. The eyes glisten ; 
the pupils are contracted ; the cheeks reddened ; nose, lips and tongue are 
dry; the tongue is not, or only slightly coated ; great thirst; little or no affec- 
tion of the mucous membrane of the intestines; discharges from the bowels 
none, or but seldom ; urine clear, of acid reaction; pulse very frequent, irri- 
tated, without energy, 110 to 130; respiration accelerated; skin mostly dry, 
hot.. Great desire to sleep, without ability to goto sleep; muscular power 
not very much decreased; slight feeling of weakness and weariness." 
(Trinks.) 



TYPHOID FEVER. 999 

Nitr. ac, in cases of typhoid hemorrhages; great sensitiveness of the 
abdomen; green, slimy, acrid diarrhoea; tenesmus; white, coated tongue, 
with sore spots; inflammatory affection of the lungs, with rattling cough and 
breathing; brownish, bloody expectoration and irregular pulse; after 
calomel. 

Nuphar., liquid, yellow, fetid stools most frequent between four and 
seyen in the morning. 

Nux mosch., profound coma; lying silent, immoyable; insensible; dif- 
ficult comprehension ; slowness of ideas ; dwells long on her answer, or does 
not answer at all; very deaf; putrid colliquative diarrhoea; rolling, rum- 
bling and gurgling in bowels; dreamy state, with drowsiness and falling of 
eyelids ; dryness of mouth, tongue and throat, with fulness of stomach and 
loss of appetite ; in the evening the dryness is so great that the tongue sticks 
to the roof of the mouth, yet there is no thirst. (Hering, confirmed by Nash.) 

Nux vom., "in the early stage, if there be chilliness on slightest move- 
ment ; dryness of the front of the mouth and tip of the tongue ; intolerance 
of impressions on the external seuses, all of which seem much exaggerated ; 
great sensitiveness to the open air ; thirst, with aversion to water ; strong de- 
sire to lie down, and considerable relief on doing so." (Wells.) 

Opium, febris nervosa stupida ; the stupor is complete; he cannot be 
roused or only with great difficulty ; lies speechless, with opeu eyes and stiff 
limbs; delirium, mild or furibund, with loud talking, laughing or singing; 
attempts so escape ; congestion to the head ; face dark red and bloated ; res- 
piration slow, deep drawn and sighing, stertorous, rattling; constipation or 
offensive watery diarrhoea; involuntary stools; retention of urine. 

Phosphor., pneumo-typhus ; violent bronchitis and even hepatization; 
hard, dry cough with tightness in the chest; or loose, rattling cough, with 
tough, transparent, or thick, yellowish, or reddish expectoration; cough 
worse from evening until midnight; vomiting of watery, bilious and slimy 
masses with great pain ; frequent, unpainful diarrhoea, with meteorism and 
loud rumbling; the discharges are watery, greenish, grayish, or black from 
decomposed blood; great weakness after each discharge; numerous roseola 
spots, ecchymosis and miliary eruption on the trunk; great heat of the 
trunk, with cold perspiration on head and extremities. " Kapid sinking of 
strength: very quick, small, thread-like pulse; stupor; unconsciousness; 
sopor and stupefaction; delirium and naccilegium ; hardness of hearing; 
dull, half-shut eyes; hippocratic face; lying on back; dry, immovable tongue, 
covered with black crusts; very sensitive abdomen, painful to touch; rolling 
and rumbling in abdomen during and after drinking; rattling in windpipe; 
impending paralysis of brain and collapse; burning pain in the brain." 
(Trinks.) 

Phosph. ac; complete apathy and indifference; don't want to talk; 



1000 FEVER. 

answers slowly and reluctantly, or short, incorrectly ; stupid sleep from which 
he may be roused, when he answers correctly, but soon falls asleep again ; 
stupor; stupid and indifferent expression of the face; bleeding from the 
nose; meteoristic distention of the abdomen, with a great deal of rumbling 
and gurgling, and unpainful, watery, grayish diarrhoea, also involuntary 
stools; great debility; relaxed pale skin; ecchymosis; bluish-red spots on 
the parts which the patient lies upon ; decubitus ; temperature of the body 
not high; constant, sticky or profuse sweat; pulse weak and small, frequent 
and intermitting. " Dryness of the mouth and throat; gray-whitish coating 
of the tongue ; the patient slumbers even in daytime, with murmuring de- 
lirium; the eyes are dim, sleepy; the skin remains dry or clammy; a miliary 
rash appears first about the neck, then upon the back, then on the chest etc., 
at last upon the feet." (Trinks.) 

Psorin., retarded convalescence from profuse perspiration; patient 
hopeless and despairing of recovery ; extreme prostration. (Hering.) 

Pulsat., at the early stage where external heat is intolerable, causing 
a sense of heat with distress; uncovering, however, is followed immediately 
by a chill ; or there is heat only of one side, or heat of one side with coldness 
of the other, or sweat of one side ; there may be great drowsiness ; delirium ; 
frightful visions ; try tongue, as if burnt, and yet no thirst ; rumbling in the 
bowels and diarrhoea, with pinching pain, worse at night ; pulsating in the 
epigastrium. 

Rhus tox., mental operations are slow and difficult; he answers cor- 
rectly but slowly, sometimes hasty; delirium; talks much to himself, or talks 
incoherently, without any seeming connection of ideas; headache; worse 
from opening and moving the eyes; bleeding from the nose, especially after 
midnight; the lips are dry and covered with brown crusts; the tongue is red 
at the tip, in the shape of a triangle; the bowels are loose, worse at night; 
involuntary alvine discharges during sleep. There is often severe cough, with 
tough, bloody expectoration; bronchitis; pneumonic infiltration of the lower 
lobes of the lungs ; severe rheumatic pains in the limbs, worse in rest ; somewhat 
ameliorated by moving and changing position; constant restlessness; tossing 
about; restless sleep, with frightful dreams, and frequent waking, and never 
that state of quiet, profound coma; dry heat or sweat, during which the 
patient desires to be covered ; roseola spots ; miliary eruption ; great ex- 
haustion. 

Secale, large purple spots on the body, particularly on the feet; body 
cold, especially hands and feet, and would not be covered; cold perspiration, 
mostly on face and forehead; copious vomiting of thick, black bile, mixed 
with mucus. (Lippe.) 

Silic, sometimes in the very worst cases, with excessive debility, pro- 
fuse perspiration and a strong desire to be magnetized ; magnetizing relieves 



TYPHOID FEVER. 1001 

the great weakness, and Silicea promotes the forming of abscesses, boils, etc., 
thus throwing the poison to the surface, and securing a gradual though slow 
recovery. 

Stramon., loss of consciousness ; imbecility; stupefaction of the senses; 
delirium; hallucinations; singing; laughing; whistling; screaming; con- 
stant, involuntary, odd motions of the limbs and body; spasmodic distortions 
of the face; staring look; wrinkled skin on forehead; loss of sight, hearing 
and speech; all objects appear oblique to him; inner mouth feels raw and 
sore, or is ulcerated ; red rash upon the chest ; blackish diarrhoea every 
hour; stools smell like carrion; suppressed secretion of urine; retention of 
urine ; copious, involuntary discharge of urine. Febris nervosa versatile. 

Sulphur, when in psoric individuals the well-selected remedy has no or 
only a superficial effect; besides, if there be sleepless nights; slow compre- 
hension when being asked ; heat and fulness in the head ; chronic sore and 
inflamed eyelids; great dryness of the ears; pale, sickly aspect; bright red 
lips; undefined redness on the tip of the tongue; bleeding from the nose, 
teeth and gums ; offensive smell from the mouth ; diarrhoea, worse early in 
the morning, unpainful or with tenesmus; great prostration after stool; 
offensive urine; catarrh and inflammation of the lungs, especially during 
commencement of infiltration, recognizable by the crepitation sound. 

Tarax., during rest intolerable tearing pains only in the lower extremi- 
ties (Khus tox. has such pains in all the limbs); constant muttering to him- 
self, similar to that of Hyosc. ; violent, tearing pain in the occiput; great 
chilliness after taking anything to eat or drink. (Von Bcenninghausen.) 
Map-tongue. 

Tart, emet., in pneumo-typhus, with great rattling in the chest, 
dyspnoea, etc.; symptoms of oedema pulmonis. 

Tereb., bloody urine. 

Veratr., during cholera epidemics; great prostration; cold sweating; 
coma; vomiting and Avatery diarrhoea; bluish face; pointed nose; wrinkled 
skin. 

Ver. vir., constant talking and muttering unintelligibly, with open 
eyes; squinting; ocular conjunctiva injected, secretion of yellow mucus at 
inner canthus; nightly agglutination ; face pale, with cold sweat; boring 
occiput into pillow, jerking head backward, sometimes forward. Pupils 
dilated; dropping of lower jaw; corner of mouth drawn down on left side; 
champing teeth; tongue coated white; red streak down the centre ; beating 
of heart when turning over in bed, shaking left side of thorax; pulse irregu- 
lar; urine dark and turbid, fetid, involuntary; great restlessness; constant 
moving, thrusting out one leg, then drawing it up; position on back with 
thighs flexed on pelvis; carphologia; picking at bedclothes; subsultus ten- 
dinum, like galvanic shocks; twitching of facial muscles. (G. W. Sherbino.) 



1002 



FEVER. 



Zincum, staring eyes; delirium with attempts to get out of bed; com- 
plete unconsciousness; lying on the back and sliding down in bed; grasping 
at flocks ; subsultus tendinum ; constant trembling of the hands and coldness 
of the extremities; relaxation of the muscles of the face; hippocratic face; 
pale, waxy complexion of the face; decubitus on the sacrum and trochanter: 
frequent, involuntary discharges from the bowels; frequent, small, intermit- 
ting, scarcely perceptible pulse ; impending paralysis of the brain. 

GENERAL HINTS. — In predominant cerebral symptoms compare; 
Apis, Bellad., Bryon., Cuprum, Hyosc, Laches., Mur. ac. Opium, Stramon., 
Zincum. 

In predominant abdominal affections : Apis, Arsen., Bryon., Carb. veg., 
China, Colchic, Ginseng, Mercur., Nux vom., Phosph. ac, Rhus tox., Secale, 
Sulphur, Veratr. 

In pneumo-typhus : Apis, Bellad., Bryon., Calc. carb., Hyosc, Mercur., 
Phosphor., Pulsat., Rhus tox., Sulphur, Tart. emet. 

In febris nervosa stupida: Arnica, Arsen., Carb. veg., Coccul., Hyosc, 
Laches., Mur. ac, Phosph. ac, Rhus tox., Secale. 

During convalescence, when there is too great hunger: Pulsat. 

Diarrhoea, with cutting in the bowels after sour things: Ipec 

Overexertion of the body : Rhus tox. 

Fright: Ignat. 

Chagrin: Nux vom. 

Loss of memory : Anac 

Complaints, which go from above downwards: Selen. 

When commencing below and spreading upwards : Guaco. 

Protracted convalescence: Psorin. 



Digest to Typhoid Fever. 



MIND. 
Consciousness, no loss of: Lauroc. 
, loss of: Apis, Arnica, Arsen., Bellad., 

Colchic, Hyosc, Laches., Lycop., Mur. ac, 

Opium, Phosphor., Rhus tox., Stramon., 

Zincum. 
, , and of senses: Helleb., Hyosc, 

Nux mosch., Stramon. 
Unconsciousness of what he is doing, 

or is said to him: Arum triph. 
and groaning, moaning and muttering 

in sleep: Mur. ac. 
Stupor, stupefaction: Arnica, Laches., 

Phosphor., Stramon. 



Stupor, delirious: Baptis. 

, indifferent expression of face : Phosph. 

ac. 
, lies speechless with open eyes and 

stiff limbs : Opium. 

, lying silent immovable: Nux mosch. 

Febris stupida : Arnica, Arsen., Bellad., 

Carb. veg., Coccul., Hyosc, Laches., Mur. 

ac, Opium, Phosphor., Phosph. ac, Bhus 

tox., Secale, Stramon. 
Self-forgetfulness, with constant staring 

at surrounding objects : Hyosc. 
Does not recognize relatives or friends : 

Hyosc. 



DIGEST TO TYPHOID FEVER. 



100< 



Forgets time, place and all he Las said: 
Mur. ac 

the word while speaking: Arnica. 

what has passed : Coccul. 

Answers correctly but slowly, sometimes 
hasty: Rhus tox. 

slowly and reluctantly, or short, in- 
correctly : Phosp>h. ac. 

slowly and comprehends slowly : 

Sulphur. 

, stares at the physi- 
cian : Helleb. 

or not at all : Xux mosch. 

Does not find the right expression for 
his ideas : Coccul. 

Uses wrong words for correct ideas: Ly- 
cop. 

Comprehension slow and difficult: Coc- 
cul., Mercur., Xux mosch., Rhus tox. 

Thoughts cannot be directed and con- 
trolled: Hyosc. 

Confusion of thoughts: Arnica, Baptis. 

Incoherent talking to himself: Rhus tox. 

Sits in thought, yet thinks of nothing ; 
like a waking dream: Arnica. 

Intellect beclouded, though he answers 
correctly; unless questioned, he says 
nothing of his condition, which does not 
seem dangerous to him: Colchic. 

Thoughts all the time occupied with 
things past and present : Mur. ac. 

The same disagreeable idea rouses the 
patient as often as he falls into a light 
slumber: Cole. curb. 

Can not get rid of one and the same 
idea: Petrol., Pulsat., Stramon. 

Hallucinations : Hyosc, Mur. ac. 

Frightful visions : Bellad., Calc. carb., 
Carb. veg., Cinchona, Hyosc, Mur. ox., 
Pulsat., Stramon. 

Sees persons who are not and have not 
been present : Hyosc, Stramon. 

Illusions : Hyosc 

, especially when shutting the eyes: 

Arsen., Bryon., Calc. carb., Carb. veg. 

, as though there were a second self 

beside the patient in bed: Arsen., Bap- 
tis., Petrol. 

Delirium: Arsen., Bellad., Calc. carb., 



Camphora, Lycop., Pulsat., Bhus tox., 
Stramon. 

Delirium, murmuring: Apis, Arnica, Bel- 
lad., Hyosc, Lycop., Phosph. ac, Bhus tox., 
Strcnnon. 

, furious: Bellad., Canthar., Colchic, 

Hyosc, Opium, Pulsat., Stramon. 

about the affairs of the day or busi- 
ness matters : Bryon. 

, with loud talking, laughing and 

singing: Opium. 

on going to sleep : Ginseng. 

, hindering sleep and rest : Mur. ac 

, with cephalalgia: Colchic 

, with attempts to run away: Bryon., 

Opium. 

, and to strike and bite: 

Bellad. 

, to get out of bed : Bellad., Hy- 
osc, Stramon., Zincum. 

, , and a tremulous propul- 
sion of the tongue and a general tremor: 
Agar. 

and fiaccilegium : Phosphor. 

Febris versatilis : Bellad., Bryon., Hy- 
osc, Lycop , Mur. ac, Xux vom., Opium, 
Phosph. ac, Pulsat., Bhus tox., Stramon., 
Zincum. 



Wants to go from one bed into another : 
Arsen., Bellad., Calc. carb., Hyosc, Bhus 
tox., Sepia, Ver. alb. 

Attempts to get out of bed : Agar., Bry- 
on., Zincum. 

Jumps out of bed: Bellad., Hyosc, Xux 
vom., Zincum. 

Attempts to run away, to escape: Bellad., 
Bryon., Hyosc, Opium, Stramon. 

, , while perfectly uncon- 
scious: Arum triph. 

to strike, bite or spit: Bellad., Can- 
thar., Hyosc, Stramon. 

Loud talking,, laughing or singing: 

Opium. 
Talking incoherently: Bellad., Gclsem., 

Hyosc, Laches., Lycop., Rhus tox., Ver, 

vir. 
to himself: Hyosc, Opium, Rhus tox., 

Tarax.. Ver. vir. 



1004 



FEVER. 



Loquacity : Apis, Bryon., Hyosc, Laches., 

Stramon. 
Muttering, murmuring: Apis, CoccuL, 

Hyosc, Laches., Lycop., Phosph. ac, Ta- 

rax., Ver. vir. 
, , with a happy expression, 

which looks strange : Apis. 
, , with picking bedclothes: Hy- 
osc. 
Singing : Bellad., Opium, Stramon. 
Laughing, whistling: Stramon. 
Screaming: Stramon. 
Sighing, groaning, moaning: Bryon. 
Picking at the bedclothes: Arnica, Ar- 

sen., Colchic, Hyosc, Lycop., Opium, Pso- 

rin., Stramon., Zincum. 
Catching, grasping at flocks: Lycop., 

Opium, Photph. ac, Stramon., Sulphur, 

Zincum. 
Playing with his own hands: Hyosc 
Sits in silence : Arnica, CoccuL 
Don't want to talk: Phosph. ac 



Apathy, indifference: Apis, Arnica, China, 
Phosph. ac. 

, , has no desire : Helleb. 

, does not complain of anything : Hy- 
osc , Opium. 

• , thinks nothing the matter with him : 

Arnica, Arsen , Hyosc. 

, thinks his condition not dangerous : 

Colchic 

Fear of being left alone: Hyosc, Lycop. 

of death : Aeon., Arsen., Baptis., Bry- 
on., CoccuL, Rhus tox., Ver. alb. 

Anxiety and restlessness: Arsen., Bryon., 
Calc carb., China, Rhus tox., Ver. alb. 

Hopeless and despairing of recovery: 
Psorin. 



Embarrassed : Hyosc, Sulphur. 

Impatient and despairing about pain and 
bad feeling: Ignat. 

Irritable, peevish, easily offended: Bry- 
on. 

, cannot endure noise or contradiction, 

speaks hastily : CoccuL 

on awaking, scolds, screams, behaves 

disagreeably : Lycop. 



Bad humor : Rhus tox. 

Quarrelsome, angry disposition : Bellad., 

Bryon., China, Nux vom. 



Easily frightened : Lgnat., Kali carb. 

Sensibility increased: Bellad., China, 
Mur. ac, Nux vom , Phosphor. 

decreased: Apis, Ballad., Carb. veg., 

Colchic, Helleb., Opium, Phosphor., Stra- 
mon , Sulphur. 



Vertigo: Gelsem. 

when rising up from bed, with nau- 
sea, compelling to lie down again : Coc- 
cuL 

, as if he were swung in a cradle or 

swing: Ignat. 

Brain, impending paralysis of: Zincum. 

, , and collapse : Phosphor. 

only seems to be the invaded part of 

the body: Helleb. 

, burning pain in: Phosphor. 

, hot and burning: Calc. carb. 

, congestion to the: Bellad., Opium. 

Headache : Kali carb. 

, with delirium: CjIcJuc. 

, stupefying: Baptis. 

and pain in back and limbs : Gelsem. 

, worse from opening and moving the 

eyes: Bryon., Rhus tox. 

Head, heat and fulness in : Sulphur. 

, in, and chilliness in remaining 

body: CoccuL 

, heaviness and muddledness of: Mer- 

cur. 

feels as big as a bushel : Gelsem. 

Occiput, tearing pain in: Tarax. 

Front of head, pain in, follows attacks 
of yawning and stretching ; does not al- 
low opening the eyes : Ignat. 

Forehead covered with cold perspiration : 
Colchic, Mercur., Veratr. 

Head and extremities, cold perspiration 
on ; great heat of trunk : Phosphor. 

boring in pillow, jerking heal back- 
ward and sometimes forward : Ver. vir. 

falls backwards if the patient is 

raised, and the mouth opens to its 
widest extent : Colchic 



DIGEST TO TYPHOID FEVER. 



1005 



Eyes dim and sleepy: Phosph. ac. 

dull, half shut : Phosphor. 

, watery: Arsen., Bryon, 

, without lustre: Carb. veg. 

sunken: Arsen. 

and pale face: Mercur. 

, hollow, staring: Cclchic. 

staring, glistening: Ai-sai., Mar. ac 

, sparkling: Bellad. 

, , red and rolling about: 

Hyosc. 

staring: Colchic, Hyosc, Opium, 

Phosph. ac, Secale, Stramon., Zincum. 

, with slow comprehension : Hel- 
leb. 

Pupils dilated : Yer. vir. 

, and vacant look : Helleb. 

and little sensitive to light, or 

immovable: Colchic 

contracted : Mur. ac 

without reaction against light : Carb. 

veg. 

Lids sore and inflamed: Sulphur. 

nightly agglutinated : Ver. vir. 

closed with sticky matter: Arsen. 

fall shut, as if paralyzed: Coccul. 

tremble and jerk, also muscles of 

face and limbs : Coccul. 

Conjunctiva injected: Baptis. 

with secretion of yellow mucus 

at inner canthus: Ver. vir. 

Squinting : Hyosc 

Moving eyes increases headache: Bryon., 
Ignnt., Rhus tox. 

Blind spells : Gelsern., Zincum. 

Loss of sight, hearing and speech : Stra- 
mon. 

Shuns the light: Bellad., Xux vom., Pul- 
sat. 

All objects appear oblique to him: S'ra- 
mon. 



Ears, great dryness of: Sulphur. 

sensitive to noise : Bellad., Bryon., 

Coccul., Lycop., Phosphor., Suphur. 
hear sounds like the falling of rain or 

music, which do not exist : Mur. ac. 
, ringing in : Coccul. 



Ears, hardness of hearing : Apis, Arsen., 
Bryon., Phosphor. 

, loss of hearing, sight and speech : 

Stramon. 9 

, deafness : Bellad., Carb. veg., Hyosc, 

Mercur., Xux mosch., Phosph. ac, Stra- 
mon., Sulphur. 

, , with sore throat : Laches. 



Nose bleeding: Arnica., Gelsem., Laches., 
Phosph. ac, Secale. 

, especially after midnight : Rhus 

tox. 

, also teeth and gums : Sulphur. 

, haemorrhages from, and mouth : 

Carb. veg. 

, dryness of: Bryon. 

, , and of mouth and throat : Bel- 
lad. 

, , and lips and tongue : Mur. ac 

pointed : Ver. alb. 

, cold, and cold mouth : Cam- 
phor a. 

Nostrils dry and black: Colchic. 

sooty, smoked : Arsen., Helleb., Hy- 
osc 

, fan-like motions of the: Lycop. 

Boring -with fingers in nose: Arum triph. 
Smell and taste verv acute: Mur. ac 



Face pale, with cold sweat : Secale, Ver. 

vir. 
, cold, sunken : Carb. veg. 

and sickly: Kali carb., Sulphur. 

and sunken : Mur. ac. 

and waxy complexion: Zincum. 

red : Cole carb., Mur ac. 

red and burning : Bellad. 

red, circumscribed and burning hot: 

Arsen. 

dark red, with besotted expression : 

Baptis. 

and bloated: Opium. 

, crimson flushes of: Gelsem. 

, cyanotic blueness of: Carb. veg., La- 
ches , Ver. alb. 

yellowish : Mercur. 

, with circumscribed redness in 

afternoon : Lycop. 



1006 



FEVER. 



Face, stupid expression : Helleb., Hyosc 

, facies quatrata : Helleb. 

, sunken countenance: Arsen., Garb. 

veg., Colchic, Laches., Lycop., Mur. ac. 

cold with perspiration: Camphora, 

Garb, veg., Colchic., SecaJ,e, Ver. vir. 

hippocratic: Arsen., Garb, veg., China, 

Colchic, Phosphor., Secede, Zincum. 

collapsed: Camphora. 

, cadaverous aspect and extreme pros- 
tration: Colchic. 
Skin on forehead wrinkled: Stramon. 
Facial muscles twitching: Ver. vir. 

trembling and jerking : Goccul. 

, distortion of: Bellad., Goccul., Hyosc, 

Stramon. 
Risus sardonicus : Colchic 
Relaxation of muscles of face : Zincum. 
Dropping of lower jaw: Arsen., Baptis., 

Laches., Lycop., Mur. ac, Opium, Ver. 

vir. 
Corner of mouth drawn down on left 

side: Ver. vir. 
Mouth distorted: Bellad., Camphora, 

Opium. 
open to its widest extent, when on 

lifting the head falls back : Colchic. 
, frequent chewing motions during 

sleep: Bryon. 
Lips bright red : Sulphur. 

dark red: Bellad. 

bluish or pale : Garb. veg. 

dry, and dry nose and tongue : Mur. ac 

dry and cracked : Arsen., Bellad. 

and bleeding: Laches. 

■ and brown : Bryon. 

and parched: Garb. veg. 

dry and covered with brown crusts : 

Rhus tox. 
, teeth and tongue covered with brown 

coating: Colchic. 
, teeth and gums covered with brown 

or black slime: Arsen. 

cracked: Colchic, Pulsat., Sulphur. 

at tip : Laches. 

, ulcerated and covered with 

vesicles: Apis. 

and corners of mouth sore and 

cracked : Arsen., Arum triph. 



Lips, trembling of lower : Arnica. 

, picking until they bleed: Arum 



Tongue bright red : Colchic 

red : Arsen., Hyosc, Laches., Rhus tox. 

red and dry: Baptis., Camphora, Ly- 
cop. 

red at tip, undefined : Sulphur. 

red, in shape of a triangle: Rhus 

tox. 

red at edges and white in centre: 

Bellad. 

, red streak in the centre : Ver. vir. 

black : Arsen., Laches., Opium, Rhus 

tox., Secale. 

, brown streak in middle : Arnica. 

brown and dry: Bryon. 

, particularly in the centre: 

Baptis. 

and cracked : Hyosc. 

dry : Ginseng., Mur. ac 

dry, as if burnt, yet no thirst : Pidsat. 

dry, it sticks to the roof of the mouth, 

without thirst : Nux mosch. 

dry, immovable, covered with black 

crusts: Phosphor. 

dry, and dry mouth and throat, with 

fulness of stomach and loss of appetite : 
Nux mosch. 

dry on tip, and front of mouth : Nux 

vom. 

dry and red: Baptis., Lycop. 

, great thirst : Camphora. 

, and cracked on tip and bleed- 
ing: Laches. 

dry, brown and cracked : Hyosc 

dry, brown, particularly in centre: 

Baptis. 

, moist and sticky sometimes: Garb. 

veg. 

coated not at all or only slightly: 

Mur. ac 

white, with a red streak through 

the centre : Ver. vir. 

white, with sore spots : Nitr. ac. 

thick, dirty-whitish : Mercur. 

thick white or yellowish : Bry- 
on. 

gray- whitish : Phosph. ac. 



DIGEST TO TYPHOID FEVER. 



1007 



Tongue coated thick brown : Gelsan. 
, and also lips and teeth : 

Oolchic. 

, map-tongue : Tarax. 

, tremulous propulsion of, and general 

tremor of the whole body : Agar. 
is spasmodically thrust to and fro 

between the teeth : Lycop. 

, trembling and heaviness of: Bellad. 

, in the attempt of protruding it : 

Laches. 

heavy, stiff and numb : Colchic. 

heavy, scarcely movable : Carb. veg. 

immovable : Phosphor. 

stiff, like a piece of wood : Arsen. 

, inability to put out the tongue and 

to speak : Apis. 

protruded with difficulty : Colchic. 

, the tip remains under the lower 

teeth and cannot be protruded : Laches. 

paralyzed: Hyosc, Mur. ac. 

Speech, stammering: Arsen., Bellad., 

Carb. veg., Lycop., Secale, Stramon. 

, , as if drunk : Bellad. 

, , lisping, unintelligible: Arsen., 

Bellad., Opium, Stramon., Veratr. 

, indistinct: Hyosc, Laches. 

, costs him a great effort to speak 

plainly : Coccul. 
, unable to talk and to put out the 

tongue : Apis. 

, loss of: Colchic, Hyosc, Ver. alb. 

, , and of sight and hearing : Stra- 
mon. 
Voice weak and trembling, hoarse, coarse, 

or crowing : Arsen. 



Teeth, grinding: A r rsen., Colchic 

, grating : Hyosc 

, champing : Ver. vir. 

, sordes on : Baptis., Stramon. 

, brown or black slime on : Arsen. 

, thick brown coating : Colchic 

Gums swollen and bleeding at the begin- 
ning : Mercur. 

bleeding : Carb. veg., Mercur., Phos- 
phor., Sulphur. 

, brown mucus on : Rhus tax. 



Mouth, haemorrhages from, and nose: 

Carb. veg. 

raw, sore, ulcerated : Stramon. 

cold : Camphora. 

, dryness of, and throat : Phosph. ac 

, , and nose : Bellad. 

, , , with fulness of stomach : 

Nux mosch. 
, , and tongue: Mur. ac, Nux 

vom. 

, , with or without thirst : Bryon. 

, , without thirst: Pulsat. 

, salivation, acrid : Arum triph. 

, fetid breath from : Arsen., Arum, 

Baptis., Mercur., Sulphur. 

, cadaverous smell from : Hyosc 

, putrid smell from : Arnica, Nux vom. 

Taste very acute : Mur. ac 

bitter : Bryon., Laches., Pulsat. 

pappy : Coccid. 

, pappy, insipid, slimy, foul : Mercur. 

Appetite, loss of: Bryon., Nux mosch. 
, too great during convalescence : 

Pulsat. 
, wanting during convalescence: Pso- 

rin., Sulphur. 
Thirst : Mercur., Mur. ac 

, excessive : Colchic, Hyosc 

, excessive, with dry, red tongue : 

Camphora. 
, excessive, but drinking little at a 

time: Arsen. 
, excessive, and drinking large quanti- 
ties: Bryon. 

, with aversion to water : Nux vom. 

, absent : Bryon., Nux mosch., Pidsat. 

Desire for refreshing things: Mercur. 
for alcoholic drinks, which are easily 

borne: Agar. 
After drinking rumbling in abdomen : 

Phosphor. 
Swallowing difficult : Apis, Baptis., Bel- 
lad., HeUeb. 

impossible: Stramon. 

, the fluid rolls audibly down the 

throat : Arsen., Hydr. ac, Moschus. 
Choking sensation from the stomach up 

into the throat, better from belching: 

Jgnat. 



1008 



FEVER. 



Sore throat : Bellad. 

Burning in throat : Ver. vir. 

Belching: Bryon., Coecul. 

Nausea, when rising up, compelling to 

lie down : Coecul. 
Vomiting : Kali carb. 

of thick, black bile) mixed with 

mucus : Secede. 

of watery, bilious and slimy masses 

with great pain : Phosphor. 

and retching : Arsen. 

and watery diarrhoea : Ver. alb. 

Epigastrium, weak and sinking feeling 

in: Ignat. 
, soreness to touch or motion, in : Bry- 
on., Colchic. 

, bloated: Carb. veg. 

, pulsating in : Pulsat. 

, burning in, and sensitive to pressure : 

Arsen. 
Liver, painful : Bellad., Bryon., Laches., 

Lycop., Mercur., Phosphor., Sulphur. 
Spleen, enlargement of: Arsen., China, 

Coecul., Phosph. ac, Rhus tox. 
Abdomen, sensitive to touch : Hamam., 

Laches., Mercur , Nltr. ac, Phosphor. 
, umbilical and ileo-caecal region 

sensitive : Mercur. 

, iliac tenderness : Cdsem. 

, surface of, hot : Colchic, Laches. 

Meteorism, distention: Apis, Arnica, 

Arsen., Carb. veg., China, Coecul., Colchic, 

Lycop., Opium. 
, distention, with rumbling and un- 

painful diarrhoea: Phosphor. 
, distention, with rumbling and gurg- 
ling: Phosph. ac. 
Tympanitis with pain in back : Colchic. 
Rumbling, gurgling, rolling: Carb. veg., 

Nux mosch. 
, with pinching pain and diarrhoea, 

worse in the night : Pulsat. 

, with painless diarrhoea : Phosph. ac 

, with involuntary stools : Camphora. 

, with constipation : Lycop. 

, after drinking: Phosphor. 

in the ileo-caecal tract : Ginseng. 

Diarrhoea: Arsen. 

, bilious, slimy : Mercur. 



Diarrhoea, blackish, 



every hour: Stra- 
blood, or 



, from decomposed 

greenish, grayish : Phosphor. 

, brownish, grayish : Carb. veg. 

, greenish, acrid : Nitr. ac. 

, watery : Arsen., Colchic, Mercur., Phos- 
phor.. 

, excessive: Calc carb., Carb. veg. 

, worse at night : Rhus tox. 

, with pinching pains : Pulsat. 

, frequent and painful : Apis. 

, with tenesmus: Nitr. ac. 

, , early in morning : Sulphur. 

, unpainful: China. 

, , watery, grayish : Phosph. ac 

, , early in morning: Sulphur. 

, , with meteorism and loud rum- 
bling: Phosphor. 

, involuntary: Apis, Colchic, Hyosc, 

Opium, Phosph. ac, Zincum. 

, , bloody and foul : Apis, Arsen. 

, , during sleep: Bhus tox. 

, — — , after much rolling and rum- 
bling : Camphora. 

, , and involuntary discharge of 

urine: Arnica, Moschus. 

Paralysis of sphincter ani : Phosphor. 

and vesicae : Hyosc 

Stool smells cadaverously: Carb. veg. 

smells like carrion : Stramon. 

, fetid: Baptis., Kreos. 

, fetid, liquid, yellow, between 4 and 

7 a.m.: Nuphar. 

, foul: Apis, Arsen. 

, offensive, whether formed or loose: 

Laches. 

, offensive, painful, liquid, dark: 

Colchic. 

, offensive, watery : Opium. 

, putrid, colliquative: Nux mosch. 

followed by prostration : Kreos., Phos- 
phor., Sulphur. 

Haemorrhages from bowels : Nitr. ac 

, fluid, dark, fetid blood : Hamam. 

, coagulated, black blood in the third 

week : Alumen. 

, decomposed, like charred straw, or 

more or less ground up : Laches. 



DIGEST TO TYPHOID FEVER. 



1009 



Constipation : Apis, Arsen., Uyosc, Ly- 
cop., Opium. 

Little or no affection of mucous mem- 
branes : Mur. ac. 

No diarrhoea : Helleb. 

Discharges none or but seldom : Mur. ac. 



Uyosc, 



Urine bloody: Tereb. 

dark: Mercur., Xirx vom., Pulsat. 

but clear : Calc. carb. 

clear and acid : Mur. ac. 

turbid : Ver. vir. 

fetid : Baptis., Ver. vir. 

offensive : Sulphur. 

leaves a red, sandy stain; 

Lycop. 

copious : Colchic, Stramon. 

profuse and watery : Mur. ac. 

Urging, frequent to urinate, with burning 
and scanty discharge: Arsen., Canthar., 
Secede. 

Discharge involuntary: Arnica, Arsen., 
Qjlchic, Helleb., Uyosc, Lycop., Mosckus, 
Opium, Phosphor., Stramon., Ver. vir. 

and stools involuntary : Bellad., 

Mur. ac 

unconscious : Apis, Helleb., Mercur. 

Paralysis of sphincter vesicae and ani : 
Uyosc 

Retention of urine : Arsen., Uyosc, 
Opium, Stramon. 

Suppression of urine: Arum triph., Can- 
thar., Colchic, Uyosc , Secale, Stramon. 



Voice hoarse, coarse and crowing : Arsen. 
and hollow : Secale. 



Bronchitis : Bellad., Bryon., Mercur., 

Rhus tox. 
Cough dry : Arsen., Bellad., Phosphor. 
short and hacking, from tickling 

under middle of sternum, worse from 

talking or moving : Calc carb. 
rattling and rattling breathing : Nitr. 

ac. 
, with tough, transparent or thick 

yellowish or reddish expectoration: 

Phosphor. 

• 64 



Bronchitis, with totigh, bloody expec- 
toration: Rhus tox. 

, with slimy, bloody expectoration : 

Laches. 

, with brownish, bloody expectoration : 

Nitr. ac 

, worse from evening until midnight : 

Phosphor. 

, with painful shocks in head: Calc 

carb. 

, with stitches in chest and liver: 

Bryon. 

, with tightness in chest : Phosphor. 

Breathing rattling: Arsen., Carb. veg., 
Opium, Phosphor., Tart. emet. 

accelerated : Arsen., Colchic, Mur. ac. 

slow : Helleb , Opium. 

oppressed : Arsen., Laches., Phosphor. 

, better from belching : Ignat. 

irregular, intermittent : Colchic 

deep, sighing, stertorous : Opium. 

weak : Moschus. 

, with pleuritic stitches: Arnica. 

Pneumonia : Bryon., Laches., Nitr. ac, 
Phosphor., Rhus tox., Sulphur, Tart. emet. 

, infiltration of lower lobes : Rhus tox. 

, gray hepatization with sputa falling 

to the bottom in water and leaving a 
trail of tough mucus behind, like a fall- 
ing star : Calc carb. 

CEdema : Tart, emet., Carb. veg., Phosphor. 

Paralysis of lungs impending : Moschus., 
Xitr. ac, Tart. emet. 

Pneumo-typhus : Apis, Bellad., Bryon., 
Calc carb., Hyosc, Mercur., Nitr. ac, 
Phosphor., Pulsat., Rhus tox., Sulphur, 
Tart. emet. 



Heart, pulsation grows Aveaker : Moschus. 

, beginning paralysis : Carb. veg. 

, slow action: Helleb. 

, palpitation : Calc. carb., Ignat. 

, beating when turning, shaking left 

side of thorax : Ver. vir. 
Pulse, weak: Apis, Arsen., Carb. veg., 

Hyosc, Laches., Mercur., Phosphor., 

Phosph. ac, Pulsat, Ver. alb. 
, and small : Arsen., Carb. veg., 



1010 



FEVER. 



Hyosc, Laches., Phosphor., Phosph. ac, 

Pulsat., Rhus tox. 
Pulse, without energy : Carb. veg. 

, , 110-130 : Mur. ac. 

, scarcely peceptible : Camphora, Carb m 

veg., Zincum. 
, without pulse: Arsen., Carb. veg., 

Colchic , Mercur. 
, small, thread-like : Arsen., Camphora, 

Carb. veg., Colchic, Hyosc, Phosphor., 

Rhus tox., Zincum. 
, frequent : Arsen., Bellad., Camphora, 

Carb. veg., Colchic, Hyosc, Laches., Mur. 

ac, Phosph. ac, Straraon., Zincum. 
, frequent by lifting or turning the 

patient, but otherwise slow : Gelsem. 
, slow : Baptis., Gelsem., Helleb., Opium, 

Secale. 
, intermitting : Apis, Arsen., Kali carb., 

Mur. ac, Phosph. ac, Secale, Ver. alb., 

Zincum. 
, irregular: Apis, Baptis., Gelsem., 

Hyosc, Nitr. ac, Ver. vir. 
, tremulous : Arsen., Cdlc. carb., Phos- 
phor. 
Carotids throbbing : Bellad., Hyosc, Stra- 



Back, pain in, with tympanites : Colchic. 

, , and limbs : Gelsem. 

, sensitive when fever sets in : Nux vom. 

Hands, trembling of: Zincum. 

, , when trying to lift them : 



and feet cold : Colchic, Gelsem., Lycop. 

, would not be moved: Se- 
cale. 

, one cold, the other hot : China, Pul- 
sat. 

Finger ends, picking at : Arum triph. 

Lower extremities, pain only in, during 
rest: Tarax. 

Feet, one hot, the other cold : Lycop. 

, heaviness in: Coccul. 

, soles of, great soreness : Cole carb. 

Extremities, pain in, worse moving: 
Bryon. 

, pain in, when in rest : Rhus tox. 

, convulsive motions of : Ignat. 



Extremities, clonic spasms of, with par- 
alytic weakness : Lauroc 

, jerkings of, and of whole body, awake 

or asleep : Lycop. 



Yawning, stretching, followed by pain 
in forehead, which does not allow to 
open the eyes : Ignat. 

Sleepy, drowsy: Coccul., Laches., Mercur., 
Pulsat, Ver. alb. 

in daytime: Phosph. ac, Rhus tox., 

Sulphur. 

, wh#n left alone: Helleb. 

, with falling of eyelids : Nux mosch. 

— — , with inability to go to sleep : Bellad., 
Mercur., Mur. ac, Opium. 

, but cannot go to sleep, because she 

cannot get herself together; head feels 
as though scattered about : Baptis. 

, but can sufficiently be roused to 

answer correctly, then falls asleep again : 
Phosph. ac. 

, cannot be roused to full conscious- 
ness: Baptis., Helleb., Opium. 

Sopor: Arsen., Laches., Lycop., Opium, 
Phosphor., Rhus tox. 

Coma: Coccul., Nux mosch., Opium, Rhus 
tox., Ver. alb. 

, with open eyes : Colchic, Opium. 

On going to sleep, and shutting eyes, 
frightful visions: Arsen., Bellad., Calc. 
carb., Ignat, Mercur., Opium. 

, delirium : Ginseng. 

During sleep, groaning, moaning, mut- 
tering: Hyosc, Mur. ac, Opium. 

, , , and chewing motions of 

the mouth : Bryon., Carb. veg., Opium. 

, outcries and loud laughing : Lycop. 

, talking and loud blowing during ex- 
piration: Arnica. 

, talking incoherently : Gelsem. 

, murmuring delirium: Phosph. ac. 

, frequent starting : Bellad., Opium. 

, with pieking: Hyosc. 

, involuntary alvine discharges: Rhus 

tox. 

, anxious dreams: Arnica, Calc. carb., 

Ignat. 



DIGEST TO TYPHOID FEVER. 



1011 



During sleep, frightful dreams and fre- 
quent waking: Rhus tox. 

After sleep, restless, tossing about and 
throwing the bed-covers off: Laches. 

, cross, irritable, screaming, behaving 

disagreeably : Lycop. 

Sleepless, restless: Arum triph,, Hyosc, 
Phosphor. 

, restless during the night: Sulphur. 

, gets only snatches of sleep : Camphora. 

, from overactivity of mind ; the same 

idea rouses him as soon as he falls asleep : 
Calc. curb. 

, from nervous excitability : Hyosc. 

, feels as though the head were scat- 
tered about, tossing about to get the 
pieces together : Baptis. 

, from various visions, as soon as fall- 
ing in a doze : Ignat. 

, from continuous delirium, which 

hinders sleep : Mur. ac 



Chilliness: Gelsem. 

on slightest motion : Nux vom. 

, on uncovering : Pulsat. 

after eating or drinking : Tarax. 

all day : Baptis. 

of body with heat in head : Coccul. 

Cold extremities: Camphora. 

body and especially hands and feet, 

would not be covered : Secale. 

face and extremities with cold sweat: 

Carb. veg. 

one side, and heat of the other : Pul- 
sat. 

one hand, and the other warm : China. 

, one foot and the other warm : Lycop. 

Fever heat not high : Cuprum, Pho*ph. ac. 

Temperature nearly normal: Helleb. 

Heat in head, with chilliness of body: 
Arnica, Coccul. 

, worse in afternoon : Laches. 

, worse towards 4 p.m.: Lycop. 

at night: Baptk. 

, wants to be uncovered : Lycop. 

or sweat, during which he wants to be 

covered : Hepar, Rhus tox. 

and distress from external warmth: 

Pulsat. 



Heat of trunk, with cold perspiration of 
extremities: Phosphor. 

of one side, with coldness of the other : 

Pulsat. 
Dry skin : Colchic. 

, hot, pungent skin, like parchment: 

Arsen. 

, burning skin, or partial clammy 

sweats: Apis. 
Sweat covers face : Colchic. 

, excessive debility and a strong desire 

to be magnetized : Silic 

profuse, retarding convalescence : Pso- 

rin. 

copious, debilitating : Mercur. 

of one side only : Pulsat. 

here and there : Gelsem. 

or dry heat, during which he wants 

to be covered : Hepar, Rhus tox. 

without alleviation: Laches., Mercur., 

Phosphor. 

cold on forehead: Colchic, Coccul, 

Ver. alb. 

cold on forehead and face: Secale. 

cold on face : Bellad., Ver. vir. 

, cold, on face and extremities: Carb. 

veg. 

, , , with heat of trunk : 

Phosphor. 

, , all over : Camphora, Ver. alb. 

, , clammy: Arsen. 

, clammy, partial, or dry, burning 

skin: Apis. 

, sour smell of body, or without sweat : 

Bryon. 

, sour, with sour diarrhoea: Rhus tox. 

, fetid : Arsen., Baptis. 

, with offensive breath : Arsen. 



Blood, dissolution of: Carb. veg., Cuprum, 

Laches. 
, , and paralytic conditions: Carb. 

veg. 

j , , no signs of: Helleb. 

Haemorrhages : China, Kreos. 
from nose: Cuprum. 

Nervous: Kali carb. 



1012 



FEVER. 



Nervous restlessness of body and limbs: 

Camphora. 
Tremor of body and tremulous propul- 
sion of the tongue: Agar. 
Trembling: Arsen., Bellad., Hyosc, Ig- 

nat., Lycop. 
— i — of whole body : Stramon. 

and jerking of limbs : Apis, Coccid. 

from weakness: Gelsem. 

Jerkings : Bellad., Hyosc, Ignat, Lycop., 

Opium. 

, especially in children: Cede. carb. 

Subsultus tendinum: Hyosc, Lycop., 

Psorin, Rhus tox., Secede, Sulphur, Ver. 

vir., Zincum. 
Automatic motion of muscles: Cam- 

phora, Rhus tox. 

of hands and feet: Coccid., Rhus tox. 

Involuntary motions : Bellad., Colchic, 

Hyosc, Rhus tox. 
odd motions of limbs afcnd body: Stra- 
mon. 
, thrusting out one leg, then drawing 

it up: Ver. vir. 
Convulsive motions : Hyosc, Ignat. 
— '■ — of mouth and face: Bellad. 
Picking at bedclothes : Arnica, Arsen., 

Colchic, Hyosc, Lycop., Opium, Psorin., 

Stramon., Ver. vir., Zincum. 
Flaccilegium : Lycop., Opium, Phosphor., 

Phosph. ac, Stramon , Sulphur., Ver. vir., 

Zincum. 
Paralytic symptoms: Carb. veg., Cocccul., 

Cuprum. 
Muscles refuse to obey the will: 



Weakness and weariness but slight: 

Mar. ac. 

great and general: Camphora, 

Coccul, Phosph. ac , Rhus tox., Secale, 
Stramon. 

better from magnetizing: Silic 

and nervous prostration : Baptis. 

and lassitude: Arnica, Bryon., Phos- 
phor., Sulphur. 
as from exertion: Colchic. 

and bruised soreness, compelling to 

lie down: Arnica. 



Muscular power not very much de- 
creased : Mux. ac 

Great sinking of strength : Arnica, Hy- 
osc, Phosphor., Phosph. ac 

Rapid sinking of strength : Arsen., Carb. 
veg., Colchic, China, Nux vom., Phosphor., 
Secale, Veratr. 

Prostration: Alumen, Arnica, Arsen., Bap- 
tis., Colchic, Gelsem., Mercur., Psorin., 
Phosph. ac, Rhus tox., Stramon , Veratr. 

at first stage : Gelsem. 

with cadaverous aspect: Colchic. 

Sliding down in bed : Apis, Arsen., Bap- 
tis, Helleb., Mur. ac, Zincum. 

Fainting : Bryon., Camphora, Laches., Se- 
cale, Tarax. 

from bodily movement, with distor- 
tion of face : Coccul. 

Emaciation: Arsen., Colchic, Mercur., 
Opium, Secale. 

Loss of flesh trifling : Helleb. 






Position on back: Arsen., Colchic, La- 
ches., Phosphor., Zincum. 
, with limbs drawn up : Helleb , 

Pulsat. 
, with knees drawn up : Arsen., 

Pulsat. 
, with thighs flexed on belly: 

Ver. vir. 
, and forearm stiffly 

bent on arm : Bellad. 

, head thrown back : Betptis. 

, any, feels too hard: Arnica. 

, tosses hands about : Phosph. ac 

, constant change of: Arsen., Bryon., 

China, Hyosc, Ignat., Pulsat., Rhus tox. 

, can't lie long in any : Baptis. 

, tossing about: Apis, Bellad., Can- 

thar., Rhus tox. 
, moving of head and limbs, while 

trunk lies still : Arsen. 



Blood stagnates, causing cyanotic blue- 

ness : Carb. veg. 
, large purple spots, particularly on 

feet : Secale. 
, bluish-red spots or spots where the 

patient lies upon : Phosph. ac 



RELAPSING FEVER, TYPHUS RECERREXS. 



1013 



Blood, decomposition of fluids: Arsen., 
Baptis., Laches., Rhus tox. 

■, hemorrhages : Alumen, Arsen., Bryon., 

Carb. veg., China, Hamam., Sit r.ac., Phos- 
phor., Rhus tox. 

Decubitus : Arnica, Arsen., Carb. veg., 
China, Fluor, ac, Jloschus, Xux vom., 
Phosph. ac, Zincum. 

Ulcerations: Bajrtis. 

Abscesses, boils: Jlercur., Silie. 

Ecchymotic spots: Arnica, Carb. veg., 
Phosphor., Phosph. ac. 

Petechiee : Arsen., Bryon., Rhus tox., Se- 
cale, Stramon. 

Roseola spots : Arsen., Hyosc, Phosphor., 
Rhus tox., Stramon. 

Miliary eruption: Apis, Arsen., Helleb., 
Phosph. ac, Rhus tox. 

, with anxiety in region of heart: 

Bryon. 

, preceding its outbreak about the four- 
teenth day : Calc carb. 

Skin dry and hot: Mur. ac. 

dry or clammy: Phosph. ac. 

bluish : Carb. veg. 

relaxed, pale: Phosph. ac. 

waxy, pale : Rhus tox. 

wrinkled: Ver. alb. 

icteroid: Jlercur. 



Cadaverous smell, scents the whole at- 
mosphere: Arsen. 



Better from lying: Bryon., Xux vom. 

from moying and changing position : 

Rhus tox. 

Worse in open air : Xux vom. 

after sleep : Laches. 

about and soon after midnight : Ar- 
sen. 

from 4-8 p.m.: Lycop. 



After bodily and mental overexertions: 
Coccul. 

anxiety and worriment of mind : 

Calc. carb. 

For drunkards : Agar. 

For debilitated persons, old age, or 
children : Arsen. 

For protracted cases : Arsen. 

For psoric individuals: Psorin., Sul- 
phur. 

In extreme cases like Carb. veg., only 
more rapid : Camphora. 

During cholera epidemics : Cuprum, Sul- 
phur, Ver. alb. 

At the commencement: Calc. carb., 
Gelsem. 

After calomel : Nitr. ac. 

Bryon: Alumina, Mur. ac 



Relapsing Fever, Typhus Recurrens. 

This fever lias been described as early as 1741 by Rutty, by Barker and 
Cheyne from 1816-21, still later by Griesinger, "Wunderlich and many 
others. Epidemics of the same have prevailed at different periods in Ire- 
land, Scotland, England, Germany, Africa and North America. Some of 
these epidemics were intermingled with other forms of typhus, were often 
widely spread, and at times preceded or followed by epidemics of intermittent 
fevers. But also single cases have now and then been observed, and in Lon- 
don the fever seems to have become stationary. 

If yellow fever is essentially a fever of one paroxysm, the relapsing fever 
consists in the majority of cases of two (seldom more) paroxysms, which are 
separated by an interval of comparative health, lasting from four to seven or 
to fourteen days. This long remission made the second paroxysm appear like 
a relapse of the disease, wherefore the name "relapsing fever*' was applied to 
it by English physicians. 



1014 FEVER. 

It is as contagious as typhus exanthematicus, and because Obermeier 
discovered protomycetes in the blood of patients with relapsing fever, some 
consider these spiral filaments, which, according to Lebert's, Weigert's and 
Buchwald's observations, are never absent during the periods of invasion and 
relapse, as the doers of all the mischief, by which iufection is brought about 
through the media of contact, air or water. 

The Symptoms of typhus recurrens are the following. Mostly in the 
morning, or in the middle of the day, less frequently in the evening or night, 
the patient is, in many eases without any premonitory signs, suddenly at- 
tacked with high fever, which may or may not be preceded by chilliness or a 
severe chill. The temperature rises rapidly to 102.2° F. in the morning, and 
to 104° F. in the evening, in a few days to 105.8° F. in the morning, and to 
107.6° F. in the evening. The pulse amounts to 108 or 112 in the morning, 
and to 120 and over in the evening. In spite of this high temperature the 
skin is usually moist. At the same time the patient experiences severe head- 
ache, and severe pain in the limbs, joints and loins; in fact, all the muscles 
of the body are the seat of severe pain, especially the calves ; there is dizzi- 
ness, congestion towards the face, sensitiveness to light and noise, restlessness 
and sleeplessness at night, loss of appetite, bad taste in the mouth, thickly 
coated tongue, later dry, nausea, vomiting and intestinal catarrh. On the 
second day already the patient complains of heaviness in the upper part of 
the abdomen, and of pain in the left hypochondrium ; the spleen begins to 
swell and rapidly increases in size, and so does the liver. There appears at 
times a miliary rash and herpes facialis, which latter are never observed in 
typhus fever. Bleeding at the nose is rare, and delirium is not a frequent 
symptom. But the loss of strength is rapid, and emaciation goes on pro- 
gressively. Thus the disease increases all the while for five, six or seven 
days, producing sometimes at the very height a deadly paleness of the face 
and lips, when all at once, with the appearance of a profuse sweat, a remission 
sets in, that is truly astonishing. The pulse sinks within a few hours, in many 
cases within two or three days, to 88, 60 or still lower per minute, and the 
temperature decreases some five, six, even seven degrees in the same time. 
With this remission of the fever, also all the other symptoms above described 
cease, and the patient although still very weak, feels comparatively well. In 
some cases, however, where the remission does not take place so suddenly or so 
completely, the patient experiences even during this apyrexia severe pains in 
the limbs, and now and then some febrile aggravations. Yet, nevertheless, 
the whole process looks to any one unacquainted with the character of the 
disease entirely as a state of convalescence. This interval of freedom from 
fever lasts for about four, seven or fourteen days, when the relapse begins 
unexpectedly, sometimes in the forenoon, or afternoon, .but most generally at 
night. This new paroxysm is quite similar to the first. After a chill or 



RELAPSING FEVER, TYPHUS RECURRENS. 1015 

mere chilliness, or neither, the temperature rapidly rises again to 102.4° F. 
and over, and the pulse to a frequency of from 112 to 120 or more. With 
this rise, all the other symptoms set in again : feeling of great malaise, vomit- 
ing, violent pain in the head and limbs, swelling of the spleen, etc. This 
second attack is usually somewhat milder than the first, lasts in favorable 
cases from two to four days, when again a sudden cessation of the fever and 
of all the other symptoms takes place, which leads either to complete con- 
valescence or is followed, though only in exceptional cases, after the lapse 
of several days by a third, or even a fourth, much milder attack. Recovery, 
even in favorable cases, is generally slow; it takes a great while before the 
patient recuperates the lost strength, and he experiences often for a long 
time severe pain in the limbs, while in other cases it is followed by various 
ailments. 

Not all cases, however, take so favorable a course, especially if they 
take the form of a bilious typhoid, or typhus biliosus, which by some authors 
i» considered as a distinct disease. In severe cases the second paroxysm does 
not terminate in sweat, may be not even the first one, but the symptoms keep 
on increasing until they assume the character of the gravest form of typhus. 
There is great prostration, stupor, delirium, hardness of hearing, dry, brown 
tongue, involuntary discharges from the bowels, sometimes continual vomit- 
ing, jaundice, coma, convulsions and death. In other cases death takes 
place unexpectedly during a short apyrexia by a sudden collapse with vomit- 
ing. In some epidemics the remission is very inconsiderable, and the second 
paroxysm appears almost as a continuation of the first; or there is indeed 
no remission at all, but a continuous fever lasting from three to four weeks. 
Or, instead of the^i?^ paroxysm being the stronger and longer, it happens 
that the second is by far the more severe. Often there has been found at the 
height of the paroxysm, when the sweat appeared, a sudden eruption of mil- 
iaria; also, especially when petechial typhus was prevalent at the same 
time, roseola eruptions and a spotted appearance of the skin. Quite unlike 
to other forms of typhus, febris recurrens frequently produces herpes facialis. 
Icterus has frequently been seen in some epidemics, in others less frequently, 
and in still others none at all. The liver now and then shows a moderate 
swelling and some sensitiveness. Peculiar is the great hunger in some cases, 
which the patient experiences during the height of the disease, and in other 
cases the continual vomiting of grass-green fluid, or the copious bilious diar- 
rhoea. Dvsentery has been observed in a great many cases either as a com- 
plication or a sequela of the disease. The second paroxysm is now and then 
attended with urinary difficulties, even cessation of the urinary secretion. 

There are also haemorrhages to be noticed, which may take place from 
the nose either at the commencement or at the end of the first paroxysm; or 
from the mouth, stomach, intestines, bladder, or beneath the epidermis as pe- 



1016 FEVER. 

techial effusions, in very severe cases which are generally complicated with 
a high degree of icterus. Decubitus, gangrene, parotitis, erysipelas are only 
occasional occurrences. An attack during pregnancy frequently causes 
abortus, whicl\, however, has only seldom proved fatal. 

As Sequels have been mentioned: abscesses, furuncles, parotitis and 
laryngeal affections ; anaemia ; palpitation of the heart ; pain in the limbs ; 
oedema ; hydrops and albuminuria ; tuberculosis ; diabetes ; paraplegia ; loss 
of speech ; amaurosis ; mental derangements. 

Diagnosis. — The distinguishing feature of febris recurrens in the first 
week is the extreme high temperature of the body and great frequency of the 
pulse, which, however, show marked daily remissions in the morning, a tem- 
perature which cannot be explained in the total absence of any local affec- 
tion. There is in short no corresponding relation between the intensity of the 
fever and the intensity of the attending symptoms. 

Abdominal typhus scarcely ever, except in the worst cases, attains in the 
first week such a height of temperature ; scarcely ever takes such a rapid 
beginning ; and never shows such a rapid remission of fever. 

Petechial typhus shows mostly about the sixth day the roseola-exanthema, 
and never such a sudden remission of fever about the end of the first week. 

The Prognosis differs essentially in different epidemics ; some are 
severer than others. It is stated that the mortality in febris recurrens 
amounts from three to four per cent., scarcely ever to six or eight. The 
fatal issue takes place mostly in the second, but frequently also at the height 
of the first paroxysm by a rapid collapse. Other patients die with ursemic 
symptoms, sudden convulsions, coma and collapse, and still others lie for 
several days in a profuse perspiration, which is followed by collapse. 

THERAPEUTIC HINTS.— There are mentioned: Arg. nitr., Arseu., 
Bryon., China, Eupat. perf., Nux vom. Compare Typhoid and Intermittent 
Fever. 



The Plague. 

This disease has been raging epidemically at different periods in the 
Eastern countries. Europe has been free from it since 1841. It is, accord- 
ing to Liebermeister, like typhoid fever, a contagious miasmatic disease, that 
is, it is not transmitted directly from person to person, like typhus exanthe- 
maticus or small-pox, etc., but almost exclusively in an indirect manner 
through clothes and other effects. The contagiousness is greatly enhanced 
by deficient ventilation of the streets and houses, by the crowding together 
of many individuals into a small space, and by uncleanliness. 

The stage of incubation is given at from two to seven days, but the capa- 



PLAGUE. 1017 

bility of the plague poison to live outside of the human body seems under cer- 
tain conditions to extend over several years. 

Its stage of invasion begins suddenly, with bodily and mental weakness, 
headache, dizziness, pale and flabby face, distorted features, languid eyes, 
awkward speech, staggering gait, without fever, exhibiting the picture of an 
intoxicated man. Sometimes it is attended with vomiting and diarrhoea, and 
lasts from a few hours to one or more days. 

The second stage is characterized by an intense fever, which is introduced 
by chilliness or by a well-marked chill; the pulse is very frequent and the 
respiration accelerated. The patient soon passes into a well-formed typhous 
condition, with wild or mild delirium, stupor and coma, dry, cracked tongue, 
sordes on teeth and lips, soot-colored crusts in nostrils, cardiac weakness? 
feeble, small, irregular pulse, sometimes cyanosis of the lips. This stage may 
continue for two or three days, when 

The third stage commences with the appearance of buboes, usually at- 
tended with a diminution of the fever, the breaking forth of a sticky, strongly 
smelling sweat, a lowering of the pulse and the returning of consciousness. 
The buboes occur oftenest in the inguinal regions, but also in the axilla? or 
on the neck, but as a rule, only in one of these regions at one time. They are 
sometimes quite small ; in other cases they attain the size of a hen's egg or 
even larger. Their suppuration is considered as favorable; in other cases 
the tumors become resolved. 

Besides buboes there occur in some cases carbuncles, usually on the 
lower extremities, also on the buttock and on the back of the neck. Petechia?, 
vibices, or extensive ecchymoses appear only in the severest cases shortly 
before death. 

" Convalescence begins generally between the sixth and tenth day, and 
is often protracted by continuous suppuration of the buboes. Among the 
Sequelae should be enumerated parotitis, furuncle, abscesses of the skin and 
muscles, pneumonia, protracted fever with continued typhous condition, 
dropsy, partial paralysis, mental disturbances, etc. Genuine relapses may 
also take pjace." (Liebermeister.) 

Death can occur during any stage of the disease. The mortality of the 
plague is greater than that of any other epidemic disease. But the different 
epidemics vary greatly in this respect. 

THERAPEUTIC HINTS.— In the August number, 1879, of the 
North American Journal of Homoeopathy, page 63, Dr. Hering says: "Lor- 
bacher proposes as the main remedies for the plague: Laches., Arsen., 
Carb. veg., Chin, sulph. and ars., Phosphor., Secale and Anthrac. 
AYe may mention here our proving of Badiaga, which might be considered 
a remedy against the plague. What Laches, will do is uncertain. Still 



1018 EXANTHEMATA. 

more uncertain is Arsen. Chin. ars. not being proved, we may leave 
aside altogether. Secale is another drug only known by poisonings. 
Anthrac. very likely will be of great importance in the plague. Kali 
phosph., proposed by Raue, we permit ourselves to mention as very prom- 
ising. Stramon. has more similarity to the plague symptoms than Bellad. ; 
and Silic. more than Hepar. Loimine, a preparation of the pus of the 
plague, brought here by Dr. Theuille, has cured cases of the greatest im- 
portance ; one with suppurating swellings along both sides of the neck, and 
cured them permanently." 



EXANTHEMATA. 

Measles, Morbilli. 

Measles are contagious, and more so during the stadium prodromorum 
et eruptionis than at a later period. The nature of the poison is entirely 
unknown. Only this much is certain, that it regenerates itself in the infected 
person, impregnates the surrounding atmosphere, and that it may be carried 
from there to other quarters. Measles prevail therefore mostly as epidemics, 
in preference, it seems, during those months which favor catarrhal affections. 
As a general rule they attack a person only once in life, and children more 
than grown persons, although there are many exceptions. Also relapses 
occur sometimes after a few days or a few weeks. The time of incubation 
varies from one to two weeks. 

The eruption of measles consists of numerous, roundish, lentil-sized red 
spots, which are a little raised above the level of the surrounding skin and 
generally contain in their centre a little papule. The closer they appear the 
more they coalesce, and in this way form irregular-shaped plaques, while on 
places where they are scarce they stand isolated. Between these spots the 
skin retains its normal color; on the face, however, it is usually somewhat 
oedematously swollen. Even in cases where they appear so abundantly as to 
coalesce {morbilli eonfluentes) they do not present an evenly diffused redness, 
but always a spotted appearance. There are cases in which the hyperemia 
of the skin results in an extravasation of blood, causing the eruption to 
assume a dark, blood-red appearance, and petechial spots to appear between 
the eruption ; this form is called morbilli petechiales or hcemorrhagici, or 
rubeola nigrce. The measly redness disappears under the pressure of the 
finger and reappears again after removing the finger, from the middle towards 
tJie periphery, contrary to scarlet fever redness, which reappears from the 
periphery towards the centre. Measles are always more or less accompanied 
by catarrhal affections of the eyes, nose, larynx and bronchial tubes, even 



MEASLES, MORBILLI. 1019 

by pneumonic symptoms. The blood is, like in other infectious diseases, 
poor in fibrin and of a dark color. 

The course and progress of measles is as follows : 

The first stage, or the stadium prodromorum, consists in a seemingly 
simple cold in the head and chest. There is chilliness and feverishness, and 
the temperature increases rapidly to 102° or 101° F., but lessens again con- 
siderably on the next day; there is headache, sensitiveness to light, watery 
eyes, watery discharge from the nose, sneeziug, nosebleed, hoarseness and 
cough, which latter sometimes assumes a croupy nature. Only in exceptional 
cases these symptoms amount to any considerable severity, and may then be 
associated with vomiting, delirium and sopor; in the majority of cases, 
however, the little patients do not mind them, but run about. On inspection 
of the fauces we observe that about the third day of this premonitory stage 
the identical eruption of measles has already made its appearance in the 
form of single, lentil-sized red spots upon the roof of the mouth and the 
palatal mucous membrane, some tw r enty-four or twelve hours before there is 
any sign of an eruption on the external skin. This accounts at once for all 
the catarrhal symptoms, and for the fact that measles are already transmitted 
at this early stage from child to child by the mere breath. 

The second stage, the stadium eruptionis, begins on the fourth or fifth 
day and is marked by an exacerbation of the fever ; the temperature of the 
body rises again, averages during the height of the disease about 104°, and 
may, in severe cases, reach even 105.8° F. During this time it happens 
occasionally that convulsions set in. The eruption appears first on the face 
and spreads gradually downwards over the whole body. There is now a 
peculiar measle-smell, scenting the whole atmosphere of the patient. In 
anomalous cases the eruption appears at first on the arms; in others it stays 
confined to single portions of the body, and in still others there is no eruption 
at all (inorbilU sine exanthemata), although all the other symptoms and the 
previous exposure to the contagion leaves no doubt as to the nature of the 
disease. The stadium eruptionis generally is completed in twenty-four to 
thirty-six hours, although in some cases it lasts three, even four days, in 
which cases the first spots already disappear when the last come out. During 
this stage diarrhoea often sets in, and the catarrhal affection generally reaches 
its acme, but in malignant epidemics death may ensue in consequence of 
general paralvsis and adynamia already at this early stage. In such cases 
the pulse grows weaker and weaker; the cutaneous capillaries burst and cause 
hemorrhages within the cutis; the prostration of strength is excessive and the 
patient sinks into a typhoid condition. 

The third stage, the stadium jioreseentice, is blended with the eruptive 
stage. In usual cases, already twenty-four hours after its full development, 
the redness commences to grow paler, and with it all the other symptoms, 



1020 EXANTHEMATA. 

heat and catarrh, gradually grow milder. Such normal cases are termed 
morbilli vulgares, simplices or erethici. 

In other cases the measle-spots grow darker, assume a purple color, and 
remain visible upon the skin for five or six days. The dark coloring of the 
eruption is owing to the rupture of the cutaneous capillaries, and for this 
reason the redness does not disappear under the pressure of the finger. The 
whole morbid process approaches that of other inflammatory processes. The 
heat rises above 104° F. ; there is throbbing of the carotid arteries, palpita- 
tion of the heart, and a full, strong pulse ; the catarrhal cough not unfre- 
quently changes into a croupy cough, and there may exist a complication 
with lobular pneumonia, or the catarrhal affection extends upon the alimen- 
tary canal and causes vomiting and diarrhoea. This state of things may aug- 
ment to complete prostration and collapse ; then the eruption disappears from 
the skin, and such a condition is not without danger. This form of measles 
has been termed morbilli inflammatorli, or synochales. 

A still other form is that which has already been alluded to in the sec- 
ond stage. It is characterized by general adynamia and torpor. The erup- 
tion remains visible only a short time, is either pale-reddish or purple, and 
frequently iuterspersed with petechias It is often combined with profuse 
bleeding from the nose ; the pulse is very frequent and scarcely perceptible, 
and the patient sinks into sopor and collapse. This form is called morbilli 
asthenici, nervosi, torpidi, or septici. 

The fourth stage, the stadium desquamationis, commences in simple cases 
usually about the eighth or ninth day of the disease. The measle-spots have 
at this time entirely disappeared, and in their places we observe a gradual 
loosening of the epidermis, which is thrown off in the form of fine scales. 
This process can best be observed on the face and hands, while on the parts 
covered, the loosened skin is rubbed off before it is noticed. This stage is 
rarely interrupted by dangerous complications ; still, it may become compli- 
cated by croupous laryngitis or pneumonia. Noma or mortification of the 
labia pudenda is of very rare occurrence. 

As Sequels of measles are mentioned as quite prominent, chronic ca- 
tarrhal cough, and chronic pneumonia, which may end in consumption. Be- 
sides these, a number of scrofulous affections, such as chronic inflammation 
of the eyes, otorrhoea, glandular swellings, and chronic inflammations of the 
periosteum and of the joints. It is but just to remark that under homoeo- 
pathic treatment sequelse are of very rare occurrence. 

THERAPEUTIC HINTS.— The bedroom should be kept of an equal 
temperature at about 65° or 66° F. It ought to be aired frequently with 
care. The light in the room should be modified according to the patient's 
own desire. If he wants to drink, he may have cold water, he may eat fruit 



MEASLES, MORBILLI. 1021 

provided his bowels are not disordered. When the fever, catarrhal irritation 
and desquamation have passed off, he should have a warm bath, and on the 
following day a cool wash all over, taking care that it be done quickly, and 
that the patient be well rubbed and dried by flannel afterwards. From this 
time he may be allowed to go into the fresh air, provided the weather allows it. 
Aeon, is the very remedy at the beginning, because it corresponds to 
all the symptoms of usual cases — full, quick pulse; dry, hot, burning skin; 
fever; restlessness; catarrhal irritation from the eyes down into the bronchial 
tubes; nosebleed; dry, hacking, or even croupy cough; stitching pains in the 
chest; restless sleep, with jerking and starting; grating of the teeth, moan- 
ing and groaning, or sleeplessness with great agitation and anxiety; pain in 
the stomach and bowels, with vomiting and diarrhoea. 

Ant. crud., pain in the ears; white coated tongue; gastric derange- 
ments. 

Apis, confluent eruption and eedematous swelling of the skin; greatly 
inflamed eyes; croupy cough; violent cough, similar to whooping-cough; 
catarrh of the bowels, with diarrhoea; prostration, muttering and delirium. 

Arsen., in adynamic cases. Persistent burning heat of the skin; fre- 
quent, quick and small pulse; great anxiety; restlessness; palpitation of the 
heart ; too early or sudden disappearance of the rash ; pale, earthy color of 
the face; bloatedness of the face; thrush in the mouth and fauces; constant 
craving for cold water,with but little drinking at a time; vomiting and 
diarrhoea ; great sinking of strength ; all worse about midnight. 

Bellad., may be indicated as often as Aeon, in the commencement, if 
there be heat with moisture of the skin, quick, but soft pulse ; constant drowsy 
sleep, or drowsiness with inability to go to sleep ; congestion to the head ; 
injected eyes; thick, white coated tongue; sore throat, even diphtheritic; 
hollow, barking, croupy cough; jerkings of the limbs; convulsions. 

Bryon., by slowly forthcoming eruptions and inflammatory affections 
of the chest ; dry, painful cough, constipation, etc. 

Camphora, in those dangerous cases where the face grows pale and 
the skin cold, assuming a bluish, purple color, with utter prostration and 
spasmodic stiffness of the body. Also in different after-complaints, especially 
painful and difficult micturition. 

Carb. veg., persistent hoarseness after measles. 
Chamom., painful, watery diarrhoea, in consequence of taking cold. 
Coffea, nervous, restless agitation, preventing all sleep; short, dry, 
hacking cough. 

Cupr. ac, measles, bronchitis, delirium, wants to go home; expectora- 
tion only during the night. (J. C. Morgan.) On falling asleep, begins to 
talk, scold, turn, twist and scream ; on being aroused, was perfectly rational, 
tongue and mouth red. (J. F. Miller.) 



1022 EXANTHEMATA. 

Drosera, cough, with drawing together of the epigastrium, similar to 
whooping-cough, also paroxysms of cough after measles, worse in afternoon 
and evening, even when attended with bloody and purulent expectoration. 

Euphras., streaming of hot, burning tears from the eyes, with great 
photophobia; profuse running from the nose, without burning; cough only 
during the day. 

Gelsem., after Aeon., great deal of coryza; drowsy with fever heat, 
no thirst. When the eruption turns livid, with cerebral symptoms. 

Hepar, croupy cough, with rattling in the chest, but without expec- 
toration ; worse in the morning. 

Ipec, tardily forthcoming eruption, with oppression of chest; tickling 
cough and vomiting. 

Kali bichr., flowing of water from the eyes, with burning when open- 
ing them ; pustules on the cornea; stitches in the left ear extending into neck 
and head, with swelling of the glands; watery discharges from the nose, with 
great sensitiveness and ulceration of the nostrils; thirst, Avith dryness of 
mouth and tongue; watery diarrhoea, followed by tenesmus ; loud, rattling 
cough, with stringy expectoration. 

Laches., livid eruption, countenance almost black, tongue coated dark 
brown, sordes on teeth, inability to protrude the tongue. (J. F. Miller.) 

Mercur., diarrhoea, with pain in the bowels and tenesmus; moist bark- 
ing cough, without expectoration; the cough is almost convulsive and cannot 
be controlled, occurring in frequent paroxysms, particularly from 9 A.M. 
till 5 or 6 p.m. (C. Wesselhoeft.) 

Nux vom., after previous use of drugs; nose stopped up; cough dry 
in the evening and loose in the morning. 

Phosphor., in complication with bronchitis and pneumonic symptoms; 
tightness across the chest, with a dry, tight cough ; worse from evening until 
midnight; unpainful diarrhoea. 

Pulsat., inflammation of the eyes and photophobia; thick, yellow dis- 
charge from the nose ; dryness of the mouth, without thirst ; nightly diarrhoea, 
after previous rumbling in the bowels ; rattling, loose cough, with expectora- 
tion of thick, yellow mucus; increase of all the symptoms towards evening; 
chronic, loose cough after measles. 

Stramon., sometimes before the outbreak of the eruption, if there be 
frightful visions of rats, mice, etc., at which the patient is startled and from 
which he tries to hide; spasmodic affection of the oesophagus, hindering 
swallowing. 

Sulphur, either during the first stage, when the eruption makes a tardy 
progress, or for after-complaints, such as chronic coughs, originating in rem- 
nants of partial pneumonia ; chronic diarrhoea ; hardness of hearing ; chronic 
discharge from the ears. 



SCARLATINA. ^ 1023 

Veratr., pale, livid color, and tardy appearance of the eruption; 
haemorrhages without amelioration; burning heat with alternate cold ex- 
tremities; very frequent, weak, intermitting pulse; delirium; restlessness; 
drowsiness; apathy. 

Ver. vir., during febrile stage, especially if pulmonary congestion is 
impending; red streak down the centre of tongue; convulsions before erup- 
tion. 

Scarlatina. 

Scarlet fever is characterized by the following features : 

1. An eruption of the skin due to hyperemia, with numerous and closely 
aggregated red points about the size of a pin's-head, in normal cases equally 
distributed over the whole surface of the body. These scarlet points are 
either flat or slightly elevated, and as the hyperemia increases, the vividly 
red points, originally isolated, gradually become confluent, and the exanthem 
assumes a uniform, intense redness, with turgescence of the skin, which ap- 
pears stretched and glistening (Scarlatina laevigata). In other cases the 
eruption is but partial, or it may assume the shape of large roseola spots, 
from the size of a lentil to that of a bean, and of various shades of color, 
when it is called "Scarlatina variegata." Or the oedema of the skin is 
more considerable, and marked by a punctate injection in the form of small 
but numerous papules, which can be better felt than seen — Scarlatina pa- 
pulosa. Or in the further development of the papular form, miliary vesi- 
cles, about as large as a millet seed, with turbid contents, may appear on all 
parte of the body, but chiefly on the trunk — Scarlatina miliaris. Or the 
hyperemia may be so intense, that under the influence of a hemorrhagic 
diathesis, exudation of blood into the superficial layers of the skin, into the 
subcutaneous cellular tissue, into the miliary vesicles, and even haemorrhages 
from internal and mucous membranes may occur — Scarlatina hemor- 
rhagica. The scarlatinous exanthem is sometimes accompanied or followed 
by other forms of cutaneous disease, such as herpes labiales, acne, urticaria, 
pemphigus, ecthema, varicella-like and pustular eruptions, sudamina, boils, 
and in septic conditions even gangrene of the skin and the subcutaneous 
cellular tissue. 

2. An angina which consists in mild cases of a uniform redness of the 
fauces, associated in more intense forms with swelling of the mucous membrane, 
enlarged follicles and tonsils in variable degrees. In still graver forms the 
mucous membrane is of a dark, livid color, greatly swollen, with abundant 
secretion, at times making deglutition considerably difficult, ori mpossible, the 
fluid taken regurgitating through the nose; the tonsils are also greatly en- 
larged and prone to suppurate. In the severest cases (angina maligna) 
there is parenchymatous inflammation of the tonsils, and infiltration of the 



1024 EXANTHEMATA. 

region of the parotid and submaxillary glands, frequently of the entire cel- 
lular tissue of the neck, of the retro-pharyngeal and laryngeal cellular tissue, 
which latter causes respiratory disturbances similar to those of oedema glottidis. 
There is great proneness of these swellings to suppuration, and even gan- 
grenous destruction of the same has occurred. 

Scarlatinous angina is often complicated with diphtheria, which may 
stay confined to the throat or spread to the nose, larynx and the contiguous 
portions of the respiratory mucous membrane ; it can be a complication of 
the mildest, as well as of the severest cases. Some authors consider the 
diphtheritic inflammation as a direct effect of the contagion of scarlatina. 

3. An inflammation of the kidneys, which may be of a catarrhal or pa- 
renchymatous nature. In the catarrhal form we find large masses of epi- 
thelial elements in the urine; it occurs mostly in the early stages of scarlet 
fever. The parenchymatous form is attended with albuminuria and hema- 
turia, and occurs-, as a rule, not before the end of the second or third week, 
but at times in the beginning; it is accompanied with dropsical effusion, mostly 
as anasarca, though hydrops of the serous sacs may also be associated with it. 
It should be understood that scarlatina is an exceedingly variable disease. 
There are cases without eruption, which are sometimes followed by a more or 
less well-marked and extensive desquamation; there are rare cases without 
angina, yet decidedly marked by kidney disease, parotitis and infiltration of 
the cervical connective tissue ; there are cases where the eruption follows an 
attack of nephritis, or parotitis, or infiltration of the cervical connective tissue, 
with or without angina. And even these different varieties may be combined 
in the most complicated manner. 

Scarlatina is a contagious disease, not only by contact and immediate 
exhalation, but also by transmission through persons who are not themselves 
affected. The nature of the poison is not known. The stage of incubation 
lasts from four to seven days, or longer. The predisposition to take the dis- 
ease seems to be not nearly as universal as that for taking measles, quite a 
number of persons escape it altogether. Infants less than six months of age 
are mostly exempt from its attacks ; but children between the ages of one to 
fifteen years are most liable to catch it ; in later years the disposition to it 
decreases greatly ; scarcely any one gets it a second time, but there are ex- 
ceptions. It generally appears as an epidemic, and the different epidemics 
vary much iu character, severity, time of year and duration. Its normal 
progress has been divided into four stages : 

1. The stadium podromorum commences with repeated chills, followed 
by heat, nausea, vomiting, violent headache, and a feeling of prostration. 
The pulse ranges from one hundred and twenty to one hundred and thirty 
and more beats per minute, and the temperature often reaches on the evening 
of the first day the height of 104° to 105.8° F. This is quite characteristic 



SCARLATINA. 1025 

of normal cases, as no other disease shows such a rapid increase of pulsation 
and temperature. Besides these symptoms the patient commences to com- 
plain of sore throat, dryness and burning, and pain when swallowing. On 
inspection we find the throat red and swollen, and the tongue coated, but red 
on its edges. This condition lasts in some cases only a few hours; in others 
it is entirely absent, or so mild that it may be overlooked, the eruption ap- 
pearing at once, while in a majority of cases it lasts one or two days, and 
quite exceptionally still longer. So, also, varies the intensity of the attack 
in different individuals; from a mere indisposition, which is scarcely noticed, 
it may at once be associated with stupor and convulsions. 

2. The stadium eruptionis is almost always accompanied by an exacer- 
bation of the fever. The eruption shows first on the neck, not, as in measles, 
on the face, which remains unchanged, presenting only feverish, reddened 
cheeks. From the neck it spreads further over the body, so that usually in 
twenty-four or thirty-six hours the whole body is covered. The deepest 
redness appears on the neck, on the extensor muscles, around the joints, and 
on the dorsum of the hands and feet. Pressure with the finger upon the 
skin causes, for a moment, a white spot, which speedily grows red again from 
the periphery to the centre, unlike that in measles, which spreads from the 
centre to the periphery. As the eruption grows and spreads, so, also, grows 
the angina faucium, and the thick, white coating of the tongue is now peel- 
ing off, leaving it red all over with highly inflamed papilla?, constituting the 
so-called strawberry tongue. The skin itches intensely. All these symp- 
toms are not, however, alike in all cases. In some the redness may spread 
almost simultaneously all over the body and be very intense; it may be either 
scarcely noticeable or of different aspects, as described above; the angina 
also may amount to scarcely anything, or be very intense ; it may be com- 
plicated with diphtheritis, or be combined with catarrh of the larynx or 
bronchial tubes. 

3. The stadium fiorescentice, the time during which the eruption remains 
upon the skin, lasts usually from four to five days ; about the second day of 
this stage it is in its fullest bloom ; at the same time the fever and throat 
symptoms reach their height. The urine contains considerable quantities of 
cast-off epithelial cells, and frequently traces of albumen; in general the 
patient is sickest at this stage. It is the climax of the disease. From this 
time all the symptoms grow milder; the eruption declines, the fever lessens, the 
angina gradually lessens, and the patient feels better altogether. Yet this 
is not uniformly the case. The fever may rise anew, because new complica- 
tions set in. 

4. The stadium desquamations sets in usually on the fifth day after the 
eruption first appeared, and lasts from eight to fourteen days. At first we 
observe fine white scales peeling off on the neck, the desquamation extending 

65 



1026 EXANTHEMATA. 

gradually over the whole body. On the hands and feet great flakes' of skin 
are often loosened by the patient himself, as a wholesome pastime after so 
severe an illness; fever and and angina lessen constantly, until finally, in 
about three or four weeks from the commencement, perfect recovery takes 
place. This is the normal course of a simple scarlatina case. 

The Scarlatina maligna, typllOSa, is characterized in the following 
way: In the premonitory stage already the patient is greatly prostrated, 
apathic, only half-conscious or comatose; the pupils are mostly dilated; 
there are either simply slight twitchings and jerkings of the limbs, or general 
convulsions ; the tongue is dry ; the pulse very small and scarcely countable ; 
the body is burning hot, with cold extremities. The eruption is either intense, 
breaking forth suddenly all over, and peeling off very soon in large flakes, 
as though the skin had been scalded. Such patients die, and it seems to me, 
for this physiological reason, that life cannot be sustained if a certain amount 
of the surface of the skin becomes destroyed. In other cases the eruption 
does not come out regularly, looks purple, livid, and is mixed with ecchy- 
mose spots; diarrhoea with meteorism associate, and the tongue and gums 
become covered with a black coating. Also such patients die mostly in the 
second stage, or sink during the stage of desquamation. 

Another bad form is that of Angina maligna, a parenchymatous inflam- 
mation of the tonsils and fauces. We observe in such cases great difficulty, 
even impossibility, of swallowing, and a nasal twang when speaking. The 
tonsils are greatly swollen, closing up the fauces; all the parts appear dark 
red; there is an abundant secretion 'in the throat, in consequence of which 
the breathing becomes rattling; the fever rises high; the face is red and 
bloated, and the conjunctiva injected; there is great restlessness and anxiety. 
This condition terminates either in the formation of abscesses, or in gan- 
grenous destruction of the parts. The first is the more favorable of the two. 
In case of gangrene we see a blister forming which bursts, and then gangre- 
nous ulcers spreading rapidly in circumference, but less in depth, emitting a 
terrible stench. All this is attended with violent fever heat, very frequent 
pulse, coma with half-open eyes, great restlessness, sudden screamings, ob- 
struction of the nose, difficulty of breathing, cold extremities, and retention 
of feces and urine. If the gangrenous process comes to a halt, the patient 
may recover, though very slowly ; if it continues the patient dies within two 
or three days. In the latter case the color of the eruption grows livid, and 
does not disappear under the pressure of the finger. 

Or the sore throat may be complicated with diphtheria and consequent 
infiltration of the parotid, submaxillary and lymphatic glands. This diph- 
theritic process may extend up into the nose (compare Diphtheritis) and 
cause a virulent coryza, that much-dreaded symptom of scarlet fever, with 
fetid discharge from the nostrils and a terrible smell from the mouth. At 



SCARLATINA. 1027 

the same time the cervical glands and the connective tissue around them 
tumefy; the patient lies in a stupid or comatose state, with his head bent 
backwards; the pulse ranges from one hundred and forty to one hundred 
and sixty per minute, and the temperature of the body 106° F. and over. 
Should this morbid process extend into the larynx, there are small chances 
left for recovery. In some cases the inflammation spreads along the Eus- 
tachian tubes into the tympanum, causing an otitis media, which may lead to 
perforation of the membrana tympani, and caries of the petrous portion of 
the temporal bone. 

In other cases the infiltrated cervical glands suppurate, accompanied by 
a new increase of fever, causing various meningeal symptoms. At this stage 
not very unfrequently the synovial membranes inflame also, or pleuritis or 
pericarditis ma}' suddenly set in, followed by an abundant purulent exudation. 

During the period of desquamation most generally the third localization 
of the scarlatinal virus takes place, that into the kidneys, causing parenchy- 
matous nephritis, with its subsequent scarlatinal dropsy. There are epidemics 
where almost all patients show symptoms of it — albumen and blood in the 
urine and dropsical swellings, while in others they are only exceptionally ob- 
served. It usually sets in with renewed chilly sensations, which are followed 
by fever, nausea, vomiting, pain in the region of the kidneys extending along 
the course of the ureters, with frequent desire to pass a little dark, dirty, 
brownish-looking urine, which contains blood, albumen and epithelial cells. 

Still another sequel of scarlet fever is to be mentioned : dropsy ivithout 
albuminuria, which generally creeps on slowly and may attain to a great 
height ; it is generally not so dangerous as that caused by nephritis, seems to 
be the consequence of loss of solid constituents of the blood, or a weakness of 
the heart, and is characterized by great weakness of the muscles, great pale- 
ness of the skin, great acceleration of the pulse from slightest motion, and 
fainting fits. 

The chronic otorrhcea after scarlet fever is mostly the consequence of a 
catarrhal inflammation of the meatus auditorius externus, while deafness has 
its cause in an inflammation of the middle ear, which has spread there 
through the Eustachian tubes and caused perforation of the tympanum, or 
thickening of the same. 

Another sequel of scarlatina is ozdema of the lungs, which usually is com- 
plicated with hydrothorax and anasarca. Under constantly increasing 
dyspnoea and cyanosis the patient dies from asphyxia. The same takes place 
if ozdema glottidis should be added to pulmonary oedema. 

In our Prognosis we must consider as unfavorable symptoms: sudden 
disappearance of the eruption, which is always a sign of a dangerous com- 
plication; sudden change of the scarlet into a livid color, with rise of tempera- 
ture and great frequency of the pulse, delirium or coma; purplish color of 



1028 EXANTHEMATA. 

the eruption with ecchynioses or petechia, bleeding of the gums, bloody alvine 
discharges, which denote a dissolution of the blood ; intercutting diarrhoea or 
dysentery, with nieteorism, great thirst and sudden loss of strength ; dimin- 
ished secretion of urine, which contains albumen and blood; intercurring 
oedema of the lungs or glottis ; gangrene of the tonsils and fauces, and diph- 
theritic inflammation of the throat. 

THERAPEUTIC HINTS —As a preventive I would still recommend 
the potentized Belladonna, one dose every night, until symptoms appear. 
If it cannot prevent the attack, it has seemed at least to mitigate its violence. 
The clumsy imitation by the old school — drop-doses of the tincture or extract 
— could not possibly produce any beneficial results. 

The terrible burning and itching of the skin is best relieved by rubbing 
the body all over with bacon (fat part of ham), olive-oil, or cocoa-butter, 
once or twice a day, always if the skin is dry, glands swollen, and there is a 
scrofulous diathesis. 

When the temperature of the body rises to 106° F. and over, it has 
been found beneficial to envelope the whole body in a wet sheet; I would 
prefer warm to cold water. 

Where there are several children in a family, the rest should be kept 
away from the sick-room. 

For complications with diphtheria compare the corresponding chapter. 

Aeon., rarely, and only in the very beginning of the attack, if charac- 
terized by the following symptoms: great dry heat and congestion of the 
skin ; thirst ; rapid and hard pulse ; great restlessness ; headache ; peevish- 
ness, which revolts against all interference ; or at a later period : sudden ex- 
cruciating pain in the stomach, gagging, retching, vomiting of blood and 
stoppage of breath ; distressed face, anguish ; cold sweat on forehead ; gasping. 

Ailanth., "violent vomiting; severe headache; intolerance of light; 
dizziness; hot red face; inability to sit up; small rapid pulse; drowsy, at 
the same time very restless ; great anxiety ; two hours after the first invasion 
the drowsiness had increased to insensibility, with constant muttering de- 
lirium ; did not recognize the members of the family ; she was now covered, 
in patches, with an eruption of miliary rash, with efflorescence between the 
points of the rash of a dark, almost livid color; the patches between the 
points of the eruption were of a dingy, dull, opaque appearance ; the eruption 
was more profuse on the forehead and face than elsewhere, and especially on 
the forehead ; the pulse was now small, and so rapid as hardly to be counted ; 
the surface had become cold and dry; the livid color of the skin, when 
pressed out by the finger, returned very slowly; the whole was a most com- 
plete picture of torpor." These toxical symptoms, caused by Ailanthus and 
observed by Dr. Wells, of Brooklyn, simulate so strikingly adynamic forms 






SCARLATINA. 1029 

of scarlatina that it must be a curative agent in such cases. Has since been 
confirmed by Dr. Chalmers and others. 

Amm. carb., hard swelling of the right parotid and lymphatic glands 
of the neck ; putrid sore throat ; miliary form of eruption. 

Apis is, according to Wolf, indicated in usual as well as in those grave 
cases where the blood is thoroughly poisoned by the virus, and the whole 
nervous system under its paralyzing influence; the fever assumes a typhoid 
character ; the tongue is of a deep red color and covered with blisters, which 
become converted into sores and ulcers, with stinging pains ; the nose dis- 
charges a thick, white, bloody, fetid mucus; the tonsils are swollen and hard, 
and the swallowing difficult; the whole abdomen is sore to the touch; the 
discharges from the bowels are diarrhoeic, slimy and bloody; nephritis; the 
urine is scanty, and of a dirty red color; micturition frequent and sometimes 
painful; the breathing is accelerated and labored; there is loss of conscious- 
ness, delirium, sopor, convulsions, trembling of the limbs; the skin is either 
burning hot all over, or gradually growing cool, or hot in some and cool in 
other places; the fever rises constantly, and the pulse changes frequently in 
character ; dropsical symptoms during desquamation. — Cerebral irritation ; 
piercing shrieks ; rolling of the head ; grating of teeth ; irregular, slow pulse. 
— "Apis is never indicated in the coryza form, only with a dry nose, dryness 
of the throat and hydrocephalic symptoms." — (Hering.) 

Arsen., when the eruption delays or grows pale suddenly, livid, or is 
intermixed with petechias; malignant sore throat; different dropsical affec- 
tions; dyspnoea; extreme restlessness and anxiety; prostration; typhoid 
svmptoms; cold hands; burning heat internally, with a cold external sur- 
face; cold perspiration; quick, small pulse. Nephritis albuminosa. 

Arum triph., great soreness of the mouth; redness of the tongue, with 
elevated papillae ; cracked corners of the mouth and lips ; stoppage of the 
nose, without or with profuse yellow discharge, filling the whole nasal cavity 
and throat; putrid sore throat; diphtheria; submaxillary glands swollen; 
urine abundant and pale; eruption all over the body, with much itching 
and restlessness ; picking at the nose, lips and finger-nails. 

Asclep. syr. is recommended for dropsy in consequence of nephritis. 

Bar. carb., swelling of the parotids, tonsils and submaxillary glands, 
with much saliva, or else dryness in the throat, with pressing, stinging pain 
on swallowing. During and after desquamation. 

Bellad., congestion to the brain, with delirium; on closing the eyes he 
sees horrible things; wants to sleep, but cannot sleep; anxious dreams; 
starts in sleep; suddenly springs up in bed, or attempts to; throbbing of the 
carotid arteries; involuntary moving of the hands to the head; bending the 
head backwards; head hotter than the remainder of the body; eyes injected; 
face fiery red, or pale and puffed, or sunken ; tongue white, with red edges, 



1030 EXANTHEMATA. 

or else red all over, with raised papillae; fauces inflamed, swollen ; cannot 
swallow, or only with greatest difficulty; external swelling of the neck; 
vomiting. (Bellad. is only indicated in the smooth form of eruption with 
vascular and nervous excitement ; it does no good in adynamic cases. The 
miliary form of eruption is much more adapted to Amm. carb., Laches., or 
Rhus tox.) 

Bromium, when the parotids became involved, especially the left, it 
did better than any other remedy. (W. Payne.) 

Bryon., when the eruption delays or suddenly disappears; beginning 
dropsical symptoms; pleuritis or meningitis. Crimson red face; dry lips; 
dry, brownish tongue ; great thirst, and drinking much at a time and hastily ; 
obstruction of the bowels ; sleep with eyes half open ; disinclined to move ; 
pain on moving. 

Calc. carb., after Bellad., about the third day; great, hard swelling 
of all the glands about the neck ; greatly inflamed throat, with aphthae on 
the tonsils and roof of the mouth ; the pale, bloated face shows no signs of 
eruption; great anxiety and oppression, threatening paralysis of the lungs; 
scrofulous individuals; longing for boiled eggs. Otorrhcea as a sequel. 

Camphora, in desperate cases, with rattling in the throat; hot breath, 
hot forehead, with hot perspiration; limbs cold and purple. 

Carbol. ac, a case by Dr. Rouht: sleeping uneasily with half-open 
eyes; twitching of hands and limbs; starting from sleep ; delirious talking; 
moaning; tossing; pulse 160; tongue thickly coated in centre, afterwards 
clearing and leaving it of a glossy, red color; throat swollen inside and out- 
side; difficult swallowing and breathing; nose stopped up; lips dry and 
cracked ; odor of breath almost unbearable ; fauces fiery red and swollen ; 
diphtheritic patches on the tonsils and pharynx; urine scanty and red; 
bowels moved every hour; eruption of a dark red color; miliary vesicles 
over the entire body. 

Carb. veg., in last stage; rattling in the throat; complete sinking of 
vitality; cold breath; cool extremities; sticky, cold perspiration; wants to 
be fanned all the time. 

Coffea, as an intermediate remedy for excessive nervous excitement, 
sleeplessness and palpitation of the heart. 

Colchic, nephritis; bloody urine, looking almost like ink and contain- 
ing albumen; dropsy. 

Cuprum, when the eruption quickly disappears, with subsequent con- 
vulsions, rolling of the eyes, distortions of the face, mouth and all the flexor 
muscles; great restlessness, tossing about; sopor; delirium. (No eruption, 
but terrible sore throat; delirious, fearing the bedclothes would catch fire, 
etc.; afraid of every one who approaches; afraid of falling; clinging tightly 



SCARLATINA. lOol 

to the nurse; afraid of being injured by any one else; conscious, knows other 
people; won't stay in bed, but on the lap.) (R. Gardiner.) 

Digit., nephritis after desquamation, with anasarca and oedema of the 
lungs. 

Gelsem., has been given in large doses to "control the pulse, calm the 
nervous erethism, determine the eruption toward the surface, relieve pain 
and lessen the cerebral congestion." I believe its proper homoeopathic 
sphere of action will be found rather in those asthenic forms of scarlet 
fever, which from the commencement show marked signs of a general toxi- 
cation of the blood by the scarlatinal virus, viz.: profound and intense pros- 
tration of the whole muscular power; cerebral intoxication; pulse frequent, 
soft, weak and so feeble as sometimes to be imperceptible ; impaired vision ; 
spasms and paralysis. Dr. Morgan gives the following hints : Chilliness, or 
at least cold hands and feet; heat with languor and drowsiness; when sleep- 
ing, the patient talks in delirious muttering, or half wakes at times ; crimson 
flush of the whole face in all positions; suffusion of eyes, heavy looking; 
throat feels as if swelled or filled up, is diffusely red ; tonsils red and slightly 
swollen ; when the eruption recedes, all the viscera are threatened. 

Helleb., dropsical symptoms, in consequence of nephritis; urine with 
sediment like coffee-grounds; squinting; pupils dilated; face pale and 
puffed. 

Hepar, after previous abuse of mercury. Best remedy for commencing 
nephritis. (Kafka.) 

Hydr. ac, has been suggested by Dr. Wells, when the eruption in its 
early appearance is dark colored and soon becomes livid, only slowly regain- 
ing its color when this is expelled by the pressure of the end of the finger ; 
rapid, feeble pulse. 

Hyosc, stupid drowsiness, or else great nervous excitability and sleep- 
lessness; utter stupidity, or else illusions of the imagination and senses; 
vacant staring at things, or else sparkling red, prominent eyes; embarrassed, 
indistinct speech ; answers no questions, or else indistinct muttering loquacity ; 
mouth and throat dry and red; inability to swallow; abdomen distended. 
tympanitic; watery, involuntary and unnoticed stools in bed. "Its sphere 
seems to be limited to cases with acute inflammatory affections of the brain, 
or to that state between erethism and torpor, which places it in relation to 
Bellad. and Stramon., as in typhoid fever, below Stramon." (P. P. Wells.) 

Iodium, after mercury; ulcers in the throat; glands swolk-n, suppu- 
rating; everything appears bright blue to him in the distance; worse from 
warmth and from warm things of all kinds. 

Kali bichr., diphtheritic inflammation; discharge from nose is tough 
and stringy; pain in left ear; swelling of parotid glands; croupy COU 
measle-like eruption ; red, raw, glistening tongue; deep ulcers in the fau« 



1032 EXANTHEMATA. 

Kali carb., swelling of the right parotid gland; fever and restlessness; 
always worse about three o'clock in the morning ; smell from the mouth like 
that of old cheese ; great dryness of the skin ; cedematous swelling, like little 
bags, between the eyebrows and upper eyelids. 

Laches., miliary form of eruption; also when the eruption turns purple 
at a late stage; in malignant cases with threatening gangrene or sloughing 
ulceration; acrid, foul secretions; low grade of inflammatory action; ap- 
proaching to a condition of torpor. Diphtheritic inflammation of the throat ; 
fluids regurgitate through the nose; ulcers on the tongue; suppuration of the 
glands of the neck; pleuritic, pericarditic and general dropsy in delayed des- 
quamation, with great oppression ; nephritis with urine almost black ; badly 
smelling stool ; fever worse in the afternoon. 

Lycop., diphtheritic sore throat; stoppage of the nose; rattling in the 
throat; comatose state ; deafness and purulent discharge from the ears ; great 
peevishness ; crossness on getting awake ; worse from being covered too much ; 
scanty, dark red and albuminous urine, with strangury; oedema of the face, 
hands and feet; ascites; secondary eruption of dark red blotches on hands, 
thighs, back or face ; colic during desquamation, with costiveness. Is some- 
times indicated at the onset. 

Mercur., consecutive anasarca and ascites; soreness and inflammation 
of the genital organs. 

Merc, jod., after Laches.; loss of voice, hoarseness, can only lisp; 
fauces bluish-red, ulcerated. 

Mur. ac, intense redness rapidly breaking out all over the body in 
the first hours of the attack with coma; or scanty eruption, w T hich is inter- 
spersed by petechia?; dark redness of the face; purplish color of the skin; 
burning heat of the body; great anxiety and restlessness, constantly com- 
pelling the patient to uncover himself; aggravation in the evening; pulse 
intermitting at regular intervals; severe angina; dark, bluish-red fauces, 
aphtha? ; foul breath; discharge of thin, acrid pus from the nose and lips; 
sighing, groaning respiration ; sliding down in the bed. 

Nitr. ac, diphtheritic sore throat extending up into the nose, from 
which a profuse, thin, purulent matter discharges; tonsils swollen; tongue 
dry, fissured ; difficult deglutition ; indistinct speech ; sometimes deafness ; 
intermitting breathing ; eruption of a fine, miliary nature; skin burning hot. 
"Remarkable bad smell of all se- and excretions: stool, urine, sweat and ex- 
halation of skin; bad smell from mouth with dark red, swollen gums, easily 
bleeding; nosebleed, often exhausting, with dark red blood; vomiting, etc. 
Fauces somewhat more dark red than usual, but no swelling." (Kunkel.) 

Opium, convulsions, delirium and a soporous condition, with snoring, 
which were not relieved by Bellad. 

Phosphor., after Mur. ac, although, on the whole, the patient be im- 



SCARLATINA. 1033 

proving, a suspicious rattle commences in the throat; also by prevailing 
chest symptoms ; likewise in case of oversensitiveness of all the senses, and 
vet an apathetic quietness and "don't-care" disposition appears; burning in 
different parts of the body, which compels change of position. Copious 
coryza; alarming weakness and increasing frequency of pulse; during night, 
hands cold and bluish ; congestion to the head. 

Phosph. ac, complete apathy and indifference; don't want to talk; 
answers slowly and reluctantly, or short, incorrectly; stupor; stupid ex- 
pression of the face; bleeding from the nose; meteoristic distention of the 
abdomen, with a great deal of rumbling and gurgling, and unpainful, watery, 
grayish diarrhoea; involuntary stools; great debility; ecchymosed spots; 
bluish spots on the parts which the patient lies upon ; pulse weak, frequent, 
intermitting ; profuse sticky sweat. 

Phytol., eruption dry, of a shriveled appearance; in passing the hand 
over the skin it feels like brown paper; urine suppressed; hands and feet 
burning hot, cannot keep them covered; restless and sleepless; tongue dry 
in centre ; sides coated brown ; throat covered with a diphtheritic deposit of 
an ash color. (C. A. Sibly.) 

Rhus tox., when, after Belladonna, about the third day the fever is 
still rising; when the eruption of the miliary kind looks dark; when the 
eyes appear swimming, as if intoxicated; when the tongue grows red and 
smooth, and a drowsy state, with delirium, sets in; great restlessness; bleed- 
ing from the nose at night; rheumatism of the joints, worse in rest; oedema 
of the scrotum and penis; the swollen parotid glands break open and dis- 
charge ichor copiously; impure, deep cavity, as if one could see into the 
throat; first the left, then the right. Often indicated at the onset of the 
miliary form. 

Secale, watery discharge from the nose, and yet a stoppage of the 
nose; bloody and albuminous urine; cannot bear the heat of the stove, or 
remain covered. 

Senega, oppression; rattling in the chest; loose, but feeble cough, with 
little expectoration ; hydrothorax. 

Silic, fever worse at night; sleep disturbed by pain in the ears; child 
wakes up throwing the arms about and screams; puts the hands behind the 
ears; otitis media; if sickly after vaccination, or soon after, scarlet fever 
follows; like to be covered, wrapped up. 

Stramon., similar to Belladonna cases, but "the eruption is less bright, 
shows a disposition to fade or recede, and the urine is small in quantity or 
its secretion suppressed." (P.P.Wells.) Parenchymatous nephritis; de- 
lirium, hallucinations, convulsions. Great dryness of the throat, compelling 
frequent drinking; swelling of the tongue, so that it hangs out of the mouth ; 
paralysis of the tongue. 



1034 



EXANTHEMATA. 



Sulphur, rapidly growing red all over, and intensely so, with following 
sopor soon after the first vomiting; burning heat of the skin; eruption at 
first bright, soon growing purple, attended with diarrhoea, worse in the morn- 
ing. Cerebral disturbances, with sopor, starting, etc. ; bloated, shining red 
face w T ith white circle around the mouth; dry nose; dry, cracked and red 
tongue. 

Tereb., especially when the kidneys become involved with parenchy- 
matous inflammation and its smoky, bloody urine. ''Albuminuria and 
dropsy after scarlet fever; urine greenish, scanty, loaded with albumen; 
much thirst, drinking often and much at a time." (J. B. Bell.) 

Veratr., in hot summers; burning heat changing with coldness of the 
extremities; small, frequent pulse. 

Ver. vir., according to western physicians, in large doses, rather anti- 
pathically, to subdue arterial excitement. Convulsions, with greatly dilated 
pupils, perfect sleeplessness. Red streak down the centre of the tongue. 

Zincum, especially in threatening paralysis of the brain; complete 
unconsciousness; the child lies perfectly motionless; jerking of the whole 
body, or twitchings of single limbs; grating of the teeth; shrill, frightful 
screams, with altered voice ; cannot speak any more ; occiput very hot ; fore- 
head cold, covered with cold perspiration; w r hite, pale, distorted face; breath- 
ing short and quick, but no rattling; discharge from the bowels and bladder 
involuntary; limbs icy cold, and the whole body cool; bluish-red all over; 
pulse thread-like, scarcely countable. "Convulsions, followed by stupor; 
occiput hotter than forehead ; screams before the spasms ; trembling of the 
muscles; constant motion of the feet between attacks; urine scanty, bloody." 



Digest to Scarlatina. 



SKIN SYMPTOMS. 

Smooth form: Bellad. 

Miliary form: Ailanth., Amm. carb., La- 
ches., Nitr. ac. 

, at the commencement: Rhus tox. 

, in patches with dark, almost livid 

color: Ailanth. 

, dark looking : Rhus tox. 

, vesicles over entire body : Carbol. ac. 

Measle-like eruption: Kalibichr. 

Eruption wanting, but terrible sore throat : 
Cuprum. 

wanting in face: Calc. carb. 

scanty, with interspersed petechise : 

Arsen., Mur. ac. 

growing rapid and intense all over 

body with sopor : Mur. ac, Sulphur. 



Eruption all over with much itching and 

restlessness: Arum triph. 

profuse on forehead and face : Ailanth. 

at first bright, soon growing purple : 

Sulphur. 

dark red : Carbol. ac. 

bluish-red all over : Zincum. 

dry, of a shriveled appearance : Phy- 

tol. 
livid, returning slowly when expelled 

by pressure: Ailanth., Hydr. ac. 

purplish : Mur. ac. 

purplish at a later stage: Laches. 

, livid, interspersed petechia : Arsen., 

Mur. ac. 
, patches between the rash of a dingy, 

opaque appearance: Ailanth. 



DIGEST TO SCARLATINA. 



1035 






Eruption, ecchymosed spots: Phosph. ac. 
, secondary of dark red blotches on 

hands, back and face: Lycop. 
, bluish spot on parts where he lies 

upon: Phosph. ac 

, when delaying: Arsen., Bryon, 

, when receding : Arsen., Bryon. 

, , all viscera threatened: 

Gelsem. 

, , convulsions : Cuprum. 

, , suppression of urine: 

Sir anion. 
Skin-, very dry: Kali carb. 

, burning hot : Nitr. ac. 

, feels like brown paper: Phytol. 

During desquamation: Bar. carb., Sulphur. 

THROAT AND NECK SYMP- 
TOMS. 

Fauces, inflamed and swollen : Bellad. 

, bluish-red, ulcerated: Mercjod. 

, , dark, aphthae : Calc. carb , Mur. 

ac. 

, dark red, but not SAVollen : Nitr. ac. 

, fiery red and swollen : Carbol. ac. 

, diffusely red, and feels filled up : 

Gelsem. 

, swollen inside and outside : Carbol. ac. 

Tonsils, swollen: Bar. carb., Nitr. ac. 

, and red : Gelsem. 

, and hard, with difficult swallow- 
ing: Apis. 

Throat dry and red : Hyosc. 

dry, with frequent drinking: Sim- 
mon. 

dry and hydrocephalic symptoms 

Apis. 

dry, with pressing, stinging pain on 

swallowing: Bar. carb. 

, difficult swallowing: Apis, Bar. carb., 

Bellad., Hyosc, Nitr. ac. 

, , fluid regurgitates through nose : 

Laches. 

, and breathing: Carbol. ac. 

, rattling in throat: Camphora, Carb. 

veg., Lycop. 

, diphtheric inflammation: Arum 

triph., Carbol. ac, Kali bichr., Laches., Ly- 
cop., Phytol. 



Throat, diphtheritic inflammation, ex- 
tending into nose with profuse, thin, pu- 
rulent discharge: Nitr. ac. 

ulcerated: Iodum, Kali bichr., Merc. 

jod. 

, putrid, sore: Amm. carb., Arum 

triph. 

, malignant: Arsen. 

, with threatening gangrene and 

sloughing : Laches. 

Glands about neck swollen: Bellad., Calc. 
carb., Carbol. ac. 

about neck swollen and suppurating : 

Lodum, Laches. 

Parotid glands swollen: Bromium, Kali 
bichr. 

first left and than right, break- 
ing, with deep cavity : Bhus tox. 

, right side: Kali carb. 

swollen and lymphatic glands: Amm. 

carb. 

swollen and submaxillary : Bar. carb. 

Submaxillary glands swollen: Arum 

triph. 

KIDNEY AND URINE SYMP- 
TOMS. 

Nephritis: Asclep., Apis, Arsen., Can- 
thar., Colchic, Digit, Helleb., Hepxr, La- 
ches., Stramon., Tereb. 

with dropsy : Asclep., Canthar., Digit., 

Helleb., Tereb. 

, with urine always black: Laches. * 

, with bloody, smoky urine : Tereb. 

Urine bloody, almost like ink : Colchic. 

, almost black : Laches. 

, smoky: Tereb. 

, albuminous: Apis, Colchic, Ly- 
cop., Secale, Tereb. 

and scanty: Zincvrn. 

scanty, dirty-red : Apis. 

, red : Carbol. ac. 

, dark red : Lycop. 

, greenish : Tereb. 

suppressed : Phytol. 

, sediment like coffee-grounds : Helleb. 

fetid : Nitr. ac. 

abundant and pale : Arum triph, 

Micturition painful and frequent: Apis. 



1036 



EXANTHEMATA. 



Micturition with strangury' : Lycop. 

Dropsy : Apis, Arsen., Bryon., Canthar., 
Colchic, etc.; see Nephritis. 

Puffed face : Bellad., Helleb. 

CEderna between eyebrows and upper 
lids: Kali carb. 

Bloated face, without a sign of eruption: 
Cede. carb. 

Ascites : Lycop., Mercur. 

CEdema of scrotum and penis : Rhus tox. 

Pleuritic and pericardiac dropsy: La- 
ches. 

Hydrothorax : Senega. 

CEdema of longs: Digit. 

of hands and feet : Lycop. 

Anasarca: Digit., Laches., Mercur. 



ACCOMPANYING SYMPTOMS. 

Conscious, knows every one: Cuprum. 

Unconsciousness : Apis, Zincum. 

Insensibility, with constant muttering: 
Ailanth. 

Oversensitiveness of all the senses: 
Phosphor. 

Stupor : Phosph, ac. 

Stupidity : Hyosc. 

Does not recognize anybody: Ailanth. 

Answers no questions : Hyosc. 

slow and reluctantly, or short, incor- 
rectly: Phosph. ac. 

Illusions : Hyosc. 

, sees horrible things on closing the 

eyes : Bellad. 

Hallucinations : Stramon. 

, fearing the bedclothes would catch 

fire: Cuprum. 

Delirium : Apis, Cuprum., Opium, Stra- 
mon. 

, with congestion to brain : Bellad. 

Delirious talking, moaning: Carbol. ac. 

muttering when sleeping : Gelsem. 

, with drowsiness : Ailanth., Rhus 

tox. 



Loquacity, indistinct, muttering : Hyosc. 

Shrieks, piercing : Apis. 

Screams, shrill, with altered voice: Zin- 



Springs up in bed, or attempts to : Bel- 
lad. 

Don't want to talk: Phosph. ac. 

Won't -stay in bed, but on the lap : Cup- 
rum. 



Apathy, indifference, "don't care" : Phos- 
phor., Phosph. ac. 

Anxiety : Ailanth. 

and restlessness : Arsen., Mur. ac. 

and oppression, threatening paralysis 

of lungs : Cole. carb. 

Afraid of falling, clinging to the nurse ; 
afraid of every one, of being injured : 
Cuprum. 

Anguish : Aeon. 

Peevish, revolts against all interference : 
Aeon. 

on getting awake : Lycop. 



Dizziness: Ailanth. 

Cerebral irritation : Apis, Gelsem. 

disturbances, with sopor, starting: 

Sulphur. 

inflammation : Hyosc. 

Meningitis : Apis, Bryon. 

Paralysis of brain threatened: Zincum. 

Congestion to head: Bellad., Phosphor. 

Headache : Aeon., Ailanth. 

Head hotter than remaining body : Bel- 
lad. 

Occiput hotter than forehead : Zincum. 

Forehead hot, with hot perspiration : 
Camphor a. 

, cold sweat on : Aeon., Zincum. 

Head bending backwards : Bellad. 

rolling: Apis. 

Eyes injected : Bellad. 

Pupils dilated, squinting : Helleb. 

Eyes appear swimming, as if intoxicated : 

Rhus tox. 

, suffusion of, heavy looking : Gelsem. 

staring, or sparkling red, prominent : 

Hyosc. 

, rolling of: Cuprum. 

Everything appears bright blue in a 

distance: Iodum. 
Vision impaired : Gelsem. 



DIGEST TO SCARLATINA. 



1037 



Intolerance of light: Ailanth] 



Ear, pain in left : Kali bichr. 

Otitis media, puts hands behind the 

ears : Silic. 
Otorrhcea as a sequel : Calc. carb. 
Deafness : Nibr. ac. 
and purulent discharge from ears : 

Lycop. 



Face distorted : Zinsum. 

, and mouth, 

muscles : Cuprum. 



and all flexor 



Nose stopped up : Carbol. ac., Lycop. ■ 
, with or without profuse yellow 

discharge : Arum triph. 

, with watery discharge : Secale. 

, discharges thick, white, bloody, fetid 

mucus: Apis. 
, profuse, thin, purulent matter : 

Nitr. ac. 
, tough and stringy mucus : Kali 

bichr. 

, acrid fluid: Mur. ac. 

Coryza, profuse : Phosphor. 
Nose dry : Apis, Sulphur. 

bleeding : Phosph. ac. 

at night : Bhus tox. 

, dark blood, exhausting : Nitr. 

ac. 
Picking at nose, lips and finger-nails : 

Arum triph. 

Face fiery red : Bellad. 

hot red: Ailanth. 

dark red : Mur. ac. 

crimson-red : Bryon. 

, flush of whole face in all posi- 
tions : Gelsem. 

shining red, with white circle around 

mouth: Sulphur. 

pale and puffed : Bellad., Helleb. 

pale and bloated, without eruptions : 

Chic. carb. 

pale and white : Zincum. 

cedematous, and hands and feet, and 

ascites: Lycop. 

, swelling, like little bags be- 
tween eyebrows and upper lids: Kali 
carb. 

stupid : Phosph. ac. 

distressed : Aeon. 



Lips dry: Bryon. 

dry and cracked : Carbol. ac. 

and corners of mouth cracked : Arum 

triph. 



Tongue red, with raised papillae: Arum 
triph., Bellad. 

red and smooth : Rhus tox. 

red, raw and glistening : Kali bichr. 

, red streak down the centre : Ver. vir. 

, deep red, covered with blisters, ul- 
cerated, stinging : Apis. 

thickly coated in centre, afterwards 

glossy red : Carbol. ac. 

dry and brownish : Bryon. 

dry, red and cracked : JSitr. ac., Sid- 

phur. 

dry in centre and sides coated brown: 

Phytol. 

, ulcers on : Laches. 

, swelling of, that it hangs out of 

mouth: Stramon. 
, paralysis of: Stramon. 



Speech indistinct : Xitr. ac. 

, loss of: Zincum. 

Teeth grating : Cuprum, Zincum. 

Gums bleeding and swollen, dark red : 
Nitr. ac. 

Bad smell from mouth: Carbol. ac, Mur. 
ac., Nitr. ac. 

, like old cheese : Kali carb. 

Mouth, soreness of: Arum triph. 

and throat dry and red : Hyosc. 

Thirst: Aeon. 

great, and drinking much at a time 

and hastily : Bryon., Sulphur, Tcreb. 

, frequent drinking: Stramon. 

Longing for boiled eggs: Gale. carb. 

Vomiting: Ailanth., Bellad., Nitr. ac. 

of blood at a later period, with ex- 
cruciating pain in the stomach, gagging, 
retching and stoppage of breath: Aeon. 

Colic daring desquamation: Lycop. 

Abdomen distended, tympanitic : Hyosc. 



1038 



EXANTHEMATA. 



Abdomen distended, meteorism, gurgling, 
unpainful diarrhoea: Phosph. ac. 

sore to the touch : Apis. 

hot to the touch : Laches. 

Ascites : Lycop., Mercur. 
and anasarca: Mercur. 



Diarrhoea worse in early morning: Sul- 
phur. 

every hour : Carbol. ac. 

, slimy and bloody: Apis. 

, unpainful, watery, grayish: Phosph. 

ac. 

, involuntary: Phosph. ac. 

, , watery, unnoticed: Hyosc. 

, and involuntary micturition: 

Zincum. 

Constipation: Bryon., Lycop. 

Stools fetid: Laches., Nitr. ac. 



Genital organs sore and inflamed : Mercur. 
CEdema of scrotum and penis: Rhus tox. 



Voice, loss of, hoarseness, can only lisp: 
Merc. jod. 

Rattling in throat : Camphora, Carb. veg., 
Lycop. 

Breath cold : Carb. veg. 

hot: Camphora. 

Breathing short and labored : Apis. 

and quick, but no rattling: Zin- 
cum. 

difficult : Carbol. ac. 

intermitting: Nitr. ac. 

sighing, groaning: Mur. ac. 

Dyspnoea: Arsen., Calc. carb., Laches. 

Oppression, and rattling in chest : Senega. 

Stoppage of breath, gasping: Aeon. 

Cough loose, but feeble, with little ex- 
pectoration: Senega. 

^croupy: Kalibichr. 

Chest symptoms prevailing: Phosphor.* 

Paralysis of lungs threatening: Calc. carb. 

CEdema and anasarca: Digit. 

Pleuritis: Bryon. 

Hydrothorax : Senega. 

Pleuritic dropsy : Laches. 

Heart, palpitation: Coffea. 

Pericarditic effusion : Laches. 



Pulse rapid and small: Ailanth., Ver. alb. 

and hard : Aeon. 

and feeble : Hijdr. ac. 

as hardly to be counted : Ailanth. 

, 160 per minute : 

quick and small : Arsen. 

thread-like, scarcely countable : Zin- 
cum. 

, soft, weak and feeble, sometimes im- 
perceptible: Gelsem. 

weak and frequent : Phosphor., Phosph. 

ac. 

irregular, slow : Apis. 

intermitting : Phosph. ac. 

at regular intervals : Mur. ac. 

changes frequently in character: 

Apis. 

Carotid arteries throbbing : Bellad. 



Hands cold : Arsen. 

and bluish during night : Phos- 
phor. 

and feet burning hot, cannot keep 

them covered : Phytol. 

Limbs cold and purple: Camphora. 

Rheumatism of joints, worse in rest : Rhus 
tox. 

Bluish spots on the parts upon which he 
lies: Phosph. ac. 



Debility 

Prostration : Arsen., Carb. veg., Gelsem. 

Inability to sit up : Ailanth. 

Lies perfectly motionless: Zincum. 

Sliding down in bed : Mur. ac. 

Torpor: Ailanth., Laches. 



Trembling of limbs : Apis, Zincum. 
Twitching of hands and limbs : Carbol. ac. 
of single limbs and jerkings of whole 

body: Zincum. 
Involuntary moving of hands to the 

head: Bellad. 
Constant motion of feet : Zincum. 
Convulsions: Apis, Cuprum, Stramon. 

, screams before : Zincum. 

, with dilated pupils : Ver. vir. 

, with snoring : Opium. 

, followed by stupor : Zincum. 



DIGEST TO SCARLATINA. 



1039 



Convulsions and paralysis: Gelsem. 
Distortions of face, mouth and all flexor 
muscles : Cuprum. 



Thorough blood-poisoning by the scar- 
latinal virus: Ailanth., Apis, Oelsem. 
Acrid, for.l secretious: Laches. 



Drowsiness: Ailanih., Beilad., Hyosc, 
Rhus tox. 

and very restless : Ailanth. 

and cannot sleep : Beilad. 

with the heat: Gelsem. 

Sopor: Ailanth., Cuprum, Opium. 

Comatose: Lycop. 

Sleeps with eyes half open : Bryon., Carbol. 
ac. 

with starting: Beilad., Carbol. ac., Sul- 
phur. 

half awake : Gelsem. 

Sleepless and nervous excitability : Cof- 
fea, Hynsc, Ver. vir. 

and restless: Phytol. 

Restlessness : Aeon , Arsen., Rhus tox. 

, tossing about: Cuprum. 

, constantly uncovering himself: Mur. 

ac. 

On getting awake, cross : Lycop. 

, throws arms about and screams : Silic. 

, scratches his head : Cede. carb. 

Sleep disturbed by pain in the ears : Silic. 

Chilliness, at least cold hands and feet: 
Gelsem. 

Cold and dry surface: Ailanth. 

hands and cool body: Zincum. 

surface, burning heat internally : 

Arsen. 

Cool in some and hot in other places : 
Apis. 

Coldness of extremities changing with 
burning heat: Ver. alb. 

Heat, great and dry, congested skin: Aeon. 

, burning of body: Mur. ac, Sulphur. 

, with languor and drowsiness: Gelsem. 

of occiput greater than that of fore- 
head : Zincum. 

of head greater than that of remain- 
ing body : Beilad. 

Burning heat changes with coldness of 
extremities : Ver. alb. 



Burning heat internally with cold surface: 

Arsen. 
gradually growing cool, or hot 

in some and cool in other places: Apis. 
in different parts of body, compelling 

to change position : Phosphor. 
Fever and restlessness : Kali carb. 

, worse in afternoon : Laches. 

, worse in night : Silic. 

Typhoid character : Apis, Arsen. 
Low grade of fever : Laches. 
Sweat profuse and sticky : Phosph. ac. 

sticky and cold: Curb. veg. 

cold : Arsen. 

cold on forehead : Aeon.. Zincum. 

and exhalation fetid : Nitr. ac. 



Bettsr from fanning : Carb. veg. 

from being wrapped up : Silic. 

from changing position : Phosphor. 

Worse in evening: Mur. ac. 

in morning 3 o'clock : Kali carb. 

from being covered : Lycop., Sicale. 

from warmth and warm things : lo- 

dium, Secale. 

from moving : Bryon. 

from rest : Rhus tox. 

OTHER REMEDIES AND CON- 
DITIONS. 

CalC. carb. after Beilad., about the third 

day. 
Hyosc, similar to Beilad. and Stramon. 
Hepar and lodium after the abuse of 

mercury. 
Merc. jod. after Laches. 
Opium, if Belial, does not relieve. 
Phosphor, after Mar. ac, when suspicious 

rattle in the throat commences. 

hus tox. after Bellt 

about the third dav, 



Lycop. sometimes at the onset, when 
there is drowsiness and crossness after 
sleep. 

Carb. veg. in last stage. 

Ver. alb. in hot summer. 

Silic. after vaccination. 

Calc. carb. in scrofulous individuals. 



1040 EXANTHEMATA. 

Rubeola, Roetheln. 

The many different views as to the nature of this disease, whether it be 
a hybrid affection of scarlet fever and measles, or an affection distinct from 
either of the two, seem now to settle down in favor of the latter view. For 
an attack of rubeola protects neither against, measles nor scarlet fever, and 
vice versa. 

Rubeola is contagious, appears in epidemics. Its stage of incubation 
lasts probably from two and a half to three weeks ; prodoma are scarcely 
ever observed. The breaking forth of an exanthem is the first, or at least 
among the first symptoms of the disease. It commences on the face and 
spreads gradually in a downward course all over the body. With it there 
may be an increase of temperature from 2° to 4° F. above the normal, though 
usually it amounts only to about 1.5° F., or there is none at all. The rash 
has great similarity with that of measles, but the rubeola spots are smaller, 
rounder in form and paler in color. Sometimes it is accompanied with some 
sneezing, coughing, slight photophobia, sore throat, and some slight transitory 
disturbance of the appetite. Affections of the kidneys do not occur. Des- 
quamation is absent in most cases. The duration of the exanthem is often 
scarcely two, but sometimes four days. Recovery takes place undisturbed 
after its disappearance. The whole process seldom needs medicinal inter- 
ference. For the catarrhal symptoms either Aeon., Bellad., or some other 
remedies may be indicated. 

Variola, Small-Pox; Variolois, Varioloid. 

The nature of the variola virus we do not know, except by its effect upon 
the organism. It is regenerated while it develops its effects, and thus prop- 
agated from organism to organism. The infectious matter is contained in 
the variola pustules as well as in the exhalation from the small-pox patient. 
Infection takes place, therefore, not only by inoculatiomor immediate contact 
with the patient, but also by more remote means. The poison can be carried 
by other persons in their clothes, or by things which have been in the atmos- 
phere of the patient. It is very persistent in its nature, and may retain its 
property for years if excluded from the atmosphere, and not exposed to great 
heat. There is no difference between the virus of small-pox and that of 
varioloid ; either may cause the one or the other disease. This seems to de- 
pend entirely upon the susceptibility of the organism, and its adaptation for 
a greater or less development of its effects. Small-pox and varioloid differ, 
therefore, only in the intensity of their symptoms. The individual predis- 
position for taking the disease is wide-spread; no sex, no age, not even the 
foetus is exempt ; some persons, however, are never affected by it. Those who 



SMALL-POX. 1041 

once lived through an attack are, almost without exception, safe from any 
further infection, at least for a long time. Vaccination seems likewise to de- 
stroy the predisposition to the disease ; if not in toto, at least partially. For, 
ever since vaccination has become generally introduced, the epidemics have 
grown decidedly milder, the majority of cases being varioloids, while previous 
to the discovery of vaccination, the reverse was the rule. Nevertheless, there 
are epidemics which are still characterized by great malignity, while others 
again are exceedingly mild. It has not been possible to trace out any cause 
for this difference. This is one view of the vaccination question. Of late 
years, however, not only great doubt of the correctness of this view, but direct 
accusations of its falsity have been propagated by men as able as its defenders. 
The lively agitation in England and Germany against the coercion law of 
vaccination has produced a whole library on this subject, and will make itself 
felt more and more every year. The statistic assertion that small-pox epi- 
demics have become milder since the general introduction of vaccination, is 
flatly contradicted by the researches of the foremost statistician of Germany, 
Dr. Engel, in Berlin, who already in the year 1862,- had to confess, " there 
has no change occurred in the coming and going of small-pox epidemics, nor 
in general in the number of small-pox patients since the introduction of vac- 
cination." (Zeitschrift des Konigl. Preussischen Statist. Bureaus, February, 
1862.) But it does not lie in the sphere of this work, to reproduce the de- 
tails of this contention ; my belief is, that vaccination after a few generations 
will be as obsolete in medical therapeutics as inoculation, blood-letting and 
kindred barbarisms of old are to-day. 

Its Course and Symptoms. After the lapse of nine or ten, sometimes 
more days of incubation, the initial stage, or the stadium invasionis, begins 
with a shaking chill, or repeated chilliness, which is followed by a violent 
fever. The temperature rises on the first day to 103° or 104° F., and on the 
second or third day to 105° or 105.5°, and even 107° F. This high fever is 
accompanied with a number of painful symptoms of the head, throat, stomach, 
and general body ; in some cases with delirium and convulsions. No other, 
however, is so characteristic of the disease as the dreadful backache, with 
which it is in most cases associated. The fever rises continually during the 
first three days, showing slight remissions only in the morning. On the even- 
ing of the third day it reaches its height, Only in rare cases is this premoni- 
tory stage absent. In some epidemics the initial stage is marked by an ery- 
thematous eruption, either diffuse or measly ; or by a hemorrhagic exanthem, 
which consists of extremely small punctate, often pin-head sized, hemor- 
rhages in the epidermis, at times so closely crowded together that the impres- 
sion of a diffuse redness is produced. Sometimes both forms are combined 
and we see, then, petechia? upon an erythematous base. The petechial erup- 
tion has its favorite seat on the lower region of the abdomen, on the genitals 
66 



104:2 EXANTHEMATA. 

and the inner surface of the thighs, also on the lateral surfaces of the trunk 
up to the axillae, the contiguous portions of the arms and the pectoralis major 
muscles. This eruption generally appears on the second day and lasts from 
twelve to twenty-four hours. As a rule the petechial form lasts longer. 

The second stage, the stadium eruptionis, commences on the evening of 
the third day. There appear little red spots first on the face. If very nu- 
merous, they coalesce like measle-spots, with which they might be confounded 
if it were not for the granulated feel which they present to the sense of touch. 
On the second day the eruption appears on the neck, chest and back; and 
on the third day it spreads over the extremities. The granulated feel of the 
eruption is due to the formation of papules in consequence of an enlargement 
of the cells of the rete Malpighii, which pushes the epidermis up. Soon an 
exudation of clear fluid from the papillary layer converts the papules iuto 
vesicles, and separating the cells into small groups, a reticulated cavity is 
formed, which contains pus-corpuscles and the epithelial framework. This 
is the reason why a pock never discharges fully if opened only in one place. 
After the formation in vesicles, most pocks show a central depression or um- 
bilicus, which some think to be due to the presence of a hair follicle or the 
duct of a sweat gland in or over its centre; others teach that the periph- 
ery of the pock swells more rapidly than its centre, and thus becomes more 
prominent. This umbilicus disappears when the pustule is fully ripe, but 
re-appears again from the earlier drying of the centre. It requires about 
six days for the ripening of the pustules ; or counting from the time of in- 
vasion, nine or ten days. Simultaneously with this eruption on the skin, an 
eruption of the same character appears upon the different mucous mem- 
branes. On the conjunctiva it causes a flow of tears, photophobia, and in 
severe cases total closure of the eyes for many days; in the mouth it causes 
salivation; in the pharynx, difficulty of swallowing; in the larynx, hoarse- 
ness and cough ; and in the genitals, itching and burning pain. Even the 
external portion of the dura mater has been found studded with pustules 
filled with matter. In several instances the suppuration was of such a 
character as to destroy the membrane where the pustules existed. (Report 
of Drs. Howell and Johnson, Small-pox Hospital, San Francisco, Epidemic 
of 1868. North American Journal, February 1869, p. 443.) 

The full development of the eruption is generally attended with great 
relief to the patient; all the pain lessens and the fever decreases considerably. 
In cases of variola confluentes only, the relief is not so marked. This is, 
however, not the end of the trouble. 

On the ninth or tenth day the fever commences to rise again ; it is the 
beginning of the stadium suppurationis s. matwationis. At this time the 
pustules enlarge still more, the surrounding skin commences to inflame and 
to swell, and a red areola forms around each pustule. Redness and swelling 



VARIOLA, SMALL-POX. 1043 

coalesce from all sides, and constitute a diffused, erysipelatous appearance of 
the whole face, greatly disfiguring the patient. This process gradually 
spreads over the whole body, in the same order in which the eruption com- 
menced to appear. The patient complains of great tension and burning- of 
the skin, and the affections of the eyes, mouth, throat, larynx and genitals 
increase in corresponding order. The temperature rises again from 102° and 
103° to 104° F., frequently attended with chilly sensations; it rises accord- 
ing to the intensity of the inflammation of the skin; and does not abate until 
the dermatitis reaches its acme. This renewal of heat is called the secondary 
or suppurative fever. It may be attended with delirium and symptoms of 
adynamia and general paralysis, in consequence of the absorption of pus 
into the blood. In other cases it combines with a hemorrhagic diathesis, 
when the contents of the pustules become bloody, and bloody extravasation 
within the skin or haemorrhages from different mucous membranes take place, 
hcemorrlwgic small-pox; or, though only in rare cases, portions of the inflam- 
mation mortify and discharge a badly-looking ichor, gangramous small-pox. 
Besides all this, as the variola-poison is apt to localize during this stage in 
serous membranes and parenchymatous organs, we meet with a number of 
different complications, such as: dyspnoea, stitching pains in the chest, cough, 
bloody expectoration, pneumonia, pleuritis, pericarditis, meningitis, suppura-. 
tive inflammation of the joints, periostitis, subcutaneous and intermuscular 
abscesses, inflammation and suppuration of lymphatic glands, suppuration 
of the eyes with hypopion, and croupous exudations in the larynx and 
trachea. 

The last stage, or the stadium exsiccationis, usually commences about the 
eleventh or twelfth day. The pustules burst and discharge their contents, or 
dry up, and become covered with hard, brownish crusts. There is still some 
fever at first ; it lessens, however, continually, and with it gradually disap- 
pear all the painful symptoms which arise from the eruption on the different* 
mucous membranes. The crusts now gradually drop off, at first those which 
cover the most superficial pustules; they leave dark red, somewhat elevated 
spots, which, however, after some time, entirely disappear. Not so these 
which form upon deep-seated ulceration. They adhere a long time, and 
leave, after dropping off, an uneven scar, which looks at first red, but by de- 
grees grows conspicuously white, to remain so for life. In confluent small- 
pox the destructive process is of a still greater extent, in circumference as 
well as in depth, and frequently the remaining scars greatly disfigure the 
face, similar to scars of deep burns. This is the course and progress of 
variola. 

Tarioloid runs a similar but much milder course; all its stages are 
milder and shorter; its secondary fever is much less intense, or wanting alto- 



1044 EXANTHEMATA. 

gether; and its suppurative process does not destroy the cutis, so as to leave 
scars. 

The Purpura variolosa represents the worst course which small-pox 
can take in the initial stage. It attacks young and robust persons by prefer- 
ence, begins with rigor, headache, very intense pain in the back, and great 
prostration. Within eighteen to thirty-six hours a scarlet-like erythema ap- 
pears over the entire body, which is mingled with petechias and larger cuta- 
neous haemorrhages, varying in size up to that of a silver dollar, which usu- 
ally become confluent upon the chest and abdomen. The face is rendered 
red and puffy, the conjunctiva bloodshot, and large black rings are formed 
around the eyes, through haemorrhage into the cellular tissue of the lids and 
their contiguous parts. The tongue is swollen and covered with a whitish- 
yellow coating, and the throat is affected with diphtheritic exudation, from 
which issues a terrible odor. There is pain in the pit of the stomach, nausea 
and vomiting of bile and blood, bloody diarrhoea and offensive urine. In 
some cases we meet a troublesome cough, with bloody expectoration, and in 
women, haemorrhages from the womb. The temperature rises to about 104° 
F. ; the intelligence is usually unimpaired until a short time before death, 
when the body, particularly the trunk, assumes a blackish or leaden-gray 
hue. Some patients die within three days after the beginning, or even 
earlier, some survive the sixth day. (Curschmann.) 

Prognosis. — The fewer the pustules, the lighter the case; confluent pus- 
tules are much more severe. Haemorrhagic, septic and gangrenous small- 
pox are not absolutely fatal, but very dangerous. 

When typhoid symptoms are added, the prognosis must be very 
guarded. 

The younger the individual the greater the danger. Very young in- 
fants are always in great danger. 
t In pregnant females it brings on abortus. 

Inebriates are liable to be taken with delirium tremens. 

Any of the complications mentioned makes the diagnosis doubtful. 

PREVENTIVES. — Vaccination is lauded and equally condemned. 
The humanized virus and the lancet have given place to the ivory point and 
the cow-pox virus. This is an improvement. Syphilis at least is thus pre- 
vented from being propagated any longer by vaccination. 

Internal vaccination is recommended and practiced by Dr. Kaczkowsky, 
and consists in the administration of one dose of Sulphur, 30 which is left to 
act for fourteen days, and is followed by the administration of Vaccininum, 4 
or Variolinum. 4 About the seventh or eighth day febrile symptoms occur, 
and on the eighth, ninth or tenth day a granular eruption, of the size of poppy 
seeds, appears under the skin, which soon ripens and heals. This process has 



VARIOLA, SMALL-POX. 1045 

never been carried out to a sufficient extent so as to enable us to judge of its 
efficacy. 

Dr. H. Boskowitz, of Brooklyn, recommends the virus of the malanders 
or grease of the horse either for inoculation, instead of cow-pox virus, or for 
internal use in a high trituration. The successful internal application of 
Malandrinum as a preventive has been confirmed this season (1880-81) by 
Dr. E. Straube and myself. Dr. Hering has advised the sprinkling of a 
weak solution of Cyanide of potassium about the house, because such me- 
chanics as use it in their manipulations, have been observed by Dr. Korn- 
doerfer to be exempt from the disease in small-pox epidemics, because the 
sulpho-cyanide of potassium, which is present in the saliva of the healthy, 
disappears from there in small-pox patients, and appears instead in the con- 
tents of the pock. This has been demonstrated by me about the year 1850. 
Still others have used Baptis., or Sarracenia, as preventives, with great 
success. Who shall gainsay it? They all were trustworthy observers, and 
epidemics of small-pox change as much in their peculiarities as epidemics of 
scarlet fever or any other disease. 

THERAPEUTIC HINTS.— Apis, where there is an erysipelatous 
redness and swelling, with stinging, burning pains ; stinging, burning pain in 
the throat ; dyspnoea ; suppression of urine. 

Arsen., in asthenic cases, with great sinking of strength, burning heat, 
frequent small pulse, great thirst, great restlessness, and when the pustules 
sink in, and their areolae grow livid. 

Baptis., typhoid symptoms; pustules appear more thickly in throat 
than on skin. It proved exceedingly effective during an epidemic, prevent- 
ing even the offensive effluvium. (E. Williams, B. J. H., 1873, p. 344.) 

Bellad., during the first stage; high fever; congestion to the head; 
sleeplessness, with desire to sleep; convulsions. Later, sore throat and 
cough. 

Bryon., at the commencement, and also when the chest symptoms in- 
dicate it. 

Calc. carb., very important during dentition. 

Camphora, in those dangerous cases where the swelling suddenly 
sinks in and the pustules suddenly dry up, showing a complete giving out of 
the life-forces. 

Carb. veg., when the eruption seems to recede, with cold extremities, 
small, empty pulse, oppression of chest and harrassing cough. 

Canthar., dysuria and bloody urine; the eruption assuming a hemor- 
rhagic tendency. 

Hepar, croupy cough ; suppuration. 

Hydrast. can. has been given successfully when there was great 



1046 EXANTHEMATA. 

swelling, redness and itching, and great soreness of the throat. Is said to 
prevent the pitting to a considerable degree. 

Melandrinum, 30 has been given during the last epidemic (1880-81) 
by Dr. R. Straube, several others and myself with great success as a pre- 
ventive as well as a curative agent. It prevented the suppurative fever, or 
lessened it at least to a considerable degree, and took away all offensive ex- 
halation. Cerebral symptoms, such as delirium and hallucinations necessi- 
tated the interposition of Stramon., while great soreness of the throat and 
cough required Bellad. An article on Melandrinum by Dr. R. Straube, 
which contains a partial proving of this remedy, can be found in the North 
American Journal of Homoeopathy, August number, 1881. 

Mercur., especially during the suppurative stage; great flow of saliva; 
dysenteric discharges from the bowels ; syphilitic taint. 

Phosphor., hemorrhagic diathesis; bloody contents of the pustules; 
hard, dry cough; bronchitis; haemorrhage from the lungs. Typhoid form. 

Phosph. ac, typhoid conditions; subsultus tendinum; great restless- 
ness; great fear of death; the pustules don't fill with matter; some degener- 
ate into large blisters, which burst and discharge a watery fluid, leaving the 
surface excoriated ; watery diarrhoea. . 

Rhus tox., typhoid symptoms, dry, cracked tongue; sordes on the lips 
and teeth; great debility and restlessness; the eruption shrinks and looks 
livid. 

Sarracenia has been used empirically, and is said by some to shorten 
and to ameliorate the progress of the disease; others deny it. The fact of it 
is, we do not know any characteristic indications of the remedy as yet. 

Sulphur is indicated where there is any tendency of metastasis to the 
brain during the suppuration ; is indispensable occasionally as an intercur- 
rent remedy when others seem to fail ; and Goullon advises its uniform use 
in the stadium exsiccationis. 

Tart. emet. has been found by some to ameliorate the progress of the 
disease. 

Thuja, recommended by von Boenninghausen as a preventive as well 
as a curative agent. He states that it shortened in the epidemic of 1849, in 
his neighborhood, all cases, and prevented all scars. 

Vaccininum has been used undoubtedly with great benefit in small- 
pox; its use has shortened and ameliorated all stages quite considerably. 
Sulphur was given afterwards. 

Variolinum makes the progress of the disease much milder ; quickly 
removes all dangerous symptoms; changes imperfect pustules into regular 
ones, which soon afterwards dry up ; promotes suppuration on the third day, 
and exsiccation on the fifth, sixth and ninth day, and prevents all scars. 



VARICELLA, CHICKEN-POX. 1047 

This is the unanimous testimony of ten physicians who have used it in differ- 
ent epidemics. 

Varicella, Chicken-Pox. 

Some pathologists consider chicken-pox as the lightest form of variola. 
This cannot be. For experience teaches, that varicella does not extinguish 
the liability to either cow-pox or small-pox, and that an infection with vari- 
cella causes the identical varicella and not variola or varioloid. 

Varicellas often prevail epidemically, and we also find sporadic cases. 
They frequently precede, accompany or succeed epidemics of small-pox, 
measles and scarlet fever. 

They consist, at first, of little red spots, like flea-bites, which in the 
course of a few hours develop themselves into vesicles, filled with a trans- 
parent, straw-colored fluid. The form of these vesicles varies, and according 
to the different forms which they occasionally assume, they have been divided 
into varicella ovales, lenticular es, coni formes, cuminatuz. Some of them often 
fill with pus and become varicelloz pustuloses, leaving, after desiccation, a scar. 
Their appearance, in most cases, is the first symptom of the disease, without 
any previous ailment. They spread irregularly over the body, and continue 
to appear in crops for several days, so that, when the first crop is already in 
a state of desiccation, a new crop shoots up. In this way the whole process 
may last fourteen days, and even longer. A similar eruption occasionally 
takes place upon the mucous membranes, and forms little ulcers in the fauces; 
but that is not always the case. The general feeling of the patient is not 
very often materially disturbed, though some cases are attended with fever, 
headache, cough, want of appetite and general indisposition. 

THERAPEUTIC HINTS.— It seldom needs particular treatment. 
The occasionally attending symptoms may be met by Aeon., Ant. crud., 
Bellad., Hyosc, Mercur., Pulsat., Rhus tox., Tart. emet. Compare Variola. 



SKIN. 



The skin, as the exterior investment of the body, serves to protect it ; 
at the same time it is the medium by which a continued exchange goes on 
between the interior organs and the outer world. It is the connecting link 
between them, the last and lowest of the human frame. Its affections are 
almost always tokens of some internal derangements, hence their suppression 
is almost always followed by an aggravation of internal troubles. On the 
other hand internal complaints get better in the same degree that the morbid 
process passes outwardly to the skin. This we might state in brief as the 
essence of Hahnemann's psora-theory, which has been thrown aside by the 
would-be-wise, who never understood it. According to Nunez the suppression 
of cutaneous eruptions on the anus is followed by liver complaints ; on the 
legs, by digestive derangements ; on the scrotum and penis, by impotence and 
seminal emissions ; behind the ears, by cough and affections of the eyes ; on 
the scalp, by pulmonary phthisis; on the arms and hands, by laryngeal 
phthisis; in the palms of the hands, by nervcms asthma; on the nose and 
nostrils, by discharges from the ears; on the face (acne rosacea), by heart 
diseases. The skin being easily accessible to ocular inspection and micros- 
copical investigation, its affections have been thoroughly searched and mi- 
nutely arranged and described, especially by Hebra. It would alone fill a 
large volume were I to give a minute investigation of this subject. For such 
there is no room in a work of this kind. I shall confine myself to a cursory 
exposition. Besides, several of these affections have been treated of in pre- 
vious chapters. 

I. HYPERTROPHY OF THE SKIN. 

A hypertrophy of the entire structure of the skin we often find in single, 
confined places, constituting so-called moles, or mother's marks, and soft warts. 
They appear raised above the level of the skin, and, from large deposits of 
pigment within the rete Malpighii, they are of a dark brown color and covered 
by a luxuriant growth of hair. 

(1048) 



ICHTHYOSIS. 1049 

A hypertrophy of the epidermis, hard and horny, constitutes callosities, 
which form on such places as are exposed to external pressure, especially on 
the hands and feet. Corns, or clavi, are callosities, which grow on small, cir- 
cumscribed places of the feet in consequence of the pressure of tight shoes. 
Horns, or cornua cutanea, consist either in an excessive, circumscribed hyper- 
trophy of the epidermis or iu enlarged hair- follicles. 

An abundant formation of pigment in the rete Malpighii causes a more 
or less dark color of the skin ; when accumulating in confined spots, without 
rising above the level of the skin, it constitutes naevi spili (mother's marks) ; 
lentigines (liver spots); ephelides (freckles); chlosmata uterina, that is, brown- 
ish spots on the forehead and upper lip during pregnancy, or in consequence 
of uterine disorders; and the peculiar darkening around the nipples and the 
darkening of the linea alba during pregnancy. 

A hypertrophy of the papillary layer of the cutis constitutes ichthyosis. 



Ichthyosis, or Fish-skin, 

Is, according to Hebra, always of a congenital or hereditary nature. The 
skin appears dry and rough, and covered with thickened and exfoliating cu- 
ticle, like scales, all over, with the exception of the face, the inner side of the 
joints and the scrotum. In light cases the skin presents merely a rough ap- 
pearance, being covered with fine, white scales, without any sign of congestion 
or inflammation underneath. These light cases are called by some authors 
pityriasis, while other writers class under pityriasis also those cases where 
such small, whitish patches of unhealthy cuticle form upon a red, inflamed 
surface, calling it piityriasis rubra. It seems that the latter is a superficial 
dermatitis, and has nothing to do with a diffused hypertrophy of the papillary 
layer of the cutis. 

Compare Arsen., Calc. carb., Clemat., Graphit., Hepar, Lycop., Petrol., 
Phosphor., Plumbum, Sepia, Silic, Sulphur, Thuja. Rubbing with oil, and 
afterwards taking a warm bath, is best suited to remove the hard scales. 

Hypertrophy of single papillce causes warts (verrucse vulgares), and fig- 
warts (condylomata). For common warts : Ant. crud., Calc. carb., Caustic, 
Dulcam., Natr. mur., Nitr. ac, Phytol., Rhus tox., Sepia, Sulphur, Thuja. 
For fig-warts compare venereal diseases. 

A circumscrioed hypertrophy of the cutis constitutes so-called polypi of 
the skin, and the molluscum simplex, a hard, sometimes pediculated tumor. 

A hypertrophy of the cutaneous capillaries causes telangiectasias. Some 
of them remain stationary through life, while others enlarge continually, and 
may give rise to profuse haemorrhages. 

Compare Bellad., Ferr. phosph., Lycop., Phosphor., Platina, 



1050 ATROPHY, HYPEREMIA AND ANEMIA OF THE SKIN. 



Sulphur, and to which may be added Calc. carb., Carb. veg., Fluor ac, 
Pulsat., Thuja. 

II. ATROPHY OF THE SKIN. 

Atrophy of the entire skin takes place in consequence of general maras- 
mus, either senilis or prsematurus, induced by exhausting diseases. 

A want of pigment throughout the whole skin is congenital to albinos or 
kakerlakes. A disappearance of pigment in single places of the skin, vitiligo 
or achroma, gives, especially to dark persons, a white-spotted appearance. 

An atrophy of the hair-follicles causes baldness, activities, or, as it happens 
mostly to aged persons, alopecia senilis. The falling out of the hair after se- 
vere illness depends merely upon a nutritive disturbance of the hair-follicles, 
not upon a wasting away of the same. Therefore the hair grows again as 
soon as these nutritive disturbances cease. 

A want of pigment in the hair makes it gray and white. 



III. HYPEREMIA AND ANJEMIA OF THE SKIN. 

A stagnation of blood in the cutaneous capillaries, in consequence of 
heart disease, causes cyanosis. 

Hyperemia, or congestion of the skin, characterized by redness of the 
skin, is caused by exposure to heat; by the application of different irritating 
substances, such as mustard, cantharides, mezereum, etc., by a blow or fall; 
by the different exanthematic diseases and fevers of different descriptions. 

~Ancemia of the skin, characterized by great paleness of the skin, is al- 
ways associated with a general ansemic state of the system; moreover, it is 
induced by exposure to cold, and is quite a characteristic sign of chills. 



IV. DERMATITIS, INFLAMMATION OF THE SKIN. 

1. Erythema. 

Erythema is characterized by a diffused redness of the skin, which, under 
the pressure of the finger, disappears, and leaves not a white, but a yellowish 
spot, which at once grows red again. It gradually disappears and is followed 
by desquamation; it is always attended with more or less burning pain. 
Erythema is caused by exposure to heat, the rays of the sun, and by different 
irritating substances. When it occurs in small children between the folds of 
the skin around the neck, behind the ears, between the thighs, etc., or in fat 
women under the dependent breasts, and becomes raw, it is called Intertrigo. 



ERYTHEMA. 1051 

It is found also between the buttocks, in consequence of friction from walking 
in hot weather. When erythema is the consequence of pressure from tying 
long in one position, as in severe illness upon the os sacrum, trochanters, or 
other prominent parts of the body, it is called Decubitus. So, also, do we 
observe erythema, in consequence of acrid discharges from the eyes, nose, 
bowels and genitals upon the adjacent parts. 

Besides all this there is an erythema, which, without any apparent cause, 
appears spontaneously upon the back of the hands and feet; in rare cases it 
spreads over the face and trunk, but never without, at the same time, showing 
itself upon the back of the hands and feet. It appears in these localities as 
an evenly diffused redness and swelling, which, after a short time, becomes 
covered with smaller, or larger, dark red, or even purplish-colored papula?, 
Erythema papulatuin seu tuberculosuin. It is always attended with 
an annoying burning pain, and in some cases with feverishness. After a few 
days the redness, swelling and papulae disappear, and the whole morbid 
process winds up with desquamation of the cuticle in the course of eight or 
fourteen days. In some cases it lasts longer, when repeated crops of papular 
eruptions follow eaeh other in succession and on different localities. 

The Erythema nodosum appears almost exclusively on the lower 
extremities of young persons. Upon the reddened skin lumps of the size 
of hazelnuts or walnuts appear, wmich are painful to the touch and have a 
great similarity to bruises, changing their color from red to purple, then to 
blue, and lastly to green and yellow. This form is always attended with 
feverishness and ends with desquamation after eight or fourteen days; only 
in rare cases new crops follow. 

THERAPEUTIC HINTS.— Intertrigo of infants between the thighs, 
when attended with acrid diarrhoea, compare Borax, Chamom., Lycop., 
Mercur., Rhus tox., Sulphur. 

When behind the ears: Graphit., Petrol., Sulphur. 

In general : Lycop. 

Erythema from exposure to the rays of the sun: Aeon., Camphora, 
Canthar. 

Decubitus: Arnica, Carb. veg., China, Fluor, ac, Sulph. ac, etc. Com- 
pare the corresponding chapters. 

Erythema from acrid discharges, compare the corresponding chapters. 

Papulous erythema, compare Aeon., Bellad., Laches., Mercur., Rhus tox., 
Sulphur. 

Erythema nodosum, compare Arnica, Laches., Ledum, Lycop., Mezer., 
Ptelea trif., Rhus yen., Sulph. ac, Sulphur. 



1052 DERMATITIS. 

2. Herpes. 

The different forms of herpes are characterized by an exudation, usually 
of a watery substance, beneath the epidermis, forming globular vesicles which 
are arranged in clusters upon an inflamed patch of the skin, and terminate 
frequently in the formation of a thin incrustation, without leaving scars. 

The Herpes facialis appears on the face ; when on the cheeks and 
upon the eyelids it is called Herpes phlyctaenoides, when upon the lips, 
Herpes labialis, or Hydroa feorilis (fever-blisters). This latter form is 
a frequent attendant upon croupous pneumonia, intermittent fevers and 
other febrile dieseases. It scarcely ever occurs in typhus. 

A special treatment is not required, but its presence may suggest Bryon., 
Graphit., Hepar, Natr. mur. (especially in intermittent fevers), Rhus 
tox., Sulphur. 

The Herpes praeputialis appears from preference on the prepuce, but 
also on the scrotum, penis and on the outer parts of the female organs. Its 
appearance in clusters of globular vesicles, which are soon covered with a 
thin crust, distinguishes it at once from chancre. 

Hepar or Mercur. are almost always sufficient for its removal, and in 
case of violent itching and burning in females, Calad. seguinum. 

The Herpes Zoster, or Zona, or Shingles, is characterized by its pe- 
culiar way of spreading along the course of certain cutaneous nerves. When 
it appears on the thorax, the cluster of vesicles occupy the space in which 
one of the spinal nerves takes its course, commenciug near one of the 
vertebrae and running around on one side of the trunk towards the 
sternum, thus forming a kind of belt around one-half of the thorax. When 
it appears on the neck, it forms not only a ring around one side of the 
neck, but appears likewise upon the trunk and the upper arm, corresponding 
to the course of the cervical nerves and the brachial plexus. In cases where 
it starts from the lower lumbar vertebrae, it spreads in a similar manner 
upon the thigh. Quite seldom is zoster found in the face, and then it occupies 
one-half of the face in the shape of a belt. Zoster is almost always preceded 
by rheumatic pains in the parts affected, by fever and debility. There is 
burning in the parts, then follows redness, upon which gradually clusters of 
vesicles appear, which often coalesce. In the course of four or six days they 
form into crusts. This terminates the attack, unless new and fresh crops of 
vesicles should break forth. The burning pain usually commences to leave 
when the eruption is fully out, and disappears entirely with the falling off of 
the crusts. Not unfrequently, however — and this is quite a peculiar feature 
of zoster — there is developed, after all seems well, an intercostal neuralgia, 
which is very painful and often quite obstinate. Sometimes the vesicles are 
converted into deep-seated pustules, leaving scars behind them ; or they be- 



HERPES. 1053 

come infiltrated with bloody serum. The duration of zoster is from 12, 14 
to 30 days, according to the degree of the inflammation and the geueral con- 
dition of the patient. 

THERAPEUTIC HINTS — Arsen., severe, burning pain, worse at 
night, and great restlessness. 

Canthar., on right side. 

Cistus, on back. 

Comocladia, on legs. 

Crot. tigl., itching and painful burning and redness of the skin; 
formation of vesicles and pustules; desiccation, desquamation and falling off 
of the pustules- — a close picture of zoster. 

Euphorb., burning in the face; inflamed cheeks, with boring, gnawing 
and digging from gums to ears, and itching and tingling in the cheeks. 

Graphit., especially on the left side. 

Iris vers., on right side, with following gastric derangement. 

Kalm. lat., facial neuralgia after zoster. 

Laches., in spring and fall. 

Mercur. is said by some to be a specific for relieving the burning, and 
preventing the appearance of new crops. Right side, extending across the 
abdomen. 

Mezer. is strongly recommended, and said to prevent and cure the 
succeeding neuralgia intercostalis. 

Pulsat., where there is gastric derangement; evening aggravation, and 
a mild, yielding, tearful disposition. 

Ranunc. bulb., preceding neuralgia intercostalis. 

Rhus tox., where there is fever, restlessness and burning-itching. 

Thuja, suppressed gonorrhoea; burning after scratching. 

Zincum, with lancinating pains; suppurating herpes. 

Herpes cireinnatllS (ringworm) is characterized by its circular form. 
The vesicles, usually much smaller than in other forms of herpes, appear in 
the form of a circle, the centre of which is fading, while on the periphery the 
vesicles are spreading. Sometimes, however, there is one larger vesicle, 
which not unfrequently is filled with a bloody fluid, right in the centre of 
the ring, and around the ring appears still another larger ring. This form 
is called Herpes iris, and is usually found upon the back of the hands or 
feet, on the fingers or toes, less frequently on the arms, thighs or face. Many 
forms of these eruptions are caused by vegetable parasites. 

THERAPEUTIC HINTS —Compare Calc. carb., Hydrant., Natr. 
carb., Natr. mur., Sepia, Tellur. "Chrysophanic acid, ringworm." (C. E. 
Fisher.) 



1054 DERMATITIS. 

3. Urticaria, Nettle-rash. 

This affection is characterized by prominent and perfectly smooth 
patches upon the skin, the color of which is either redder or whiter than 
the surrounding skin. They are formed by a serous infiltration of the 
papillary layer of the cutis. The causes of these eruptions are numerous. 
As such we may mention — 1. Various external irritations, such as contact 
with nettles, or with some kinds of caterpillars and mollusks; the sting of 
.fleas, bed-bugs, mosquitoes, bees; scratching with the finger-nails. 2. Intes- 
tinal irritations from eating strawberries, crabs, clams, mushrooms; from 
taking copaiva-balsam. 3. Uterine irritatio?is, during pregnancy; menstrua- 
tion; different uterine diseases, and after the introduction of pessaries. 

Entirely unknown are the causes of Urticaria febrilis, which is chiefly 
attended by digestive disturbances, and has in its course and progress great 
similarity to other exanthematic fevers. I have often observed that symp- 
toms which simulated croup, asthma or different other complaints, all at once 
disappeared as soon as nettle-rash made its appearance upon the skin. We 
also find it associated with chills and fever, and other febrile complaints. In 
some cases it assumes a chronic form, when it is quite difficult to get rid of it. 

THERAPEUTIC HINTS.— Anac, from emotional causes. 

Ant. crud., white lumps with red areolae and itching; thick, white- 
coated tongue ; gastric derangement. 

Apis, stinging, burning; croupy cough; uterine catarrh. 

Arsen., burning; chills and fever; alternating with croup and asthma. 

Bellad., during profuse menstruation; after eating cabbage or sour- 
kraut. 

Berber., heartburn, with soap-sud taste in mouth. 

Bryon., fever and rheumatic pains, worse from motion. 

Calc. carb., fat, plump children; teething period; chronic form; rash 
disappears in the fresh air. 

Dulcam., itching; after scratching, burning; after taking cold; grip- 
ing pain in the bowels, with nausea and diarrhoea. 

Hepar, chronic cases; eruption on hands and fingers, during intermit- 
tent fever; disguised croup. 

Ignat., during the chilly stage of intermittent fevers. 

Kali carb., during menstruation; swelling of parotid glands. 

Lycop., chronic cases. 

Pulsat., during delayed and scanty menses; rheumatic tendency. 

Psorin., after suppressed itch, frequently repeated attacks of urticaria, 
with fine vesicles on the top, which dry and peel off in fine scales ; appearing 
regularly after any exertion. 



ECZEMA. 1055 

Rhus tox., itching, burning; skin swollen and red; after getting wet; 
worse in the cold air ; rheumatic pains, worse during rest ; fever ; thirst. 

Sepia, chronic; breaks out during a walk in the cold air and disap- 
pears again in the warm room; especially on the face, arms and thorax; 
uterine troubles. 

Sulphur., chronic cases; worm symptoms; rheumatism; frequently 
indicated after Pulsat. 

Urtica urens, without any concomitant symptoms. 

Ustil., itching at night; ovarian irritation, with menstrual irregu- 
larities. 

4. Eczema, Vesicular Eruption. 

Eczema consists of a diffuse, superficial dermatitis, which causes numer- 
ous little vesicles upon an inflamed, irregular surface; sometimes these ves- 
icles are intermingled with pustules (impetigo), at other times the exudation 
may not be abundant enough to raise the epidermis into vesicles, but only 
loosens it, so that it dies off and forms a scaly surface ; or the epidermis is 
actually thrown off, leaving a raw, moist surface behind (intertrigo), which, 
in some cases, becomes covered with a thin scurf, in others with a thick crust. 

Its Causes are — 1. Direct irritation of the skin by too high a tempera- 
ture (bakers itch); hot baths; the application of wet bandages; the rubbing 
in of mercurial salve or croton oil; and by various other irritating sub- 
stances. 

2. Stagnation of the venous blood within the capillaries. As this takes 
place most frequently on the lower extremities, we find the consecutive 
eczema there also, in the form of salt rheum. 

3. A dyscratic diathesis of scrofulous or rachitic individuals; in over- 
fed, plump children. 

4. In many cases we cannot trace it to any cause. 

It chooses as favorite localities: the scalp, where it is called tinea fur- 
furacea, if it causes merely a separation of the epidermis in fine scales; or 
tinea amiantacea, if the dried exudate and the loosened epidermis form a 
kind of asbest-like layer upon the inflamed surface. Such peeling-off pro- 
cesses are known under the name of dandruff. But it may also form thick 
crusts, matting the hair together (tinea capitis). 

When the eruption commences with vesicles and violent itching: Rhus 
tox., Merc, sol., Lycop., Arsen., Crot. tigl. 

When attended with swelling of the glands of neok and nape of neck: 
Bar. carb., Sulphur, Calc. carb., Conium. 

In rachitic individuals: Silic, Sulphur. 



1056 DERMATITIS. 

When forming out of nodes and pustules with thick crusts: Hepar, 
Calc. carb., Graphit. 

In scrofulous subjects: Bar. carb., Calc. carb., Sulphur, Silic, 
Phosphor. (Kafka.) 

The face. Here it occurs in all forms and has received many different 
names : eczema impetiginosum, when intermingled with pustules ; and rubrum, 
when growing upon an inflamed, red surface; porrigo larvalis, when forming 
thick crusts; tinea faciei, crusta lactea, when appearing during lactation; 
crusta serpiginosa, etc. 

The genital organs, in males the penis and scrotum, and in females the 
labia majora. It is either acute or chronic; the latter especially when on the 
scrotum. By its terrible itching it drives one almost to madness. It may 
appear also upon the perineum and around the anus. 

The inner side of the thigh, just where the scrotum touches it. This is 
called eczema marginatum, and has been observed especially in shoemakers 
and cavalry-men. It commences on the inner side of the thighs, just where 
the scrotum touches it, but soon appears also on the corresponding place of 
the other thigh. 

The legs. Here it forms a large, red, raw, constantly secreting surface, 
sometimes ulcers covered with thick crusts. This is called salt rheum. 
When the ulcers heal, the skin appears thickened and is usually of a darker 
color from alteration of the pigment. 

The bends of the extremities. The scanty exudate generally dries with 
the loosened epidermis, and forms a brittle covering which, on motion of the 
limbs, cracks in different directions. Sometimes the secretion is more pro- 
fuse, and keeps the affected parts constantly moist. 

Hands and feet. It is a peculiar fact, that the hands and feet are at- 
tacked almost always simultaneously. When it appears on the dorsal side, 
it generally assumes the form of simple eczema or vesicles, and may be con- 
founded with itch. On the palms of the hands or soles of the feet it scarcely 
ever occasions vesicles, but causes the epidermis to peel off in the form of 
white scales, for which reason it has been called psoriasis or pityriasis palma- 
ris or plantaris. It is also found on the external ears, on the eyelids, on the 
trunk, on the nipples of nursing women ("sore nipples"), on the navel, in 
the axillse, in the inguinal region of children, between the toes in conse- 
quence of sweating. The progress of the disease is seldom acute ; all forms 
are characterized by great itching ; scratching is apt to spread the affection 
further. 

THERAPEUTIC HINTS —In selecting the remedy for such affec- 
tions, the constitutional symptoms must never be lost sight of. I can give 



ECZEMA. 1057 

hints only to local symptoms, as the other would lead too far, and still could 
not meet all the possible complications. 

Eczema on the scalp, compare: 

Arsen., generally dry, scaly eruption, sometimes fetid, purulent secre- 
tion, with nightly burning or terrible itching; better from external warmth. 

Bar. carb., moist crusts, with falling off of the hair; glandular 
swelliugs on the neck and under the lower jaw. 

Calc. carb., thick crust, moist or dry, with scrofulous diathesis. 

Chrysoph. ac, especially for the squamous variety. (C. E. Fisher.) 

Clemat., the eruption inflames during the increasing, and dries up 
during the decreasing moon. 

Cicuta, with itching, or burning, or both; the secretion from the vesi- 
cles forms a yellow, thick crust, which mats together. Also on chin. (C. 
"Wesselhoeft.) 

Graphit., impetiginous eruption; soreness after scratching; worse on 
left side, and in the evening ; sticky secretion. 

Hepar, purulent secretion, itching and sore; worse in the morning, 
and on the right side; unhealthy skin, even slight wounds suppurate. 

Lycop., thick crusts, with fetid secretion underneath; bleeds easily 
after scratching. 

Mercur., yellow crusts, stinging, burning; the surroundings inflame 
easily after scratching. 

Natr. mur., raw, inflamed surface, continually dischargiug a corroding 
fluid, which eats away the hair ; on the boundaries of the hair. 

Rhus tox., thick, moist crusts; tingling, stinging, burning, especially 
at night. 

Staphis., yellow, acrid moisture oozes from under the crusts; upon 
the denuded surface new vesicles form at once which burst. By scratching 
one place the itching ceases, but appears in another place. 

Sulphur, crusts and pimples itch spontaneously, especially at night; 
bleed easily. 

Besides, compare Anacard., Ant. crud., Borax, Bromium, Cicuta, 
Cyclam., Dulcam., Kali bichr., Lappa, Nitr. ac, Oleander, Phosphor., 
Sepia, Silic, Thuja, Viola trie. 

Eczema on the face, compare Arsen., Bellad., Borax, Calc. carb., Clemat., 
Cicuta, Crot. tigl., Cylam., Dulcam., Graphit., Hepar, Iri<, Lycop., Mercur., 
Mezer., Natr. mur., Rhus tux., Sarsap., Sepia, Staphis., Sulphur, Viola trip. 

Eczema on the genital organs, compare Arg. nitr., Arsen., Calad., Crot. 
tigl., Graphit., Hepar, Lycop., Xatr. mur., Nitr. ac, Petrol., Rhus tox., 
Sepia, Sulphur, Thuja. 

Eczema marginatum, compare Natr. mur., Sepia, Sulphur. 

Eczema on the legs, salt rheum. As this affection is the result of stagna- 
67 



1058 DERMATITIS. 

tion in the venous circulation, it will be a great service to bandage the limbs 
tightly. Among the remedies compare Arsen., Calc. carb., Carb.' veg., 
Graphit., Laches., Lycop., Mercur., Natr. mur., Pulsat., Rhus tox., Sarsap., 
Sepia, Silic, Sulphur. 

Eczema in the bends of the extremities, compare Amm. carb., Bryon., 
Calc. carb., Graphit., Ledum, Mercur., Sepia, Sulphur. 

Psoriasis, or pityriasis palmarum, or plantaris point to Magn. carb., 
Ran. bulb., Rhus tox., Sepia, Sulphur. 

5. Impetigo, Pustular Eruption. 

It differs from eczema only by its pyogenic tendency. As, however, the 
contents of eczema vesicles frequently become milky and purulent, no dis- 
tinct line of demarcation can be drawn between these two skin affections. 
In fact, many of the eruptions cited under eczema of the scalp and face may, 
with equal propriety, be classed under impetigo. Its causes are the same as 
those of eczema. In addition, we find this form especially in scrofulous sub- 
jects, in whom there is a great vulnerability of the skin, so that any little 
irritation or wound of the skin at once begins to fester. We also find it 
sometimes after vaccination sprouting forth over the body. 

Impetigo contagiosa. — The eruption is attended with fever; a part 
of the skin reddens, burns and itches, and now little vesi co-pustules appear, 
which in five or six days reach the size of a split pea or a hazelnut ; they 
are generally umbilicated, and form after a while yellowish, straw-colored 
crusts, which look as if stuck on. The eruption may remain confined to the 
forehead and cheeks, but frequently extends further. The scratching with 
the nails is especially apt to spread the affection, and it may, in this manner, 
be transmitted to other persons. 

THERAPEUTIC HINTS— All that has been said under eczema is 
applicable here. All the constitutional symptoms must be considered. If 
Hebra and his echoes assert that it be pure imagination of an erroneous idea 
of the natural processes in the human body to suppose that eczema, if cured 
by external means (id est, by being suppressed by green soap, Kali causti- 
cum, Tar, etc.), could ever do any harm, we leave them to grow wiser by 
closer observation, and stick to old Hahnemann and our own experience. 
There is no distinct line of demarcation between eczema and impetigo. The 
latter is admitted by Hebra himself to be in connection with a scrofulous 
diathesis; why not the eczema? If the one be the expression of a general 
contamination of the system, why not the other ? But it is so much easier to 
cut off the fruit of a tree than to root out the tree itself. 



PEMPHIGUS. 1059 

For Impetigo contagiosa, Dr. Kippax in his hand-book of skin 
diseases gives the following hints : 

Ant. crud., is the main remedy. 

Aeon., if there is much febrile disturbance. 

Euphorb., when there is an irritable skin, with swelling of the face 
and pea-sized yellow vesicles. 

Kali bichr., stands next to Ant. crud. 

Tart, emet., when the disease is exceedingly pustular. 

Thuja, after vaccination. 

Silic. and Kali nitr., are at times indicated. 

6. Ecthyma, Isolated, Large Pustules. 

Upon a red and swollen surface single pustules appear, of the size of a 
pea, which contain a yellow, purulent, or dark-colored fluid, if there be blood 
mixed with it. They are surrounded by a red areola, and appear most fre- 
quently upon the extremities, on the seat, on the chest, and on the neck, less 
often on the face. Ecthyma is almost always attended with stinging pains, 
and in irritable persons with slight fever. In the course of a few days the 
pustules dry up and form round, brownish crusts which, when being re- 
moved, leave more or less extensive excoriations, resulting in temporary 
scars and pigmentation. In chronic cases the disease is protracted by suc- 
cessive crops of pustules for a long time. 

We meet it at any time of life, and especially in consequence of pro- 
tracted diseases, poor living and cachectic conditions. 

THERAPEUTIC HINTS— Compare Ant. crud., Arsen., Calc. carb., 
Cicuta, Cy claim, Kali bichr., Laches., Lycop., Merc, sol., Nitr. ac, Piper 
nigr., Secale, Silic, Sulphur, Tart. emet. 

The general constitutional symptoms must never be lost sight of. 

7. Pemphigus, Pompholyx, Isolated Large Bullae or 

Blisters. 

Upon a red, inflamed, but net infiltrated surface, pretty large blisters 
appear, which are filled with clear serum and greatly resemble those occa- 
sioned by burns or fly-blisters. About their causes nothing is known, except 
that if they occur in newborn children they are of syphilitic origin, and in 
grown persons they are symptoms of some general dyscrasia or cachexia. 

The acute form of this affection is extremely rare. It is always attended 
with prettv high fever and general indisposition, and lasts about fourteen 
days. Renewed outbreaks may prolong it much longer. The chronic form 



1060 DERMATITIS. 

of pemphigus, which may grow out of an acute attack, lasts months and even 
years. One crop after another appears upon the skin, showiug the bullse in 
all the phases of their development ; the youngest are transparent, the older 
have a milky appearance ; they burst and leave an excoriated surface. This 
raw surface still continues to secrete serum, and is finally covered with a 
thin crust. The worst form is Pemphigus foliaceilS. It begins with a 
single blister, which is continually increasing, until the whole surface of the 
body is literally skinned and then covered by a brownish crust. It often 
takes a fatal termination. 

THERAPEUTIC HINTS. — Compare Arsen., Bellad., Canthar., 
Caustic, China, Dulcam., Kreos., Laches., Mercur., Phosphor., Ran. 
bulb., Rhus tox., Sepia, Sulphur, Thuja. 

8. Rupia or Rhypia, Isolated Blisters, which form thick 

Crusts. 

The bullae contain a purulent, reddish matter, which gradually dries 
and forms a thick dark crust. Underneath this crust matter continues to 
form, which again dries and consequently raises the centre of the crust, 
while on the periphery it becomes encircled by a vesicated border, which 
also dries up into a crust. And as this latter is much thinner than the first, 
which has been successively heaped up, the whole assumes a great similarity 
to an oyster-shell. On removing the crust we find a deep, foul, excoriating 
ulcer. Rupia is a late and malignant manifestation of syphilis. 

THERAPEUTIC HINTS.— Compare Syphilis. Berjeau gives the 
following hints: 

Clemat., growing worse during the increasing moon; discharge of a 
sanious pus, yellow and corrosive ; burning and tingling in the ulcer ; itch- 
ing worse at night in bed. 

Mercur., violent itching, worse in bed ; ulcerating pimples ; desquama- 
tion of the skin ; excoriations of a tettery nature, which are oozing constantly 
and bleed easily when scratched. 

Nitr. ac, after mercury; copper-colored spots; watery, bloody se- 
cretion. 

Sarsap., also after the abuse of mercury; purulent vesicles, itching; 
depression of spirits. Especially in the spring. 

Sulphur, scabious eruptions with burning, itching, surrounded by a 
yellow or brownish areola ; secretion of a sanious, fetid or thick and yellow 
pus ; spots covered with small vesicles, discharging serous lymph. 



CARBUNCULUS. 1061 

Thuja, brown or red mottled spots, with itching shootings in the even' 
ing; purulent pimples, containing fluid-like varnish. 

9. Furunculus, Boil. 

A furuncle commences as an inflammation of one or several closely- 
grouped cutaneous glands, or hair-follicles, which become infiltrated. By- 
and-by the inflammation spreads to the surrounding cellular tissue, and 
through the entire skin, suppuration takes place, and, accompanied by acute 
pains, and at times fever, the boil breaks and discharges a bloody matter ; 
the core (which consists of destroyed cellular tissue), however, is not dis- 
charged until all of it has been loosened from its surroundings. Large boils 
generally occur singly; small ones, so-called blind boils, which discharge 
very little, or nothing at all, frequently appear in crops, or in rapid suc- 
cession, and may torture a patient for a considerable length of time. Their 
exact cause is unknown, but they seem to depend upon some depraved state 
of the blood in the general system, they frequently appear during the recon- 
valescence from severe illness, and at times as epidemics. 

THERAPEUTIC HINTS— Never use the lancet nor allow it to be 
used, because it never does any good, but always harm, as.it increases the 
inflammation and protracts the healing process. 

For large boils, compare Apis, Crotal., Hepar, Laches., Lycop., Mercur., 
Nitr. ac, Silic, Stramon. 

For small ones: Arnica, Bellad., Nux vom., Sulphur. 

For a disposition to boils: Arsen., Calc. carb., Lycop., Nux vom., Phosph. 
ac, Plumbum, Silic. and Sulphur. 

10. Carbunculus, Carbuncle. 

The carbuncle is a phlegmonous dermatitis, and commences with severe 
pains in the part affected, which are mostly of a burning character, and con- 
tinue to be so through the whole course. The painful spot commences to 
swell, to harden, to discolor; it generally assumes a purplish hue. After five 
or six days numerous little holes form in the swollen and discolored place, 
from which a yellowish mattery substance projects. The swelling and hard- 
ness still continue to increase in circumference. Only a little pus is dis- 
charged from the small holes. They, however, gradually widen and coalesce, 
until by degrees a considerable portion of the cutis is entirely destroyed ; or 
the epidermis is raised in the form of a gangrenous blister, which finally 
breaks. We now observe the necrosed cellular tissue underneath ; the pus 
discharges more copiously, and with it large pieces of destroyed tissue slough 



1062 DERMATITIS. 

off. The loss of substance sometimes amounts to several square inches. This 
process is always attended with considerable fever, and is quite apt to assume 
an adynamic character. When complicated with cerebral symptoms, which 
are the consequence of the absorption of the pus by the blood, it may ter- 
minate fatally. In favorable cases new granulations appear at the bottom 
of the wound, and by a slow healing process the whole lost substance is finally 
restored. 

Carbuncle differs entirely from furuncle. It is of a much more destruc- 
tive character, appears principally on the nape of the neck, or along the 
spine, on the forehead, or buttocks, and chiefly attacks aged persons, while 
furuncle is never associated with gangrenous destruction of substance, it 
appears here and there and everywhere, and attacks all ages alike. 

THERAPEUTIC HINTS.— No knife. But compare: 

Anthrac, when the burning pain is violent and not relieved by Arsen. ; 
cerebral symptoms ; absorption of pus by the blood ; gangrenous destruction. 
A carbuncle on the back of a man, some sixty years of age, had attained 
the size of nine inches in length, and five inches in its greatest width. There 
was sloughing, abundant discharge of ichorous, terribly smelling pus, and 
poisoning of the blood by absorption of pus. Arsen. had no beneficial effect ; 
Anthrac. relieved at once. Ever since then I have given Anthrac. in several 
cases, where there were symptoms of the same destructive character, with 
the same beneficial result. 

Apis, when the erysipelatous inflammation extends further and further. 

Arsen., great burning; great restlessness; great thirst, drinking but 
little at a time ; great debility ; all the symptoms are worse in the night, and 
better from external warm applications. 

Bellad., bright redness; throbbing pain; drowsiness, with inability to 
go to sleep. 

Bufo, at the commencement very efficient. 

Carb. veg., dark, blackish appearance; fetid odor; hippocratic face; 
blood poisoning. 

Hepar. 

Kreosot. 

Laches., bluish, purplish appearance; inability to bear any bandage 
around the neck; cerebral symptoms. 

Nitr. ac. 

Rhus tox., great restlessness; feels somewhat relieved of the violent 
pain as long as he is in motion. 

Secale, cannot bear external warmth. 

Silic, during the process of ulceration; it seems to clear the wound of 
its decayed masses, and to promote healthy granulation. 

Tarant. cub. 



PUSTULA MALIGNA. 1063 

11. Pustula Maligna, Malignant Pustule, 

Also called Carbimculus COlltagiosilS, is characterized by the appearance 
of an angry-looking pustule, associated with gangrenous destruction of the 
surrounding parts which owes its origin either to a direct inoculation of the 
poison from an animal affected with the disease called Anthrax, Milzbrand 
or Charbon, or to a transmission of the poison by flies, or to inoculation of 
the poison from man to man, or to the eating of the flesh ©f diseased animals. 
It is therefore most frequently found among persons who have to do with 
diseased animals, or who work in manufacturing establishments, where the 
products of such animals (hides, horsehair, wool) are prepared for different 
uses. The infection takes place principally on the uncovered parts of the 
body which are exposed to the entrance of the poison. The eating of diseased 
flesh first causes general malaise and intestinal troubles, after which, in about 
eight or ten days, anthrax carbuncles appear, by preference on the arm, 
forearm and head. 

After an incubation of from a few hours to several days, there is at first 
felt on the spot where the poison took hold, a slight burning and itching, as 
if from the bite of an insect, and one can see a little red speck with a black 
point in its centre. This soon becomes changed into an itching papule, 
capped with a small, generally reddish or bluish vesicle, which gradually 
enlarges. After bursting;; it discloses a dark red base, which becomes covered 
with a crust, while often, though not always, secondary vesicles spring up 
around it, which contain a yellowish, reddish or blackish fluid. At the same 
time the surrounding parts swell oedematously over a considerable area, the 
cellular tissue underneath also becomes infiltrated, and in many cases dis- 
colored lines mark the course of the veins, or red stripes the course of the 
lymphatic vessels in the cedematous region; the corresponding lymphatic 
glands also swell. The general symptoms correspond with the severity of 
the local affection; there is fever, great weakness, delirium, excitement, con- 
fusion; sweating, diarrhoea and pain in the extremities; in fatal cases col- 
lapse; in favorable cases after the dead masses have been removed by slough- 
ing off, the wound gradually heals by healthy granulation. 

THERAPEUTIC HINTS.— Laches., bluish color of the pustule 
and red streaks along the lymphatic vessels. (Dunham.) 

Anthrac, blood poisoning. 

Malandrinum, blackish diarrhocea; pain in back and limbs; pustule 
similar to a badly-looking vaccine-pustule. (K. Straube.) 

Compare Carbuncle. 



1064 DERMATITIS. 

12. Epithelioma, Epithelial Cancer. 

It usually begins as a little tubercle, or flat infiltration, which sooner or 
later cracks and ulcerates, forming a roundish sore with indurated edges, and 
a thin scanty secretion, that sometimes covers the ulcer with a brownish or 
yellowish crust. At an. advanced stage the edges become undermined and 
bleed easily, the base assumes a dirty or grayish, more or less papillated 
aspect, secreting an offensive, pale, yellowish, viscid fluid. At other times 
the epithelioma develops in the form of warts or cauliflower excrescences of 
various sizes, which ultimately break down and form irregularly shaped ul- 
cerating excavations which bleed easily. The first or roundish form infects 
by preference the lower lip ; if occurring on the upper two-thirds of the face, 
it constitutes the rodent ulcer of English writers, and when originating on 
the scrotum, it is termed Chimney sweeper's cancer. It is, however, also 
found on the tongue and mucous membrane of the cheeks, and may appear 
on any part of the body. T^he second form, of cauliflower appearance, attacks 
by preference the vulva, clitoris, penis and rectum, and might be mistaken 
for a syphilitic affection if it were not for the history of the case. 

The course of epithelial cancer is sometimes slow, sometimes rapid. It 
sooner or later involves the lymphatic glands, is attended by sharp, lancinat- 
ing pains, and if left alone destroys life, by exhaustion, in from two to five 
years. 

THERAPEUTIC HINTS.— The main remedies seem to be: Arsen., 
Calc. oxal., Hydrast., PhytoL, Sepia and Thuja. An external application 
of the well-chosen remedy at the same time will often be of great service. 

13. Panaritium, Paronychia, Whitlow, Run- Around, Felon. 

It is an inflammation of the thumb or of one of the fingers, which ter- 
minates in suppuration. There are two distinct varieties of this inflamma- 
tion, a superficial and a deep-seated one. 

The superficial form, Whitlow, Rllll-Aroimd, is generally seated im- 
mediately around and beneath the nail, commencing either at the side of the 
finger, upon its dorsal surface, or at its extremity. Without much, if any 
swelling, the part is of a dusky reddish aspect, tender on pressure, and ex- 
quisitely painful, throbbing violently and incessantly, and causing more or 
less constitutional disorder. Two or three days after these phenomena pre- 
sent themselves, matter is observed beneath the epidermis, which is elevated 
into a yellowish vesicle at the side and root of the nail. In many cases pus 
is also situated beneath the nail, especially at its posterior extremity; and 
sometimes, again, it is found chiefly, if not exclusively, in the cellular sub- 



PANARITIUM, PARONYCHIA, WHITLOW. 1065 

stance, immediately beneath the true skin. The inflammation generally ex- 
tends some distance up the finger, and occasionally even over a considerable 
portion of the hand, which may be considerably swollen, stiff and painful. 
Not unfrequently a reddish line, indicating the course of an absorbent vessel, 
is seen running along the limb, as high up, perhaps, as the axilla. 

In the deep-seated variety, Felon, the inflammation involves all, or 
nearly all, the structures of the finger, and is frequently followed by the 
destruction of one or more of the phalanges. The pain is of extraordinary 
severity, depriving the patient of sleep for days and nights together, throb- 
bing, tensive and diffused, often extending as high as the elbow, and even to 
the shoulder, steady and persistent, but greatly aggravated by a depending 
position, and only subsiding with evacuation of the inflammatory deposits, 
or the death of the parts. The swelling also is great, sometimes enormous, 
involving both finger, hand and wrist ; the skin is red and cedematous, puffy* 
erysipelatous in aspect/and the whole limb is often stiff and useless. In con- 
sequence of the inflammatory action, -pus forms deep among the tissues, in 
the connecting cellular substance, within the sheaths of the tendons, and 
beneath the periosteum, and spreading in all directions, causes extensive 
destruction, burrowing along the finger and hand. In neglected cases even 
gangrene may occur, followed by sloughing of the tendons, and exfoliation 
of the phalanges. This grave form is always attended with well-marked 
constitutional disturbance. The patient, tortured with pain, is feverish and 
unable to sleep; his appetite is lost; his head, back and limbs ache; the face 
is flushed, and the pulse is strong, hard and frequent. In some cases delirium 
is present. (Gross.) Causes unknown; no doubt of a psoric nature. 

THERAPEUTIC HINTS.— Amm. carb. I have seen the nightly 
pain which had deprived the patient of sleep for several nights, relieved in 
a few hours, and the morbid process stayed at the same time by one or two 
doses of Amm. carb. 500 

Anthrac, where there is sloughing, with terrible burning, and when 
Arsen. gives no relief. 

Apis, according to Wolf, specific especially after the abuse of Sulphur; 
the characteristic pain is burning-stinging. 

Arsen., when the sore assumes a gangrenous aspect; burning like fire, 
with anxious restlessness; worse about midnight. 

Bryon., in the commencement, where there is a gastric-rheumatic dis- 
position ; white or yellowish-coated tongue; dry feeling in the mouth, with- 
out thirst, or great thirst; bitter taste in the mouth; dry, hard stool, as if 
burnt. 

Caustic, recommended by Goullon, to be used externally and in- 
ternally. 



1066 DERMATITIS. 

Graphit., according to Kreussler, superficial inflammation about the 
root of the nail, with burning and throbbing pain, and subsequent inflamma- 
tion and proud flesh. 

Hepar, violent throbbing, "gathering" pain; it accelerates suppura- 
tion. The hand is kept wrapped up, because it ameliorates the pain. 

Iris vers., "an early application either in tincture, or the whole fresh 
plant bruised and bound on the part, will, in many cases, completely abort 
the felon." (Gilchrist.) 

Juncus eff., recommended by Minnichreiter, who applied the pith of 
this plant upon the panaritium with the greatest success. 

Laches., according to Hering, in severe cases, where the inflamed por- 
tion assumes a purplish hue, or becomes gangrenous. 

Ledum, when the whitlow is the consequence of the prick of a needle, 
a splinter, etc. 

Lycop., when there are the following constitutional disturbances: fre- 
quent belching, bloatedness of the region of the stomach and belly; pressure 
and heaviness, and sometimes throbbing in the precordial region ; burning 
in the stomach and oesophagus; nausea; sensation of twisting, crawling and 
emptiness in the stomach, accompanied by frequent yawning; congestion to 
the head; cold feet; dry stool; red, burning urine; mental irritability. 

Maland., suppuration of all the finger and toe-nails. (Straube.) 

Mercur., when the inflammation extends to the sheaths of the tendons 
and ligaments of the joints, and in superficial whitlows. "The pain is re- 
lieved when the finger is exposed to the air." (Gilchrist.) 

Natr. sulph., suppuration at the root of the nail, with deep red swell- 
ing of the whole phalanx, and great painfulness; the patient looks sickly 
and pale; feels weary and dull in the head, especially in the morning; has 
no appetite, and is chilly and feverish in the evening ; the pain is easier out- 
of-doors than in-doors. Prominent causes : damp region, damp walls, damp 
cellars. 

Nitr. ac, "the hand is carried wrapped up, but the finger exposed, 
from a sensation as if a splinter or a piece of glass were in the part, which 
the friction of the wrappings aggravates." (Gilchrist.) 

Rhus tox., where there are rheumatic pains in the limbs; worse during 
rest and on beginning to move; sensation in the limbs as of going to sleep, 
and formication ; tired feeling and sweating from any little exertion; erysipe- 
latous redness of the inflamed part. 

Sanguin, suppuration of the roots of all the finger-nails. 

Silic, deep-seated inflammation; affection of the bone; proud flesh; 
terrible pain ; worse in bed ; very important after Hepar. 

Stramon., is most important when the pain is almost unbearable, driv- 
ing to despair. It ameliorates it at once, and hastens benign suppuration. 



PSORIASIS. 1067 

Sulphur, according to Wolf, when Apis is not sufficient on account of 
latent psora. 

14. Psoriasis. 

It consists of a chronic dermatitis, with infiltration of the corium and 
a morbid condition of the epidermis. The effusion upon the corium is not 
abundant enough to raise the epidermis into vesicles. It causes a mere 
hyperemia of the skin, in consequence of which the papillary layer produces 
a sickly epidermis, which soon loosens and drops off in scales. Its causes are 
quite obscure. In some families it is hereditary. Quite young children and 
quite old persons are seldom attacked by it. This affection commences in 
small, red, somewhat elevated, roundish spots, like drops, which are soon 
covered with dry, oblong, white scales — Psoriasis guttata. When the spots 
increase in number, they necessarily coalesce as they grow, and form large 
irregular surfaces, which are covered with scales of various thickness and 
adhesiveness — Psoriasis diffusa of Willan. They sometimes accumulate 
in round patches. While on the periphery new spots still appear, those in 
the centre dry up, and this gives rise to a circular eruption — Psoriasis 
aillllllata (ringworms). Or, several of such circles meet, their peripheric 
lines are broken off by already healed up centres, and now they form various 
figures, parts of circles, straight lines, etc. — Psoriasis gyrata. In some 
cases this morbid process continues for a long time, and causes the skin to 
become thickened, rigid and cracked. This takes place especially in the dif- 
fuse and irregular forms ; then it is called Psoriasis iuveterata. These 
different names are not to be understood as indicating different varieties, but 
forms and stages of the same cutaneous affection. The favorite places for 
psoriasis are the extensor sides of the extremities, especially the knee and 
elbow. In many cases the disease is confined to these localities. Frequently it 
appears symmetrically on both sides of the body, similar to eczema. Some- 
times it is found on the eyelids, lips, prepuce, scrotum and labia majora. 
The so-called Psoriasis palmaris and plantaris, by which the redness and 
infiltrated surfaces of the palms of the hands and of the soles of the feet are 
covered with dry scales, belongs to eczema, and its circumscript form is 
always of syphilitic origin. 

THERAPEUTIC HINTS.— Compare Arsen., Calc. carb., Clemat, 
Corall., Cuprum, Fluor, ac, Hydroc, Ipec. (F. Frederick), Iris vers., Mercur., 
Nitr. ac, Petrol., Phosphor., Phosph. ac, Phytol., Psorin., Selen., Sepia, 
Silic, Sulphur, Tellur. 



1068 DERMATITIS. 



15. Lichen. 



One form, Lichen simplex, consists of little red papules, of the size of 
a millet seed, usually appearing on the outer parts of the forearm, sometimes 
on the back of the hands, on the neck and thigh. They appear mostly in 
summer time and are accompanied by itching. 

The other form, Lichen planus, consists of dull red, flat-topped papules 
of the size of a millet seed, at first of a shiny appearance, but later covered 
with thin scales; their centre presents an umbilicated depression, the opening 
of a hair- follicle, and after their disappearance they leave at times a darkish 
stain or a little pit. They appear singly and in groups, and are found espe- 
cially on the forearms, wrists, thighs, abdomen and legs, below the knees. 
The Lichen ruber of Hebra is commonly associated with marasmus. 

THERAPEUTIC HINTS. 

For Lichen simplex Kippax recommends: Alum., Amm. mur., Anan- 
ther., Ant. crud., Arsen., Bellad., Bovista, Bryon., Castanea vesca, Calad., 
Iod. of sulphur, Kreos., Ledum, Mercur., Nabulus serp., Natr. carb., Nux 
jugl., Plant, maj., PhytoL, Rumex, Sepia, Sulphur, Tilia. 

For Lichen planus: Ant. crud., Agar., Arsen., Chin, ars., Iodium, 
Iod. of Sulphur, Kali bichr., Ledum, Nuxjugl., Potass, iod., Sarsap., 
Staphis. 

16. Prurigo, Pruritus. 

Instead of conical pimples, as found in lichen, prurigo exhibits flat 
papules, which have the same color as the surrounding skin. When broken 
they discharge a small drop of a clear fluid, and are attended with an in- 
tolerable itching. Want of personal cleanliness, of the proper change of 
clothing, and poor and unwholesome food are probably its most frequent 
causes. Hebra asserts that it is found only in the poorer classes of the people. 
With the exception of the first years of childhood it is found in all ages, and 
more frequently in men than in women. The flat papules, which at first 
appear singly, and which may even be difficult to detect by sight, as they do 
not differ in color from the surrounding skin, cause a most terrible itching, 
which incites the person to scratch. Hereby the papules become denuded of 
their epidermis ; they bleed, and the exuding blood forms dark crusts upon 
the scratched localities. Thus, it closely resembles in appearance the torn 
surface from scratching, in consequence of itch or lice. Prurigo, however, 
has favorite localities, differing from either itch or lice. While the acarus 
prefers to locate between the fingers, in the bends of the limbs, and on the 
belly, and lice take their abode in preference where the shirt lies in folds, on 



SCABIES, ITCH. 1069 

the neck, around the waist, etc., prurigo is found principally on the extensor 
sides, especially of the lower limbs and on the back; a feature decidedly dis- 
tinguishing prurigo from itch. The finding of the acarus or of lice would 
settle the question. But even then there might be a complication between 
prurigo and itch. The spotted appearance of the skin is nothing but the 
necessary consequence of the violent and continued scratching. The skin 
being continually torn, simple crusts not only form, but the surface com- 
mences to fester and to cicatrize. 

Milder cases of prurigo, where the disease is confined to the lower ex- 
tremities, are called prurigo mitis; graver cases are called prurigo formicans. 
Those which are confined to the anus, penis, scrotum or vulva, prurigo pu- 
dendorum, are related to eczema. 

The disease has its remission during spring and summer and its exacer- 
bations during fall and winter. 

The effects of prurigo upon the general organism grow the more appar- 
ent the longer the disease lasts. The constant unbearable itching, which 
destroys all comfort, rest and sleep, wears the patient out, and has led some 
to utter despair and suicide. There is also combined with this disease a re- 
markable tendency to rapid serous exudations into the serous membranes of 
the brain and lungs, a tendency to aberrations of the mind and to tuber- 
culosis. 

PriiritllS is a hyperesthesia of the cutaneous nerves, frequently a reflex 
symptom, without any eruption, or an itching of the skin in consequence of 
some foreign material, like bile, coursing in the blood and irritating the cu- 
taneous nerves, as in jaundice. 

THEKAPELTIC HINTS— Arsen., Calc. carb., Carb. veg., Dolichos 
prur., Graphit., Iodium, Lycop., Mercur., Mezer., Nitr. ac, Kumex crisp, 
(the itching is made worse by cold and better by warmth — H. Bernard- 
Hardenpont), Sepia, Sulphur. 

The pruritus of pregnant women has been relieved by the smoking of a 
cigar. 

17. Scabies, Itch. 

Itch, namely, acarus-itch, is a dermatitis, which is caused by a parasite, 
called acarus scabiei seu sarcoptes hominis. This insect burrows itself into 
the skin in order to find shelter and to deposit its eggs. This causes the in- 
flammation, which produces papules, vesicles and pustules. It is always 
attended with great itching, especially at night, when these animals are the 
liveliest, leave their holes and pay each other visits. One pregnant female 
acarus, if it be transplanted to another person, is sufficient to invest this 



1070 DERMATITIS. 

person with the itch. Her eggs ripen in about eight or ten days; the 
youngsters creep out and do exactly as the old ones did; the mischief is done. 
Infection takes place, therefore, most readily if one happens to sleep with 
another who has the itch ; but also by shaking of hands, by clothing, by 
using the same towel, etc., the female acarus may be transplanted. The fact 
makes itself known first by,;an intolerable itching on those parts, which the 
acarus seems decidedly to prefer, namely, the hands, especially between the 
fingers, the cleft of the nates, the bends of the extremities, the abdomen, and 
the genital organs, never the face. It seems that this terrible itching is 
caused not only by the action of the insect in burrowing itself into the skin, 
but also by an #crid juice, which it probably secretes. The objective signs 
which now follow are the above mentioned pimples, vesicles and pustules, on 
account of which the books speak of a scabies papulosa, vesiculosa, and pustu- 
losa. The most characteristic signs of acarus-itch are, however, the little fur- 
rows which are dug by the insects. They present dotted, irregular streaks, 
which have a great similarity to little scratches of a ueedle. At their com- 
mencement there is generally a vesicle, seldom a papule or pustule; at their 
end, a little way from the vesicle, the insect sits, appearing as a whitish 
speck. By carefully entering this small channel with a fine needle the per- 
petrator may be pierced and extracted. 

Itch never heals spontaneously, and the more the insects multiply, the 
worse it grows. The original irritation caused by the insects, and the ad- 
ditional one by scratching, causes the whole eruption to assume the form of 
eczema and impetigo, with vesicles, pustules and crusts of different sizes. 

GENERAL THERAPEUTIC REMARKS.— The old school consid- 
ered it a great triumph when, in the year 1834, by M. Renucci, a young Cor- 
sican in Paris, who had learned in his native island the art of extracting the 
little animal, the question about the nature of itch seemed to be settled. 
Hahnemann's psora-theory had thus been exploded by a needle in a Corsi- 
can's hand, and with it, all Homoeopathy ! They simply forgot, in their 
heart's delight, that before that time many other cutaneous eruptions were 
considered as itch; amongst them, as Hebra himself supposes, prurigo, with 
its undoubted metastases to inner organs. If we now take a glance over 
Hahnemann's masterly picture of what he calls psora, we shall at once per- 
ceive that, under psora, he did not understand acarus-itch solely, but gave a 
tout ensemble of chronic cutaneous affections in general. The child had to 
have a name, and psora was as good a name as eczema, impetigo, prurigo, or 
any other. Thus the needle, although it found the acarus, altogether missed 
Hahnemann's psora. It is just as true to-day that a suppression of cutaneous 
eruptions, of various kinds, will be followed by disastrous consequences upon 
the general system, as it was true when Hahnemann and others observed it. 



SCABIES, ITCH. 1071 

Instead, then, of desiring to have Hahnemann's psora theory wiped out of 
the pages of Homoeopathy as a disgraceful spot, we ought to be proud of our 
old master's keen observations. But then Ave must understand him rightly. 
I admit that, in recent cases of acarus-itch, the killing of the animal is the 
shortest procedure to cure, without detrimental effects upon the organism. 
This end may be attained not only by the external application of sulphur and 
mercurial salves, but also by Peruvian balsam or the twigs of the balsam poplar 
tree, populus balsamifera (L.), Tacamahac (Ind.), which secretes a kind of 
resinous substance on the pedicles of its leaves and around its twigs. But as 
it is an undoubted fact that itch never heals spontaneously, and as we have 
likewise undoubted facts that it has been cured solely by the internal appli- 
cation of homoeopathic remedies, it seems that those who contend that even 
acarus-itch in the course of time is not altogether a mere local, cutaneous 
trouble, are after all deserving some credit. All parasites, no matter whether 
animal or vegetable, can grow only upon a suitable soil ; if this soil be made 
insupportable to them, they die or leave, and this is as good as killing, re- 
garding the riddance of the intruders, but it is infinitely better for the pa- 
tient, as by this means the organism is not injured, but brought into a healthy 
state. 

SPECIAL HINTS. — Arsen., inveterate cases; eruption in the bends 
of the knees; pustulous eruption ; burning and itching; better from external 
warmth. 

Carb. veg., eruption dry and fine, almost over the whole body, worst 
on the extremities; itching worst after undressing; dyspeptic symptoms; 
belching of Avind and passing flatus; after the abuse of mercurial salves. 

Caustic, after the abuse of sulphur and mercury; yellowish color of 
the face; warts on the face; involuntary discharge of urine when coughing, 
sneezing or walking; sensitiveness to the cold air. 

Hepar, fat, pustulous and crusty itch; also after previous abuse of 
mercury. 

Mercur., fat itch, especially in the bends of the elbows. 

Psorin., inveterate cases; with symptoms of tuberculosis; also in 
recent cases; eruption in the bends of the elbows and around the wrists; 
repeated outbreaks of single pustules, after the main eruption seems all gone. 

Sepia, after previous abuse of sulphur; itching worse in the evening; 
especially in females. 

Sulphur, main remedy; voluptuous tingling-itching, with burning and 
soreness after scratching. 

Sulph. ac, when itchiness of the skin and single pustules appear 
every spring, after an imperfectly cured itch. 



1072 DERMATITIS. 

18. Prairie Itch, Prurigo Contagiosa, 

" Is an acute inflammation of the skin, appearing in new districts, where it 
may be for a time endemic. It may be preceded by the premonitory symp- 
toms of malaise, headache and slight febrile disturbance ; or its onset may be 
first marked by the appearance of erythematous points, covered with small 
transparent vesicles, varying in size from a pin's-head to a mustard-seed, and 
situated for the most part on the neck, shoulders, back and outer surface of 
the limbs. An intolerable nightly itching accompanies the eruption, creating 
an almost irresistible desire to scratch the parts. The scratching obliterates 
the vesicles, and gives rise to scratch-marks, and to the secretion of an ex- 
ceedingly acrid, irritating fluid, which oftentimes indefinitely prolongs the 
disease. Large blackish crusts covering suppurating ulcers are an occasional 
result. Furuncles quite frequently complicate the trouble." (Kippax.) 

THERAPEUTIC HINTS. — Rumex crisp., principal remedy. 
(Searle.) Diluted lye-of-wood ashes locally. 

Rhus tox. and Ledum may be studied. (Kippax.) 

19. Burns and Scalds. 

Injuries to the skin or flesh caused by the action of fire or heated solid 
bodies are called Burns; injuries by the action of some hot fluid or steam, 
are called Scalds. Both may vary greatly in degrees of intensity and danger, 
from a mere superficial dermatitis to a complete destruction of the parts in- 
volved ; they may be confined to only a small spot, or extend over large 
surfaces, or may reach the internal mucous membranes by inhalation or 
deglutition, or may involve particular sensitive parts of the body, such as 
the genitals, or places where large trunks of nerves or blood-vessels lie close 
to the surface, for instance in the region of throat and neck. 

Upon all these different possibilities depends the more or less pronounced 
constitutional effect of the injury and its danger. The shock is sometimes 
terrible, manifesting itself in a sudden sinking of vital power, cold extremi- 
ties, vomiting and anxiety. In superficial and not widely extended injuries 
these symptoms are wanting, and it is more the intense burning pain in the 
parts involved, that causes distress; but even in lighter cases fever and sleep- 
lessness may be a speedy consequence. Severer burns are followed by sup- 
puration, ulceration, sloughing, attended by fever, and sympathetic affections 
of the bowels, such as colic, diarrhoea, intestinal haemorrhage. The destruc- 
tion of two-thirds of the entire cutaneous surface is considered as fatal ; but 
death may also ensue from the shock, or subsequent ulceration, sloughing 
and hectic fever, or haemorrhage. 



BURNS AND SCALDS. 10 to 

THERAPEUTIC HINTS— Blisters must be emptied by pricking 
with a fine needle, or sowing a thread through them, so that the epidermis 
may remain intact. 

To "draw the fire out", several applications have proved efficacious. 
Pure alcohol will do it in many cases. An alcoholic tincture of Cantharides, 
3d dilution, acts frequently like a charm ; so does a like tincture of Causticum, 
or Urtica urens. If there be bicarbonate of soda, the common baking powder, 
close at hand, a paste made of it and applied quickly, has also been found of 
excellent use. But castile soap, or any other common soap, made into a paste 
by scraping and mixing with warm water, is indeed one of the best external 
applications, because it is most always at hand. So may sweet oil, either 
alone or mixed with a few drops of the 3d dilution of Cantharides, or with 
equal parts of lime water, act very beneficial. Sometimes a mixture of sweet 
oil and chloride of lime made to a sal^e has relieved where Cantharides and 
soaj} were of no use. 

It is of great importance that the air should be excluded from the parts 
involved. Haw cotton, not glazed, and free from seeds, is excellent for this 
purpose, as it is light, soft and pliable, easily adopting itself to any part. 

Some physicians moisten its surface which is intended to come in con- 
tact with the burn or scald with the tincture of Calendula, or of Cantharides 
or of another of the articles mentioned, before applying it. 

SPECIAL HINTS. — Aeon., shock, fever, restlessness, sleeplessness. 

Arnica, stays abundant suppuration. 

Arsen., great restlessness, sinking of strength; colic and diarrhoea. 
Internal burns. 

Canthar., internal burns. 

Carb. veg., shock, with symptoms of collapse. 

Caustic, internal burns. 

Chamom., colic; convulsions. 

China, profuse suppuration, weakness, hectic fever. 

Coffea, nervous excitability and sleeplessness. 

Kreos., discharge fetid and wound bluish. 

Laches., wounds do not heal, take a purplish aspect. 

Opium, shock, tendency to convulsions, especially in children; sleep- 
lessness. 

Sapo, internal burns, most important. 

Urtica urens. 



1074 DERMATITIS. 

20. Chilblains, Frostbites. 

Like heat, so does intense cold produce inflammatory affections, most 
frequently on the least protected parts of the body, the ears, nose, fingers and 
toes. But this inflammation is of a secondary nature, and sets in when heat 
and circulation of the frosted parts have been restored too hastily by the 
application of external warmth, and is called Chilblains or Frostbites. 
Here, too, as in burns, the injury may be superficial or involve deeper struct- 
ures. The parts become swollen, look dark red and have a sensation of 
tingling, burning and itching; there form vesicles upon the outside, which 
burst and produce unhealthy looking sores, and gradually a more or less deeply 
ulcerated surface. Even gangrene may result from this cause. A peculiarity 
of frostbites is, that, after healing or spontaneously disappearing, they fre- 
quently return again at the next cold season, or become troublesome again 
during the hot weather. 

THERAPEUTIC HINTS.— A frozen part of the body must not be 
exposed to external heat. Covering or gentle rubbing with snow, or im- 
mersion into cold water in a cold room are the first best things to be done 
for its restoration. Hering has recommended as a preventive the rubbing 
with Camphor spiritus of the least protected parts before the exposure to 
intense cold; the same remedy maybe applied as a restorative when snow or 
cold water have "drawn out the frost*' as far as they can. 

SPECIAL HINTS. — Agaricus muse, toes or fingers are red and 
swollen and burn and itch intensely. 

Arnica, parts are blue, red, swollen. 

Arsen., after handling of ice, the pain is relieved by external warmth; 
bluish-redness of the sides of the feet ; vesicles turn blackish ; tendency to 
gangrene. 

Bellad., bluish-red inflammation; pain burning, or stinging, or creep- 
ing, tingling, worse at night and on moving. 

Canthar., externally, if Camphor does not relieve. 

Carb. veg., if Arsen. is not sufficient. 

Fragaria vesca, pain from chilblains during hot weather. 

Hepar, very painful and suppurating. 

Kali carb., inflammation with aching, cutting pain ; bluish appearance. 

Laches., parts swollen become blue and black. 

Natr. mur., "intense burning and tenderness of the soles of the feet, 
painful when walking, with stinging vesicle on the tip of the tongue and sen- 
sation as if a hair were lying on the tongue." (Gilchrist.) 



ANOMALIES. 1075 

Nitr. ac, parts swollen, itching and painful; worse during any slight 
increase of cold weather ; fetid sweat of feet. 

Nux vom., "superficial inflammation, with bright red swelling, burn- 
ing and itching, or when the tumefied part cracks and bleeds easily." 
(Helmuth.) 

Petrol., "burning and itching like fire; heel painfully swollen and 
red; feet tender and bathed in a foul moisture." (Lilienthal.) Popular 
remedies of the same nature are : Cosmoline, Vasoline, Coal-oil. 

Phosphor., when the pain is very intense. 

Pulsat., swollen, red and bluish; worse in warm weather and better 
from cold applications. 

Rhus tox., burning, itching pain, worse in afternoon and during rest. 

Ruta, burning pains in the bones after frostbites. (Hering.) 

Secale, when the pain is worse in the warmth and better in the cold; 
gangrene. 

Sulphur, " thick, red chilblains on the fingers." (Hering.) 

Zincum, "chilblains itch and smell." (Hering.) 

V. ANOMALIES IN THE SECRETIONS OF THE 

SKIN. 

The secretion of gaseous substances is either augmented, for example, in 
fevers, when the temperature of the body is considerably raised, and in a hot 
atmosphere ; or it is diminished, when the air is damp and its temperature 
low. In disease, a diminution of gaseous secretion has been ascertained by 
actual measurement only in diabetes mellitus. 

The secretion of watery substances, which is called perspiration or sweat, 
may be promoted in any healthy person by drinking large quantities of 
water, and covering with a thick blanket, by strong exercise of the body, by 
the heat of the weather, etc. In disease it is sometimes entirely wanting, at 
other times, a very prominent symptom, for example, in pneumonia, in some 
forms of rheumatismus acutus, etc. Some persons are much more inclined 
to sweat than others ; an excessive inclination to sweat is called Hyperidro- 
sis. It seems that repeated sweatings increase the inclination to it. When 
the fluid which is secreted in the sudorific glands cannot pass freely upon 
the surface, either because the sudorific ducts are stopped up, or because they 
are too narrow to give vent to all the fluid which is produced within the 
glands, we observe the fluid to collect under the epidermis, and to raise it 
into numerous little vesicles, which contain a perfectly transparent fluid of 
an acrid reaction. This eruption is called 



1076 ANOMALIES. 

Sudamina, or Miliary Rash. 

The stoppage of the outlets of the sudorific glands occurs most frequently 
in diseases in which there has been great dryness of the skin previous to the 
outbreak of the sweat, as, for example, in the first weeks of typhus. The 
appearance of the eruption has no influence upon the course of the disease; 
it is observed as well in critical sweats as in those which break out sometimes 
when the disease takes a bad turn, and may even appear during the last 
struggles of agony. When the transparent, minute vesicles appear upon a 
naturally colored skin, it is called miliaria alba, when upon a skin which is 
reddened by hyperemia or hemorrhagic effusions, it is called miliaria rubra. 
As a symptom it may indicate Arsen., Bryon., Calc. carb. or Ipec. 

Prickly lieat is likewise a miliary rash, consisting of numerous pin- 
head-sized, reddened papules, or vesico-papules, in consequence of a disordered 
action of the sw r eat-glands, covering the trunk, arms, neck and even, at times, 
the face. It occurs during the hot weather, and is often very annoying on 
account of its stinging-itching, but usually disappears when cooler weather 
sets in. 

Quite frequently do we find partial hyperidrosis on the palms of the 
hands, on the soles of the feet, under the arm-pits and on the genitals. The 
sweat of the feet, in the axillae and on the genitals, is often excessively offen- 
sive, which seems to have its cause in a decomposition which the sweat, the 
sebaceous secretion and the softened and loosened epidermis undergo. The 
suppression of these partial sweats has been considered from olden times as 
very detrimental to health, causing spinal affections and different other com- 
plaints. In later times this has been reversed ; now they say : intercurring 
diseases stop this partial sweating. May be, may be not. So much is cer- 
tain, and I have observed many a time that the cessation of partial sweats 
stands in closest relation with various general complaints, and that the 
patient does not get better until the foot-sweat or axilla-sweat, etc., is re-es- 
tablished. 



Foot-Sweats. 

" Bar. carb., fetid foot-siveat, with callosities on the soles which are pain- 
ful on walking; soles feel bruised at night, keeping one awake, after rising 
and walking. 

Calc. ost., foot-siveat which makes the feet sore; feet feel cold and 
damp, as if she had wet stockings; burning in the soles. 

Canthar., temporary cold sweat on feet; smells like urine. 

Carb. veg., foot-sweat excoriating toes; toes red, sw T ollen; stinging, as 
if frosted ; tip of toes ulcerated. 



FOOT-SWEATS. 1077 

Graphit., profuse foot-sweat, not fetid as in Sepia or Silic, but the most 
moderate walking causes soreness between the toes, so that the parts become 
raw; spreading blisters on the toes, thick and crippled toe-nails. (Jahr 
gives fetid feet under Graphit.) 

Helleb., humid, painless vesicles between the toes. 

Iodum, acrid, corrosive foot-sweat ; (edematous swelling of the feet. 

Kali carb., profuse fetid foot-sweat; swelling and redness of the soles; 
chilblains; stitches in the painful and sensitive corns. 

Lac. ac, profuse foot-sweat, but not fetid (Graphit.). 

Lycop., profuse and fetid foot-sweat, with burning in the soles; one foot 
hot, the other cold, or both cold and sweaty ; swelling of the soles ; they pain 
when walking ; fissures on the heels. 

Mur. ac, cold sweat on the feet, evening in bed; swelling, redness and 
burning of tips of toes ; chilblains. 

Nitr. ac, foul-smelling foot-sweat; chilblains on the toes. 

Petrol., feet tender and bathed in a foul moisture ; feet swollen and 
cold; hot swelling of the soles, with burning; heel painfully swollen and red ; 
chilblain ; tendency of skin to fester and ulcerate. 

Plumbum, fetid foot-sweat ; swelling of the feet. 

Podoph., foot-sweat evenings. 

Sepia, profuse foot-sweat or very fetid, causing soreness of toes ; burning, 
or heat of the feet at night ; crippled nails. 

Silic, offensive foot-sweat with rawness between the toes; itching of 
soles, driving to despair. 

Squilla, cold foot-sweat; sweat only on toes; soles red and sore when 
walking. 

Sulphur, sweating and coldness of the soles ; burning soles, wants them 
uncovered. 

Thuja, fetid sweat on toes, with redness and swelling of the tips; nets 
of veins, as if marbled, on the soles of the feet; suppressed foot-sweat; nails 
crippled, brittle or soft. 

Zincum, the feet are sweaty and sore about toes; also fetid; chilblains 
from scratching and friction ; the suppression of sweat causes paralysis of the 
feet. 

Jahr gives the following: 
Foot-sweat. — Aeon., Amnion., Baryta, °Calcar., Carb. veg., Coccul., 

Cuprum, Cyclam., Droser., Graphit., Iodum, °Kali, Kreos., Laches., 

°Lycop., Magn. mur., Mercur., Natr. mur., Nitr. ac, Nuxjug., Petrol, 

Phosphor., Phosph. ac, Plumbum, Pulsat., Sabad., Sabina, °Sepia, 

°Silic, °Squilla, Staphis., °Sulphur, Thuja, Zincum. 
corrosive, Iodum, Lycop., Xitr. ac, Silic, Zincum. (Carb. veg.) 



1078 ANOMALIES. 

Foot-Sweat, fetid, Ammon., Baryta, Cyclam., Graphit, Kali, °Mtr. ac, Nux 
jug., Phosphor., Plumbum, Sepia, Silic, Zincum. 

cold, Coccul., Droser., Ipec, Lycop., Mercur., Squilla, Staphis., Sul- 
phur. (Canthar.) 

night (at), Coloc. (Evening, Mur. ac, Podoph.) 

— Suppressed, ° Cuprum, °Kali, °Natr. mur., °Nitr. ac, ° Sepia, ° Silic. 

(Apis, Pulsat., Rhus tox., Thuja, Zincum.) 

soles of feet (on), Aeon., Arnica, Kali, Natr. mur., Nitr. ac, Petrol., 

Plumbum, Sabad., Silic, Sulphur. 

toes (between the), Aeon., Arnica, Qemat., Cyclam., Ferrum, Kali, 

Sepia, Silic, Squilla, Tarax., Thuja. 
To this we may add: 

profuse, Carb. veg., Graphit., Kali carb., Lac. ac, Lycop., Sepia. 

With much itching of soles, Silic, Sulphur. 

With burning, Calc ostr., Lycop., Mur. ac, Petrol., Sepia, Sulphur. 

— With rawness, Graphit., Silic. (Carb. veg.) 

With soreness, Bar. carb., Calcar., Carb. veg., Graphit., Iodum, Petrol., 

Sepia, Squilla, Zincum. 

With redness and swelling in the soles, Iodum, Kali carb., Lycop., 

Petrol., Squilla; in the feet, Plumbum; in the tips, Mur. ac, 
Thuja; in the toes, Carb. veg. 

With pain, on walking, Bar. carb., Graphit., Lycop., Squilla; at 

rest, Carb. veg. (stinging), Petrol, (pain in heel of foot). 

■ With crippled nails, Graphit., Sepia, Thuja. 

moisture (rather than sweat), fetid, Petrol; cold, Calcar." 

(Dr. E. Fornias.) 

A diminution of fluid secretion, causing great dryness of the skin, often 
attends marasmus senilis. Sometimes it is a disturbed innervation, and 
sometimes the consequence of skin diseases. Besides, there are cases of 
Allidrosis and even of half-sided anidrosis, for which there is no explanation. 

A Qualitative change in the secretion of sweat takes place in icterus, 
w T hich colors the linen yellow, and in suppressed urinary secretions, when 
the sweat contains urinary ingredients. 

The secretion of sebaceous substances, if diminished, causes great dryness 
and brittleness of the skin ; if augmented (seborrhea), it forms crusts upon 
the scalp, especially in children, or on the cheeks, nose, eyelids, ears and 
nipples, especially in females who menstruate irregularly. A thickening of 
it within the excretory ducts oauses comedones, milium and atheromata. 

A Comedo has a dark surface from the dust and dirt outside, which 
has been mixed with it. 



FOOT-SWEATS. 1079 

A Milium is a collection of hardened sebum within the extended follicle ; 
being covered by the epidermis it shows no dark, dirty point. 

A MollllSClini is a greatly enlarged sebaceous gland, which is filled by 
thickened sebum. Being always united with a hair-follicle, with which it 
has a common outlet, the swelling or tumor generally shows a dark point 
and umbilical depression on its summit. The color of the skin over it is 
either normal in color or pinkish. It attacks mostly the face, but it may 
appear on oth&r parts. Its contents can often be squeezed out. 

Internal remedies are: Silic, Calc. ars., Bryon., Kali hydr., Lycop., 
Xatr. mur. 



INDEX. 



Abdomen, 461 
Abortive typhoid, 990 
Abscess of ankle-joint, 845 

of the brain, 81 

of cornea, 153 

of lid, 132 

peritonsillar, 273 

renal, 666 

retro-pharyngeal, 283 

retrotonsillar, 273 
Absence of inspiratory murmur, 348 
Acaris lumbricoides, 573 
Accomodation, 171 
Acne punctata and rosacea, 239 
Acne syphilitica, 709 
Acute yellow atrophy of liver, 602 
Adaptation, 171 
Aegophony, 356 
Agraphia, 92 
Alcoholism, chronic, 110 
Alopecia circumscripta, 129 

syphil., 710 
A kinesis, 911 
Amaurosis, 165 
Amblyopia, 165 
Amenorrhcea, 772 
Amygdalitis, 272 

parenchymatous, 273 
Amyloid degeneration of kidneys, 665 

degeneration of liver, 604 
Anaemia, 928 

of brain, 33 

of skin, 1050 

of spine, 791 

of summer-complaint 34, 
Anaemic murmurs, 432 



Anaesthesia, 849, 877 

of soft palate, 275 

of trigeminus, 877 
Analogy between eye and ear, 183 
Anchylops, 132 

Anchylostomum duodenale, 57S 
Aneurism in brain, 115 

cardiac, 439 

of thoracic aorta, 457 
Aneurisms, valvular, 439 
Angina catarrhalis, 275 

faucium, 275 

granulosa or follicularis, 277 

Ludovici, 284 

pectoris, 453 

tonsillaris, 272 
Angular curvature of spine, 846 
Anidrosis, 1078 

Anomalies in secretions of skin, 1075 
Anteflexion uteri, 747 
Anteversion, 747 
Aorta, 457 
Aphasia, 92 
Aphonia, 331 
Aphtha?, 287 
Apoplexia pulmonum vascularis, 408 

sanguinea, 85 

serosa, 74 
Apoplexy of spine, 792 
Arthritis, 830 

deformans, 832 
Articuli duplicati, 833 
Ascites, 588 
Aspect of face, 234 
Aspermatism, 725 
Asthenopia, 174 



(1081) 



1082 



INDEX. 



Asthenopia, accommodative, 174 
Asthma bronchiale nervosum seu convul- 
sivum, 375 

Millari, 332 

spasmodicum or laryngeum of infants, 
332 

thymicum Koppii, 332 
Astigmatism, 173 
Ataxy, progressive, 805 
Atony of bladder, 680 
Atrophy of the brain, 97 

of nerves, 848 

of skin 1050 

of the skull, 119 
Auditory canal, 186 
Auricle, 185 
Auscultation of cough, 356 

of heart, 426 

of larynx, 312 

of lungs, 345 

of voice, 353 
Azoospermism, 725 

Balanitis, 693 

Baldness, 129 

Basedow's disease, 180 

Bilious fever, 467 

Bladder, 672 

Blennorrhcea of bronchi, 360 

of lachrymal sac, 138 

blepharitis marginalis, 132 
Blepharospasm, 179 
Blisters, isolated large, 1059 

isolated, which form thick crusts, 1060 
Bloatedness, 555 
Blood, 924 

in urine, 648 
Boil, 1061 

Bothriocephalus latus, 576 
Break-bone fever, 981 
Bright's disease, first stage, 653 

second stage, 658 

third stage, 661 
Bronchial asthma, 375 

catarrh, 357 

respiration, 349 
Bronchiectasia, 360 
Bronchitis, 357 

capillaris, 359 



Bronchocele, 306 
Bronchophony, 353, 355 
Bronchorrhoea, 360 
Broncho-pneumonia, 379 
Broncho-typhus, 990 
Bruised head after birth, 117 
Buboes, 691 
Bubo, inguinal, 706 
Bullae, isolated large, 1059 
Bunion, 847 
Burns, 1072 
Bursitis, 845 

Calculi, kidneys, 666 

vesicae, 677 
Camp-fever, 982 
Cancer of the breast, 788 

of intestines, 567 

of liver, 605 

of pancreas, 632 

of rectum, 568 

of spleen, 630 

of the stomach, 481 

of tongue, 267 

of womb, 759 
Cankers of the mouth, 287 
Caput succedaneum, 117 
Carbunculus, 1061 
Carcinoma in brain, 115, 116 

hepatis, 605 

of larynx, 330 

mammse, 788 

testis, 716 

uteri, 759 

ventriculi, 481 
Cardialgia nervosa, 472 
Carditis, 447 
Caries, 837 
Catalepsy, 893 
Cataract, 168 

Catarrh on the chest of infants, 359 
Catarrhal diphtheria, 291 
Catarrhus intestinal is, 489 
Catarrh of larynx, 314 

nasal, chronic, 220 

of nose, 216 

of stomach, 466 

of stomach, chronic, 470 

of uterus, 733 



INDEX. 



1083 



Catarrh of vagina, 784 

Catheterism of Eustachian tube, 192 

Cauliflower excrescences of womb, 759 

Cavernous voice, 356 

Cavity of nose, examination of, 214 

Cephalalgia, 853 

Cerebral paralysis, 913 

Cervico-occipital neuralgia, 868 

Cervico-brachial neuralgia, 868 

Chalazion, 136 

Chancre, 693 

Chancroid, 694 

Chicken-pox, 1047 

Chilblains, 1074 

Chimney sweeper's cancer, 1064 

Chlorosis, 930 

Cholsemia, 615 

Cholelithiasis, 610 

Cholera, 512 

infantum, 524 

morbus, 523 

nostras, 523 
Cholesteatomata in brain, 115 
Chordee, 686 
Chorea, 881 
Choroiditis, 160 

disseminata, suppurativa, 160 
Chromotopsy, 167 
Chronic alcoholism, 110 

intestinal catarrh, 493 
Cirrhosis of liver, 599 
Click-sound, 352 
Clinical thermometry, 945 
Closure of womb, 746 
Coating of tongue, 262 
Coccyodynia, 812 
Cold in head, 216 
Colica, 557 

renalis, 666 
Colloid liver, 604 
Color of face, 236 

of nose, 213 

of tongue, 261 
Coma, 56 
Comedo, 239, 1078 
Comma-bacilli, 516 
Condylomata, 705 
Congestion of brain, 36 

of liver, 593 



Congestive fevers, 967 
Conjunctivitis, croupous, 151 

diphtheritica, 150 
Consistence of tongue, 264 
Constipation, 533 
Constitutional syphilis, 696 
Constriction of aortic opening, 443 

of left auriculo-ventricular opening, 
442 
Consumption of bowels, 566 

of lungs, 389 
Contamination of system by gonorrhoea, 692 
Convulsion, 878 
Convulsions of children, 906 
Corneitis, 152 

diffuse or parenchymatous, 152 
Coxalgia, 840 
Coxarthrocace, 840 
Coryza, 216 

Cracked pot sound, 345 
Cracks of tongue, 264 
Cramp, 878 

of stomach, 472 
Craniotabes, 118 
Crisis, 947 
Critical days, 947 
Croup, 320 

secondary, 322 
Croupous diphtheria, 291 

pneumonia, 380 
Crural neuralgia, 877 
Crusta lactea, 238 
Cyanosis, 924 
Cyclitis, 161 

Cystic tumors of larynx, 330 
Cystitis, 672 
Cysts of ovaries, 730 

Dacryocystitis, 137 
Dandruff, 126 
Deafness, nervous, 209 
Decubitus, 1051 
Delirium tremens, 107 
Dementia paralytica, 98 

senilis, 100 
Dengue, 981 
Dermatitis, 1050 

Deviations from normal vesicular respira- 
tion, 348 



1084 



INDEX. 



Diabetes, 639 

insipidus, 647 
Digest to acute and chronic catarrh in 
head, 224 

to acute and chronic inflammation of 
throat, 280 

to acute and chronic intestinal catarrh, 
496 

to acute and chronic laryngitis, 318 

to acute and chronic otitis media, 204 

to amenorrhoea and dysmenorrhea, 
779 

to bronchitis, 367 

to chancre and constitutional syphi- 
lis, 701 

to cephalalgia, 857 

to chlorosis, 934 

to colica, 564 

to constipation, 538 

to dementia paralytica, 103 

to diphtheria, 300 

to displacement of womb, 754 

to dysentery, 510 

to epilepsy, 901 

to gastralgia, 476 

to haemorrhoids, 552 

to jaundice, 623 

to intermittent fever, 959 

to leucorrhoea, 739 

to meningeal inflammation, 67 

to metrorrhagia and menorrhagia, 769 

to neuralgia of face, 865 

to the different forms of ophthalmia, 
147 

to phthisis, 399 

to pneumonia, 387 

to rheumatism, 825 

to scarlatina, 1034 

to sciatica, 875 

to spotted fever, 78 

to summer-complaint, 530 

to typhoid fever, 1002 

to vertigo, 48 

to yellow fever, 976 
Dilatation of heart, 448 

of oesophagus, 310 
Diaphragm, 458 
Diaphragmitis, 458 
Diphtheria, 289 



Diphtherltis, 289 
Dipsomania, 110 
Diseases of liver, 592 
Dislocation of the lens, 170 
Displacements of womb, 746 
Dissolution of red blood-corpuscles, 925 
Distiachis, 132 
Diverticula eesophagi, 310 
Dochmius duodenalis, 578 
Dular faciei Fothergillii, 861 
Doppelte Glieder, 833 
Dropsy of chest, 422 

of ovaries, 730 

of pericardium, 437 

of the peritoneum, 588 

of scalp, 117 
Drumhead, 186 
Dry catarrh, 360 
Dull sound, 344 
Dysentery, 504 
Dysmenorrhcea, 775 
Dyspepsia, 464 
Dysphagia inflammatoria, 307 

Ear speculum, 191 

Earwax diminished or increased, 187 

Echinococcus-cysts, 608. 

of spleen, 630 
Eclampsia acuta, 904 

gravidarum et parturientium, 905 

infantum, 906 
Ecthyma, 1059 

syphiliticum, 710 
Ectropium, 132 
Eczema, 1055 

on auricle, 185 

capitis, 123 

syphil., 709 
Embolism and thrombosis, 90 
Emphoric echo, 356 
Emphysema pulmonum, 403 

of pleura, 415 
Encephalitis, 81 
Endocarditis, 438 
Endometritis, 733 
Enlargement of prostate, 718 
Enteritis catarrhalis, 489 
Entero-colitis, 525 
Entozoes, 572 



INDEX. 



1085 



Enteralgia, 557 
Entropium 132, 
Enuresis nocturna, 682 
Epididymitis, 690 
Epilepsy, 893 
Epistaxis, 231 
Epithelial cancer, 1064 
Epithelioma, 1064 

of lid, 137 

of lip, 241 
Epulis, 243 
Erysipelas of face, 119, 238 

of scalp, 119 
Erythema, 1050 

nodosum, 1051 

papulatum seu tuberculosum, 1051 
Essential infantile palsy, 918 
Examination of abdomen, 461 

of auditory canal, 186 

of cavity of nose, 214 

of female organs, 726 

of middle ear, 191 
Exanthemata, 1018 
Exophthalmic goitre, 180 
Expiratory murmur, 347 
Expression of face, 235 
Exostosis, 837 

Extravasation of blood in spinal canal, 792 
Eyes, 131 

Face, 234 

Faevus, 127 

Falling of the upper eyelid, 176 

Fatty degeneration of heart, 449 

heart, 449 

liver, 603 

pancreas, 632 
Febris mucosa, 467 
Felon, 1064 
Female genitals, 726 
Fever, 945 
Fever and ague, 949 
Fibroids in womb, 758 
Fibroma of larynx, 329 
Figwarts, 705 
Fish-skin, 1049 
Fissura ani, 569 
Fissures of tongue, 264 
Fistula ani, 504 



Fistula lachrymalis, 137 

recti, 570 

of teeth, 244 
Fixed eyeball, 178 
Flatulency, 555 
Form and shape of nose, 213 
Form of thorax, 336, 338 

of tongue, 263 
Foot-sweats, 1076 
Friction sound, 352 
Frog, 271 
Frostbite, 1074 

Furuncles of external meatus of ear, 189 
Furunculus, 1061 

Gall-stone colic, 611 
Gall-stones, 610 
Gangrsena pulmonum, 409 
Gangrene, 926 

of cheeks, 303 
Gangrenous diphtheria, 292 
Gastralgia, 472 
Gastric fever, 467 
Gastritis, 466 

toxica seu caustica, 471 
Gastromalacia, 488 
General observations on neck, 305 

on nose, 213 
Gin-drinker's liver, 599 
Glaucoma, 162 
Gleet, 686 
Glioma, 114, 116 
Glossitis, 266 
Glycosuria, 639 
Goitre, 306 

exophthalmic, 180 
Gonarthrocace, 843 
Gonorrhoea, 685 

of rectum, 691 

spuria or praeputialis, 693 

vesicae, 691 
Gonorrhoeal rheumatism, 692 
Gout, 830 

Granulated liver, 599 
Graphospasms, 881 
Grating feel, 339 
Gravel, 66Q 
Graves' disease, 180 
Gray degeneration of posterior columns, 805 



10S6 



INDEX. 



Grippe, 228, 359 
Gumboil, 243 
Gummata, 712 
Gums, 242 

Haematemesis, 485 
Haematoma dura? matris, 80 
Haematothorax, 424 
Hematuria, 648 
Haemometra, 746 
Haemophilia, 941 
Haemoptoe, 410 
Haemoptysis, 410 
Haemorrhage from stomach, 485 

from womb, 762 
Haemorrhages of lungs, 410 
Hsemorrhagia intestinalis, 546 
Haemorrhagic infarction of spleen, 627 

infarctions, 410 
Haemorrhoids, 547 
Haemorrhophilia, 941 
Hair cutting, 130 
Hair gray and white, 130 
Hard cataract, 168 

Harshness of expiratory murmur, 348 
Hay asthma, 230 

fever, 230 
Heart, 426 
Heart-clots, 446 
Helminthes, 572 
Helminthiasis, 583 
Hemeralopia, 167 
Hemicrania, 853 
Hemiopia, 166 
Hemiplegia, 912 
Hepar adiposum, 603 
Hepatitis vera, 596 
Hernia, 540 
Herpes, 1052 

syphil., 709 

tonsurans, 128 

Zoster, 1052 
Hiccough, 459 
Hip disease, 840 
Hob-nail liver, 599 
Honey-comb ringworm, 127 
Hordeolum, 136 
Humectation of tongue, 262 
Humid tetter or scald, 123 



Hydatids of liver, 608 

of womb, 758 
Hydraemia, 927 
Hydroa febrilis, 1052 
Hydrocele, 714 
Hydrocephalus acutus, 59 

sine tuberculis, 61 

chronicus, 72 

congenitus, 72 

ex vacuo, 74 

senilis, 73 
Hydrocephaloid, 34, 524 
Hydrometra, 746 
Hydronephrosis, 668 
Hydropericardium, 437 
Hydrophobia, 918 
Hydrops cystidis felleae, 612 

ovarii, 730 
Hydrorrhachis congenita, 797 
Hydrosarcocele, 716 
Hydrothorax, 422 
Hyperaemia of brain, 36 

of liver, 593 

of lungs, 407 

of skin, 1050 

of spine, 791 

of spleen, 628 
Hyperesthesia, 849 

of bladder, 679 

of soft palate, 275 

retinae, 167 
Hyperidrosis, 1075 
Hyperkinesis, 878 
Hypermetropia, 172 
Hyperplasia of the pineal gland, 114 

of the pituitary gland, 115 
Hypertrophy of the brain, 96 

of heart, 448 

of nerves, 848 

of skin, 1048 

of the skull, 117 

of spleen, 629 
Hypopion, 153 
Hysteralgia, 762 
Hysteria, 885 

Ichthyosis, 1049 
Icterus, 615 
Ileo-typhus, 985 



INDEX. 



1087 



Ileus, 545 

Impaired hearing, 200 

Impetigo, 1058 

contagiosa, 1058 

of scalp and face, 124 
Impotence, 724 
Indigestion, 464 
Induration of connective tissue of kidneys, 

661 
Infantile wasting palsy, 918 
Infant's sore mouth, parasitic, 285 
Infarctions, hemorrhagic, 410 
Inflammation of auditory canal, 190 

of biliary passages, 609 

of bladder, 672 

of the breasts, 786 

of connective tissue of throat, 284 

of diaphragm, 458 

of the dura mater, 80 

of eyelids, 131 

phlegmonous, 132 

of gray anterior horns, chronic, 811 

of gray anterior columns, 810 

of heart-muscle, 447 

interstitial, of kidneys, 661 

interstitial, of liver, 599 

of liver and Glisson's capsule, 596 

of the nerves, 848 

of nose, 233 

of pancreas, 631 

of pericardium, 433 

of the pleura, 413 

purulent, of portal vein, 613 

of prostate, 691, 717 

of rectum, 502 

of renal capsule, 670 

of renal pelvis, 669 

of skin, 1050 

of spinal marrow, 800 

of spleen, 627 

of stomach from poisoning, 471 

syphilitic, of liver, 601 

of testicles, 715 

of tongue, 266 

of uvula, 275 

of vermiform process, 499 
Influenza, 228, 359 
Ingrowing toe-nails, 847 
Insomnia, 57 



Inspection of thorax, 335 
Inspiratory sound, 345 
Insufficiency of aortic valves, 443 

of mitral or bicuspid valve, 441 

of pulmonary valves, 444 

of tricuspid valves, 444 
Insulatio, 82 

Intercostal neuralgia, 879 
Intermittent fever, 949 
Internal and external strangulation, 540 
Intertrigo, 1050 
Intestinal canal, 489 

catarrh, 489 
Intussusception, 544 
Invagination, 544 
Inversion of womb, 748 
Irido-cyclitis, 161 

choroiditis, 161 
Iritis, 158 

plastic, parenchymatous, suppurative, 
syphylitic, rheumatic, traumatic, ser- 
ous, 158 
Irritability of bladder, 679 
Ischias antica, 877 

postica, 870 
Ischuria vesicalis, 683 
Itch, 1069 

Jail-fever, 982 
Jaundice, 612, 615 

Keratitis, 152 
Kidney diseases, 632 
Kyphosis, 846 

Lardaceous kidney, 665 

liver, 604 
Largness of head, abnormal, 117 
Large white kidney, 658 
Laryngeal ulceration, 327 
Laryngismus stridulus, 332 
Laryngitis, catarrhal, 314 

chronica, 316 

stridulosa, 332 
Laryngophony, 353 
Laryngoscopy, 312 
Larynx and trachea, 312 
Leucoma cornese, 153 
Leucorrhoea, 733 



1088 



INDEX. 






Leukaemia, 926 

Leukomyelitis posterior chronica, 805 

Leptomeningitis infantum, 61 

spinalis, 798 
Lichen, 1068 
Lienitis, 627 
Lobular pneumonia, 379 
Lumbago, 818 

Lumbo-abdominal neuralgia, 879 
Lupus, 240 

syphiliticus, 710 
Luscitas, 178 
Lychen syphiliticus, 709 
Lyssa, 918 

Macula cornese, 153 

Malacosteon, 835 

Malsena, 546 

Malarial, continuous fevers, 967" 

Male genitals, 685 

Malignant pustule, 1063 

Malum Contunnii, 870 

Pottii, 846 
Mammas, 786 

Manual examination of chest, 337 
Mastitis, 786 
Mastodynia, 870 
Matted hair, 130 
Measles, 1018 
Melansemic liver, 593 
Melanoma, 115 
Mellituria, 639 
Membrana tympani, 186 
Meniere's disease, 210 
Meningitis cerebro-spinalis epidemica, 74 

of the convexity, 62 

metastatic, 63 

simple, 61 

simple, of the base, 62 

traumatic, 63 

tuberculosa, 59 
Menorrhagia, 766 
Menstrual anomalies, 766 
Menstruatio difficilis, 775 
Metallic ringing percussion sound, 344 

tinkling, 351, 356 
Meteorism of abdomen, 555 
Metritis, parenchymatous, 742 
Metrorrhagia, 762 



Middle ear, 191 
Migrsena, 853 
Miliary rash, 1076 

tuberculosis, acute, 402 
Milium, 1079 
Milk crust, 238 
Mimic spasm of face, 880 
Miserere, 545 
Mogographia, 881 
Moles, 758 
Mollities ossium, 835 
Molluscum, 1079 

Morbid growths within the womb, 757 
Morbid winking of lids, 178 
Morbilli, 1018 
Morbus Addisonii, 670 

anglicus, 833 

maculosus Werlhofii, 940 
Morphine-poisoning, 113 
Mother's mark, 129 
Motions of thorax, 338 
Motory apparatus, 815 
Mouth, 242 
Mucous membrane of mouth, 285 

rattle, 351 
Muffled sound, 344 
Mumps, 269 
Muscular asthenopia, 174 

rheumatism, 81.7 
Myalgia cervicalis, 818 

rheumatica, 817 
Mydriasis, 176 
Myelitis spinalis, 800 
Myelomalacia, 803 
Myocarditis, 447 
Myopathia, 817 
Myopathic paralysis, 913 
Myopia, 172 
Myosis, 176 
Myxoma in brain, 115 

Nsevus, vascular, 129 

Nails, alteration of, 710 

Narrowing of oesophagus, 309 

Nasal blennorrhoea, 217 

Neck, 305 

Necrosis, 837 

Neoplasms of larynx, 329 

Neoplastic formations in the nerves, 84S 



INDEX. 



1089 



Nephralgia, 666 

Nephritis, acute parenchymatous, 653 

chronic parenchymatous, 658 

suppurative, 666 
Nephrolithiasis, 666 
Nervous palpitation of heart, 451 
Nettle-rash, 1054 
Neuralgia, 850 

of diaphragm, 460 

of eye, 179 

facialis, 861 • 

ischiadica, 870 

of mammas, 870 

of trigeminus of fifth nerve, 861 
Neurasthenia spinalis, 796 
Neuritis, 848 
Neuroma, 115 

Neuromata vera et spuria, 849 
Neuroses of larynx, 330 
Neuro-retinitis, 164 
Nerves, 848 

Nervous sick headache, 853 
Night-blindness, 167 
Noma, 303 

Non-tympanitic sound, 343 
Normal sounds of respiration, 345 
Nose, 213 
Nosebleed, 231 
Nutmeg liver, 594 
Nystagmus, 178 

Observations, general, on the ear, 184 
Occlusion of the cerebral arteries, 90 

of portal vein, 613 
Odontalgia, 245 
(Edema glottidis, 325 

laryngis, 325 

of lungs, 379, 407 

of uvula, 275 
Oesophagitis, 307 
(Esophagus, 307 
Old sight, 171 
Oligemia, 928 
Oligocythemia, 925 
Omodynia rheumatica, 818 
Onyx, 153 
Oophorititis, 727 
Ophthalmia, catarrhal, 139 

gonorrheal, 141, 691 

69 



Ophthalmia, granular, 143 

neonatorum, 141 

purulent, 141 

phlyctenular, 145 

scrofulous or strumous, 152 

tarsi, 132 
Opium-poisoning, 113 
Orbital cellulitis, 180 
Orchitis, 690, 715 
Osteitis, 837 
Osteomalacia, 835 
Otalgia nervosa, 212 
Otitis externa, 190 

media acuta, 195 

media chronica, 199 
Ovarian dropsty, 730 
Ovaries, 727 
Ovaritis, 727 

Oxyuris vermicularis, 572 
Ozena, 220 

Pachymeningitis, 80 

externa, 80 

interna, 80 

hemorrhagica, 80 
Painful menstruation, 775 
Palpitation of chest, 337 

of heart, 451 
Panaritium, 1064 
Pannus, 144, 153 
Pancreas, diseases of, 630 
Pancreatitis, 631 
Papilloma of larynx, 329 
Paragraphia, 93 
Paralysis, 911 

agitans, 910 

ascendens acuta, 811 

of bladder, 680 

of larynx, 331 

of soft palate, 275 

spasmodic, spinal, 809 

spinal, atrophic, 811 

of tongue, 264 
Paranephritis, 670 
Paraphasia, 93 
Paraplegia, 912 
Paraphimosis, 686 
Paresis of bladder, 680 
Parotitis, 269 



1090 



INDEX. 



Paronychia, 1064 
Parulis, 243 

Pectoriloquy, 355 
Pemphigus, 1059 
foiiaceus, 1060 

syphiliticus, 709 
Percussion, 340 
Pericardial murmurs, 433 
Pericarditis, 433 
Perichondritis laryngea, 326 
Peri-hepatitis, 596 
Perinephritis, 670 
Perioophoritis, 727 
Peripheral paralysis, 912 
Periproctitis, 503 
Peritonitis, 585 
Peritonsillar abscess, 273 
Perityphlitis, 499 
Pernicious intermittent, 967 
Pertussis, 371 
Petechial typhus, 982 
Photophobia, 167 
Photopsia, 167 
Phimosis, 686 
Phthisis, 389 

laryngis, 327 
Pianist's cramp, 881 
Pigment liver, 593 
Piles, 547 
Plague, 1016 
Pleura, 413 
Pleurisy, 413 
Pleuritis, 413 

Pleurodynia rheumatica, 818 
Plethora, 927 
Plica polonica, 130 
Pneumonia catarrhalis, 379 

from embolism, 379 

notha, 359 

serous, 407 
Pneumothorax, 420 
Pneumo-typhus, 990 
Podagra, 830 
Podarthrocace, 845 
Politzer's method, 192 
Polyarthritis rheumatica acuta, 815 
Poliomyelitis anterior, 811 

anterior acuta, 810 
Polypi, aural, 209 



Polypi, of larynx, 329, 330 

of nose, 233 

true, of heart, 447 

recti, 568 

uteri, 757 
Polhrtiones nocturnse et diurnse, 721 
Pompholyx, 1059 
Porrigo devalcans, 129 

favosa, 127 

lupinosa, 127 
Prairie itch, 1072 
Preacher's sore throat, 277 
Presbyopia, 171 

Pressure diverticula of oesophagus, 310 
Prickly heat, 1076 
Procidentia uteri, 748 
Proctalgia, 572 
Proctitis, 502 
Progressive locomotor ataxy, 805 

muscular atrophy, 836 

pernicious ansemia, 929 
Prolapsus recti, 571 

of womb, 748 
Prolongation of expiratory murmur, 348 
Prosopalgia, 861 
Prostate gland, 717 
Prostatitis, 717 

gonorrhoica, 691 
Prurigo, 1068 

contagiosa, 1072 
Pruritus, 1068 

vulvas, 785 
Psammona, 115 
Pseudo-croup, 322 
Psoriasis, 1067 
Pterygium, 151 
Ptosis, 176 

Puerperal convulsions, 905 
Pulmonary apoplexy, 410 

consumption, 389 

parenchyma, 379 
Purulent nasal catarrh, 217 
Purpura hemorrhagica, 940 

variolosa, 1044 
Pustula maligna, 1063 
Pustular eruption, 1058 
Pustules, isolated, large, 1059 
Putrid sore mouth, 287 
Pyelitis, 669 



INDEX. 



1091 



Pyelonephritis, 669 
Pylephlebitis, 613 
Pylethrombosis, 613 
Pyothorax, 415 

Quinsy, 273 

Quivering of eyelids, 179 

Babies, 918 

Eachitis, 833 

Raehitisnms, 833 

Eanula, 271 

Battling noises in lungs, 349 

Red and yellow softening of the brain, 81 

Relapsing fever, 1013 

Renal abscess, 666 

gravel or calculi, 666 
Remittent fevers, 967 
Resistance of thorax, 338 
Respiratory motion, 335 

murmur, 346 
Retention of urine, 683 
Retinitis albuminurica, 165 

apoplectica, 165 

diabetica, 165 

lencsemica, 165 

pigmentosa, 165 

syphilitica, 165 
Retraction, 170 
Retroflexion, 747 
Retrotonsillar abscess, 273 
Retroversion, 747 
Rheumatismus, 815 

articulorum aoutus, 815 

articulorum chronicus, 817 

of joints, chronic, 817 

muscularis, 817 , 

Rhonchi in lungs, 349 
Rhonchus crepitans, 350 
Rhypia, 1060 
Rickets, 833 

Ringworm of the scalp, 128 
Rodent ulcer, 241 
Bcetheln, 1040 
Rose cold, 230 
Roseola syphilitica, 708 
Round perforating ulcer of stomach, 478 
Round worm, 573 
Rubbing feel, 339 



Rubeola, 1040 
Run-around, 1064 
Rupia, 1060 

syphilitica, 710 
Rupture and perforation of diaphragm, 460 

of spleen, 630 
Rush of blood to the head, 36 

St. Vitus' dance, 881 
Saliva, 268 
Salivary glands, 268 
Sand tumor, 115 
Sarcocele, 716 
Sarcoma in brain, 115 
Scabies, 1069 
Scald, 123 
Scalds, 1072 
Scarlatina, 1023 

with diphtheria, 292 
Sciatica, 870 
Scirrhus of the breast, 788 

mammse, 788 

ventriculi, 481 
Scleritis, 157 
Sclerosis of middle ear, 199 

multiple, 803 

of posterior columns, 805 
Sclerotico-choroiditis posteriora, 161 
Sclerotitis, 157 
Scorbutus, 937 
Scotomata, 167 
Scrofulosis, 942 
Scurvy, 937 
Sea-sickness, 53 
Seborrhoea capillittii, 126 
Septicaemia, 926 
Septic diphtheria, 292 
Serous pneumonia, 379, 407 
Shaking palsy, 910 
Shingles, 1052 
Ship-fever, 982 
Short-sightedness, 172 
Singultus, 459 
Skin, 1048 
Sleep, 54 
Sleeplessness, 57 
Small-pox, 1040 
Softening of the bones, 835 

of the brain, 90 



1092 



INDEX. 



Softening of brain red and yellow, 81 

of spinal marrow, 803 

of the stomach, 488 
Soft cataract, 168 

occiput, 118 
Sore throat, chronic, 277 

mouth of infants, 285 

mouth, putrid, 287 

throat, 275 

throat, ulcerated, 282 
Spasm, 878 

of bladder, 679 

of glottis, 332 
Spasmodic spinal paralysis, 809 
Spasmus facialis, 880 
Spermatocele, 717 
Spermatorrhoea, 721 
Spina bifida, 797 
Spinal irritation, 794 

nervous weakness, 796 

paralyses, 912 

paralysis, 809 

paralysis, atrophic, 811 
Spine, 791 
Spleen, anatomical peculiarities, 626. 

examination of, 625 
Splenitis, 627 
Spondylarthrocace, 846 
Spotted fever, 74 
Squint, 177 
Stagnation aktesiae, 310 

of blood in brain, 37 
Staphyloma, ulcerative corneal, 154 

anterior of sclera and choroid, 157 

cicatricial corneal, 154 

partial of cornea and iris, 154 

.posterior, 161 

total of cornea and iris, 154 
Stenocardia, 453 
Stenosis of aortic opening, 443 

of left auriculo-ventricular opening, 
442 

of right auriculo-ventricular opening, 
444 

oesophagi, 309 

of pulmonary opening, 444 
Sterility in the male, 724 
Stiff neck, 818 
Stomacace, 287 



Stomatitis ulcerosa, 287 

Stones in the bladder, 677 

Strabismus, 177 

Strangulation of bowels, 540 

Strictures of urethra, 692. 

Strongylus duodenalis, 578 

Struma, 306 

Stupor, 56 

Stye, 136 

Subcrepitant rattle, 351 

Sudamina, 1076 

Summer-complaint, 524 

Sunstroke, 82 

Suppression of menses, 773 

Swelled face, 261 

Sycosis, 705, 926. 

Synchronous respiration and pulsation, 335 

Syphilides, 707 

Syphilis congenita seu hereditaria, 713 

laryngis, 329 
Syphilitic affections of inner organs, 712 

of mucous membranes, 711 

of periosteum, bones, etc., 711 
Syphilitic contraction of muscles and ten- 
dons, 712 

inflammation of liver, 601 

skin diseases, 707 

Tabes dorsalis, 805 
Taenia canellata, 576 

saginata, 576 

solium, 575 
Tape-worms, 574 
Teeth, 244 
Teleangiectasia, 129 
Temperature of face, 238 
, of nose, 214 

of thorax, 338 

of tongue, 262 
Testes, 714 
Tetanus, 889 

neonatorum, 890 
Thermic fever, 82 
Thermometry, 945 
Thorax, 335 
Thrombosis and embolism, 90 

of the cerebral sinuses, 95 

of portal vein, 613 
Thrombus after birth, 118 



INDEX. 



1093 



Thrush, 285 

Tic douleureux, §61 

Tinea, 128 

favosa, 127 

maligna, 127 

tarsi, 132 
Tinnitus aurium, 211 
Tongue, 261 
Tonsils, 272 
Tonsillitis, 272 
Toothache, 245 
Torsion of bowels, 543 
Torticollis, 818 
Tracheophony, 353 
Tracheotomy, 324 

Traction diverticula of oesophagus, 310, 311 
Traumatic cataract, 168 
Trembling, 909 

of eyeballs, 178 
Tremor, 909 
Trichiasis, 132 
Trichina spiralis, 579 
Trichinosis, 581 
Tricocephalus dispar, 578 
Trismus, 889 

Tubercles in brain, 115, 116 
Tubercula mucosa, 705 
Tubercular ulceration of larynx, 327 
Tuberculosis, acute miliary, 402 

intestinalis, 566 

of joints, 839 
Tumor, acute, of spleen, 628 

chronic, of spleen, 629 

albus genu, 843 
Tumors of brain and its membranes, 114 

fatty, of lid, 137 

of lid, sebaceous, 136 

of prostate, 718 

syphilitic, in brain, 115 
Tuning-fork examination of ear, 194 
Tussis convulsiva, 371 
Twisting of bowels, 543 
Twitching of eyelids, 179 
Tylosis, 132 

Tympanites abdominalis, 592 
Tympanitic sound, 342 
Typhlitis, 499 
Typhoid fever, 985 

pneumonia, 382 



Typhus, 982 

abdominalis, 985 
ambulatorius, 990 
exanthematicus, 982 
recurrens, 1013 
tumultuarius, 990 

Ulcer, round, of stomach, 478 
Ulceration of cornea, 153 
Ulcers in the fauces, 282 

in the mouth, 287 
Ulcus rodens, 241 

ventriculi perforans, 478 
Uraemia, 652 

Urine, examination of, 632 
Urticaria, 1054 
Uterus, 733 
Uvula and soft palate, 275 

Vagina, 784 
Vaginismus, 784 
Vaginitis, 784 
Vasalva's method, 191 
Vascular naevus, 129 
Varicella, 1047 
Varicocele, 717 
Variola, 1040 
Varioloid, 1040, 1043 
Variolois, 1040 
Venereal diseases, 685 
Venous murmurs, 432 
Vertigo, 40 

Vesiculse seminales, 720 
Vesicular eruption, 1055 

murmur, 346 
Vicarious menstruation, 773 
Vocal fremitus, 338 
Vomiting, 465 

Warts on lid, 137 
Watch-examination of ear, 194 
Waxy liver, 604 

kidney, 665 
Wen of the scalp, 128 
Wens on lid, 137 
White swelling, 839 

swelling of knee, 843 
Whitlow, 1064 
Whooping-cough, 371 



1094 



INDEX. 



"Winking of eyelids, 17£ 
Word-blindness, 93 
Word-deafness, 93 
Worms, intestinal, 572 
Writer's cramp, 881 



Yearly cold, 230 
Yellow fever, 968 

Zona, 1052 
Zweiwuchs. 833 



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